Meniere’s Disease
Meniere's disease produces vertigo attacks and requires ear surgery more often than other dizzy disorders of the inner ear, in approximately 10% of patients. When disabling vertigo does not respond to diet and medication, other treatment options should be considered. These options vary with level of hearing, age and health of the patient, previous surgery and other factors. Each option listed below is designed to preserve hearing.
Meniere's disease produces vertigo attacks and requires ear surgery more often than other dizzy disorders of the inner ear, in approximately 10% of patients. When disabling vertigo does not respond to diet and medication, other treatment options should be considered. These options vary with level of hearing, age and health of the patient, previous surgery and other factors. Each option listed below is designed to preserve hearing.
Meniette Device and PE Tubes
Reproduced with permission by Medronic Xomed, Inc.
The Meniette device is self-administered at home by placing the tubing into the ear canal, which sends small air pressure-pulses across a temporary pressure-equalization (PE) tube into the inner ear.
Many different types of PE tubes can be used.
The Meniett device requires placement of a pressure-equalization tube across the eardrum, is self-administered at home, works by delivering a small pressure-pulse to the inner ear, and helps perhaps half the patients who try it.
Unlike with ear surgery, there are no significant risks caused by the device.
Color photographs by Eiji Yanagisawa, M.D. are reproduced with permission from Hughes GB and Pensak ML: Clinical Otology 3rd Edition, Thieme Medical Publishers, New York, 2006 (in press).
Gentamicin is an antibiotic which reliably reduces ear balance function when injected behind the eardrum for 30 minutes as an outpatient office procedure, usually weekly for 2-3 treatments. Small temporary openings are made in the front and back portions of the drum.
Gentamicin is placed through the back hole and air escapes out the front hole. The procedure is easy to perform and does not require general anesthesia. Unfortunately, treatment has a relatively high risk of partial hearing loss (15-20%), lasts only several years, and produces lightheadedness and imbalance for several months after treatment, even though it controls vertigo attacks.
Reproduced with permission from Hughes GB and Pensak ML: Clinical Otology 3rd Edition, Thieme Medical Publishers, New York, 2006 (in press).
Endolymphatic Sac Surgery
The endolymphatic sac below the balance organ and facial nerve is decompressed and opened. Occasionally a small shunt is placed to open the duct between the sac and the balance organ.
This type of ear surgery decompresses the sac within the mastoid bone behind the ear. It is performed as an outpatient under general anesthesia, has no postoperative imbalance like gentamicin, and helps 65% of patients long-term with only 1% risk of some hearing loss. Because it is relatively safe, simple, effective and has no postoperative down time, sac surgery frequently is the treatment of choice.
Reproduced with permission from Hughes GB and Pensak ML: Clinical Otology 3rd Edition, Thieme Medical Publishers, New York, 2006 (in press)
Retrosigmoid Vestibular Nerve Section
Through a small opening in the back of the skull, the balance (vestibular) nerve can be reached and cut to cure vertigo attacks.
Vestibular nerve section cuts the balance nerve between the ear and the brain. It has the highest success rate for control of vertigo, 90-95%, but requires craniotomy, several days in the hospital, and postoperative recovery similar to gentamicin. Neurosurgeon Joung Lee, M.D. participates in vestibular nerve section. Spinal fluid leak occurs in 2-3% of patients but usually stops spontaneously. Compared with other treatment options, nerve section has several distinct advantages: high success rate, long-term control over many years, less than 1% risk of hearing loss, and can be offered when other treatments have failed.
Reproduced with permission from Hughes GB and Pensak ML: Clinical Otology 3rd Edition, Thieme Medical Publishers, New York, 2006 (in press).