Case report: a case of intractable Meniere's disease treated with autogenic training.
BACKGROUND
Psychological stress plays an important role in the onset and course of Meniere's disease. Surgical therapy and intratympanic gentamicin treatment are options for cases that are intractable to conventional medical therapy. Psychotherapy, however, including autogenic training (AT), which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of AT in a subject suffering from intractable Meniere's disease.


METHODS
A 51-year-old male patient has suffered from fluctuating right sensorineural hearing loss with vertigo since 1994. In May 2002, he was first admitted to our hospital due to a severe vertigo attack accompanied by right sensorineural hearing loss. Spontaneous nystagmus toward the right side was observed. Since April 2004, he has experienced vertigo spells with right-sided tinnitus a few times per month that are intractable to conventional medical therapy. After four months, tympanic tube insertion was preformed in the right tympanic membrane. Intratympanic injection of dexamethasone was ineffective. He refused Meniett therapy and intratympanic gentamicin injection. In addition to his vertigo spells, he suffered from insomnia, tinnitus, and anxiety. Tranquilizers such as benzodiazepines and antidepressants such as serotonin selective re-uptake inhibitors (SSRIs) failed to stop the vertigo and only slightly improved his insomnia. In December 2006, the patient began psychological counseling with a psychotherapist. After brief psychological counseling along with cognitive behavior therapy (CBT), he began AT. He diligently and regularly continued his AT training in his home according to a written timetable. His insomnia, tinnitus, and vertigo spells disappeared within a few weeks after only four psychotherapy sessions. In order to master the six standard formulas of AT, he underwent two more sessions. Thereafter, he underwent follow-up for 9 months with no additional treatment. He is now free from drugs, including tranquilizers, and has continued AT. No additional treatment was performed. When we examined him six and nine months later for follow-up, he was free of vertigo and insomnia.


CONCLUSIONS
AT together with CBT can be a viable and palatable treatment option for Meniere's disease patients who are not responsive to other therapies.
Goto
Fumiyuki
F
Department of Otorhinolaryngology, Hino Municipal Hospital, Tamadaira 4-3-1, Hino-shi, Tokyo 191-0062, Japan.|Department of Otolaryngology, Keio School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8520, Japan.
Nakai
Kimiko
K
Department of Otorhinolaryngology, Hino Municipal Hospital, Tamadaira 4-3-1, Hino-shi, Tokyo 191-0062, Japan.|Department of Otolaryngology, Keio School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8520, Japan.
Kunihiro
Takanobu
T
Department of Otolaryngology, Keio School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8520, Japan.
Ogawa
Kaoru
K
Department of Otolaryngology, Keio School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8520, Japan.