Is This Patient Operable?

If the patient responded to the diuretics, 84% of the otologists said that they would consider the patient an operative candidate; 16% said they still would not operate on the patient, even with improvement. In this case, regarding the time period for intervention after diuretics, three otologists (10%) indicated that they would wait one month; seven (23%) would wait six to eight weeks; 13 (42%) would consider three to six months an appropriate amount of time; and only seven (23%) thought waiting for longer than six months was appropriate.

ENG with Initial Management

Twelve participants (16%) thought that electronystagmography was not recommended with initial management. Of the 43% who thought ENG was appropriate, 22 (71%) indicated that they would consider a patient a surgical candidate if the difference was less than 20%. Seven others (23%) said a difference of less than 20% did not make the patient a candidate for operative intervention.

Survey respondents were asked to indicate if they would immediately proceed with a stapedectomy/stapedotomy or would decide on further management and work-up.

If the difference on the ENG was greater than 20%, suggesting an abnormality, seven otologists (23%) said that they would operate, but 13 (42%) would not.

Symptom-Free Interval

Forty-three otologists responded to a survey question on requiring an imbalance symptom-free interval before operating. Within that group, 36 (84%) agreed that an interval was needed. A smaller number, seven (16%) disagreed, saying that no such interval is needed. Of the majority who thought a waiting period was needed, 14% agreed less than three months was appropriate; however, 8% indicated that they would wait three months to a year or longer.

Since chronic sinusitis is an inflammatory, perhaps systemic disorder, the use of anti-inflammatory medication plays an important treatment role prior to surgery.

Quality of Balance Disorder

The survey asked which disorders or symptoms respondents would class as indicating poor candidate for surgery. Forty-four physicians (61%) said that they would avoid patients with a history of recurrent vertiginous attacks with hearing loss, aural fullness, tinnitus, and nausea. Twenty-two (30%) said that a history of true vertigo was also a contraindication, and 39 (55%) indicated that patients with a history of Ménière’s disease were poor candidates.

As for appropriate candidates for stapes surgery, 56 otologists (78%) said that patients with dizziness or mild imbalance would be appropriate. Only 4% would operate on a patient with active Ménière’s disease. Roughly one-half (49%) said that positional or gaze induced nystagmus was an acceptable pre-operative symptom.