Recent surgical advances and continued controversies in medically refractory Meniere's disease.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 9417024 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-6998 (Electronic) Linking ISSN: 10689508 NLM ISO Abbreviation: Curr Opin Otolaryngol Head Neck Surg Subsets: MEDLINE

Publication: <2003->: Philadelphia, PA : Lippincott Williams & Wilkins
Original Publication: Philadelphia, PA : Current Science, c1993-

Meniere Disease*/diagnosis ; Meniere Disease*/surgery ; Meniere Disease*/complications ; Ear, Inner* ; Hearing Loss*/complications ; Deafness*; Humans ; Vertigo/drug therapy ; Vertigo/etiology ; Gentamicins/therapeutic use

Purpose of Review: Meniere's disease is caused by hydropic changes in the endolymphatic system, and manifests as a collection of vertigo, hearing loss, tinnitus, and aural fullness. Although high-quality clinical practice guidelines exist for the diagnosis and initial management of Meniere's disease, there is no strong consensus for treatment of medically refractory Meniere's disease. This review summarizes treatment options and highlights controversies surrounding surgical treatment of Meniere's disease.
Recent Findings: Intratympanic steroid and intratympanic gentamicin injections continue to be widely used as in-office therapies in medically refractory Meniere's disease. Despite historical controversy surrounding the use of endolymphatic sac (ELS) surgery, the use of ELS decompression has been widely adopted by the international neurotologic community due to high vertigo control rate, coupled with low risk of audiovestibular loss. Wider decompression of the sac and surgical manipulation of the endolymphatic duct may impact outcome and are the subject of discussion. An emerging surgical technique called Triple Semicircular Canal Occlusion (TSCO) holds promise as a partially ablative procedure with high vertigo control rate in Meniere's disease. Cochlear implants may be placed in active Meniere's disease patients, or during an ablative surgery such as labyrinthectomy.
Summary: For the medically refractory Meniere's disease patient, treatment options include intratympanic steroid injection, endolymphatic sac decompression, medical or surgical labyrinthectomy, and vestibular nerve section. TSCO holds promise as an emerging partially ablative procedure. Cochlear implants maintain an important role in the rehabilitation of hearing loss associated with Meniere's disease.
(Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

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0 (Gentamicins)

Date Created: 20230602 Date Completed: 20230906 Latest Revision: 20230906

20230906

10.1097/MOO.0000000000000907

37266594