title: Do middle ear muscles trigger attacks of Menière's disease?
abstract: OBJECTIVE
  Current surgical methods for treating Ménière's disease (MD), e.g. endolymphatic sac surgery, mastoidectomy or insertion of middle ear ventilation tubes, only improve vertigo and fail to influence the hearing threshold. In this retrospective study we examined the long-term effects of tenotomy on the symptoms of MD.
  
  
  METHODS
  A total of 45 patients suffering from definite MD underwent middle ear muscle tenotomy, a treatment that is very rarely considered nowadays. Of these 45 patients, 20 were observed postoperatively for a period of > 2 years. The disease was scored pre- and postoperatively and the results were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy for MD.
  
  
  RESULTS
  Sectioning of the tensor tympani and stapedius muscle tendons significantly reduced the frequency and intensity of vertigo and improved both the functional profile and tinnitus. Pure-tone audiometry at frequencies between 500 and 3000 Hz substantiated the improvement in hearing threshold, as did the pure-tone average. The therapeutical outcome was stable in cases where both tendons remained persistently disconnected. Intratympanal inflammatory reactions were observed in most patients during surgery.
  
  
  CONCLUSIONS
  Our results prove that tenotomy is a successful and enduring therapeutic approach for treating the auditory and vestibular symptoms of MD and strongly suggest that it should be reconsidered as a promising surgical treatment for the symptoms of MD.
authors.affiliation: Department of Otorhinolaryngology, University of Vienna, Vienna, Austria. peter.franz@akh-wien.ac.at
authors.forename: Peter
authors.initials: P
authors.lastname: Franz
authors.forename: Jafar Sasan
authors.initials: JS
authors.lastname: Hamzavi
authors.forename: Barbara
authors.initials: B
authors.lastname: Schneider
authors.forename: Klaus
authors.initials: K
authors.lastname: Ehrenberger
mesh_terms: D000328:Adult; D000368:Aged; D001299:Audiometry / Q000379:methods; D015331:Cohort Studies; D004432:Ear, Middle / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000503:physiopathology; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery; D013506:Otologic Surgical Procedures; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013710:Tendons / Q000601:surgery*; D016896:Treatment Outcome; D014717:Vertigo / Q000209:etiology / Q000503:physiopathology