Placebo Effect for Meniere's Disease Sac Shunt Surgery Disputed

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To the Editor.—A careful analysis of the article entitled "Placebo Effect in Surgery for Ménière's Disease: A Double-blind, Placebo-Controlled Study on Endolymphatic Sac Shunt Surgery" by Thomsen et al in the May Archives (1981;107:271-277) indicates that some of the conclusions are not supported by the data and may reflect the prior bias of the authors. To the casual reader, the conclusions of this study suggest that there is no clinically significant difference between the results achieved with an endolymphatic sac shunt operation (Silastic sheet mastoid shunt) (active group) and those achieved by a simple mastoidectomy (placebo group) at the one-year follow-up. Nothing could be more misleading. The authors' own data do not support this conclusion. Using the American Academy of Ophthalmology and Otolaryngology (AAOO) criteria, 87% of the patients undergoing "active surgery" showed improvement compared with only 47% in the "placebo surgery" group (Table 2). According to this rating

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