title: Surgical results and psychological status in patients with intractable Ménière's disease.
abstract: OBJECTIVE
  Mental disorder is often one of the causes to make treatments for Ménière's disease more difficult. The aim in the present study is to examine ratios of the neurosis and depression in patients with intractable Ménière's disease and also relationships between the ratios and surgical results after endolymphatic sac drainage with large doses of steroids.
  
  
  METHODS
  Between 1998 and 2009, we enrolled 263 intractable Ménière's patients and divided into two groups, 207 in surgical group and 56 in non-surgical group. We used the Cornell Medical Index (CMI) and the Self-rating Depression Scale (SDS) at the diagnosis in our hospital to evaluate their psychological condition before treatments. CMI domains III and IV were defined as neurosis and SDS scores more than 40 as depression as a matter of convenience. Two years as well as seven years after surgery, patients with vertigo zero/month and hearing change>-10dB were evaluated in success group and the others in non-success group.
  
  
  RESULTS
  Neurosis and depression were diagnosed in approximately 40% and 60%, respectively, of intractable Ménière's disease. Our results showed that surgical treatment significantly improved vertigo suppression and hearing gain in patients with no psychological symptoms compared with those exhibiting psychological symptoms both in surgical and non-surgical groups. Furthermore, surgical results in cases with mental disorder were superior to non-surgical results in cases without mental distress.
  
  
  CONCLUSIONS
  All taken together, psychological supports could be necessary for improving results both in the surgical and non-surgical treatments for patients with intractable Ménière's disease. Some cases with intractable Ménière's disease should really require additional surgical treatments even after psychological therapies.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yokota
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan. Electronic address: tkitahara@naramed-u.ac.jp.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kitahara
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Sakagami
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Taeko
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Okayasu
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Yamashita
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Yamanaka
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications / Q000523:psychology*; D001008:Anxiety Disorders / Q000150:complications / Q000523:psychology*; D016022:Case-Control Studies; D003863:Depression / Q000150:complications / Q000523:psychology*; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology*; D004322:Drainage; D004712:Endolymphatic Sac / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000150:complications / Q000523:psychology / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014717:Vertigo / Q000209:etiology / Q000523:psychology
keywords: Depression; Endolymphatic sac drainage; Hearing loss; Intractable Ménière's disease; Neurosis; Surgery; Vertigo attack