Surgical indication in Menière's disease therapy: clinical and epidemiological aspects.
The aim of this study was to evaluate the frequency of surgical approach in a population of patients affected by definite Menière's disease (MD). In the majority of patients, relief from vertigo attacks can be achieved by means of medical therapy (MT). In cases in which MT fails surgery may offer relief to vertigo. The most applied surgical procedures are intratympanic gentamicin (ITG) and vestibular neurectomy (VN), based on vestibular deafferentation. Until now, the real incidence of the different therapeutic approaches for MD has not been evaluated. The study design was a retrospective study. The study was performed in 177 patients affected by definite MD. Subjects referred directly for surgery by other centers were excluded from the study. All the patients were medically treated with salt restriction and diuretics. In case of MT failure, surgical therapy, ITG or retrosigmoid VN were proposed. In the 75% of cases, the only therapeutic approach was MT, while in 20% of cases we carried out ITG and in 5% VN. In 33% of VN group, this operation was carried out after ITG failure and in 67% as the first surgical approach. The VN group was characterized by younger age and higher disability degree. The primary therapy in definite MD seems to be MT. Ablative therapy represents the second choice: ITG was carried out in 80% of cases, while VN was performed in 20%.
ENT, Department of Clinical Physiopathology, University of Turin, Turin, Italy.
Roberto
R
Albera
Andrea
A
Canale
Fiorella
F
Parandero
Alessandro
A
Ducati
Michele
M
Lanotte
D000328:Adult; D000368:Aged; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D008845:Microinjections; D008875:Middle Aged; D018579:Patient Selection; D011500:Protein Synthesis Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane; D014725:Vestibular Nerve / Q000601:surgery*
D005839:Gentamicins; D011500:Protein Synthesis Inhibitors
Otol Neurotol. 2004 Jul;25(4):544-52
15241234
Laryngoscope. 1956 Jul;66(7):859-70
13358249
Curr Opin Neurol. 2004 Feb;17(1):9-16
15090872
Otolaryngol Head Neck Surg. 1990 Sep;103(3):443-50
2122376
Otolaryngol Head Neck Surg. 1987 Sep;97(3):300-7
3118312
Curr Opin Neurol. 2005 Feb;18(1):23-8
15655398
Otol Neurotol. 2001 May;22(3):401-16
11347648
Am J Otol. 1996 Mar;17(2):253-8
8723957
Can Med Assoc J. 1936 Apr;34(4):369-81
20320220
Acta Otolaryngol. 2004 Mar;124(2):172-5
15072419
Acta Otolaryngol Suppl. 1997;526:10-3
9107348
Skull Base Surg. 1991;1(1):16-25
17170816
Acta Neurochir (Wien). 2005 Apr;147(4):401-4; discussion 404
15618995
Otol Neurotol. 2007 Feb;28(2):145-51
17255880
Clin Otolaryngol Allied Sci. 1998 Jun;23(3):263-4
9669078
Acta Otolaryngol. 1968 Jul-Aug;66(1):120-8
4236556
Arch Otolaryngol. 1978 Feb;104(2):99-102
629706
Acta Otolaryngol Suppl. 1997;526:54-7
9107358
Laryngoscope. 2004 Feb;114(2):216-22
14755193
Int Tinnitus J. 2004;10(2):137-43
15732511
Arch Neurol. 2001 Jul;58(7):1151-6
11448308
Laryngoscope. 2009 Apr;119(4):792-8
19213044
Lancet. 2008 Aug 2;372(9636):406-14
18675691
Otolaryngol Head Neck Surg. 1995 Sep;113(3):181-5
7675476