Tenotomy of the middle ear muscles causes a dramatic reduction in vertigo attacks and improves audiological function in definite Meniere's disease.
CONCLUSIONS
Because the presented data reveal an immediate and persistent reduction of vertigo and a clear improvement in hearing function and functional scales, we conclude tenotomy to be effective in unilateral, definite Meniere's disease - laying the foundation for future prospective, randomized controlled trials.


OBJECTIVE
This study compares the unique long-term results of tenotomy of the stapedius and tensor tympani muscles in definite Meniere's disease refractory to medical treatment and presents a hypothesis on why tenotomy seems effective.


METHODS
This was an interventional cohort study. The study sample comprised 30 patients (15 males, 15 females; average age 57 ± 13.1 years) with definite Meniere's disease (AAO-HNS criteria, 1995). Patients were evaluated pre- and postoperatively using pure tone audiometry, AAO-HNS questionnaires regarding vertigo attacks, functional level scores, and tinnitus, and were followed up for 2-9 years. Postoperative values were calculated for the patient collective as a whole and consequently divided into three equal postoperative terms of 3 years each.


RESULTS
A statistically significant improvement of inner ear hearing levels postoperatively (p = 0.041) and a major reduction in vertigo attacks in all groups (p < 0.001) with complete absence of attacks in 26/30 patients was noted. Results remained constant up to 9 years postoperatively. Although tinnitus persisted, the intensity was lower overall (p = 0.013).
Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Vienna, Vienna General Hospital, Austria. benjamin.loader@meduniwien.ac.at
Benjamin
B
Loader
David
D
Beicht
Jafar-Sasan
JS
Hamzavi
Peter
P
Franz
D001301:Audiometry, Pure-Tone; D004432:Ear, Middle / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing / Q000502:physiology*; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D008875:Middle Aged; D013198:Stapedius / Q000601:surgery; D011795:Surveys and Questionnaires; D058971:Tenotomy / Q000379:methods*; D013719:Tensor Tympani / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014717:Vertigo / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*