Surgery for Meniere's disease

ENT Surgery,University Medical Centre Utrecht, Utrecht, Netherlands.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 01/2013; 2(2):CD005395. DOI: 10.1002/14651858.CD005395.pub3
Source: PubMed

ABSTRACT This is an update of a Cochrane review first published in The Cochrane Library in Issue 1, 2010.Ménière's disease is characterised by three major symptoms: vertigo, deafness, and tinnitus or aural fullness, all of which are discontinuous and variable in intensity. A number of surgical modalities, of varying levels of invasiveness, have been developed to reduce the symptoms of Ménière's disease, but it is not clear whether or not these are effective.
To assess the effectiveness of surgical options for the treatment of Ménière's disease. All surgical interventions used in the treatment of Ménière's disease, either to alter the natural history of the disease or to abolish vestibular function, were considered for this review.
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 7 November 2012.
Randomised or quasi-randomised controlled studies of a surgical modality versus a placebo therapy in Ménière's disease.
Two authors independently assessed trial quality and extracted data. We contacted study authors for further information.
The only surgical intervention which has been evaluated in randomised controlled trials and met the inclusion criteria was endolymphatic sac surgery. We identified two randomised trials, involving a total of 59 patients; one comparing endolymphatic sac surgery with ventilation tubes and one with simple mastoidectomy. Neither study reported any beneficial effect of surgery either in comparison to placebo surgery or grommet insertion.
The two trials included in this review provide insufficient evidence of the beneficial effect of endolymphatic sac surgery in Ménière's disease.

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    ABSTRACT: To analyze current endolymphatic surgery techniques and quantify their efficacy in controlling vertigo and maintaining hearing in the short and long term. A comprehensive literature search using the PubMed-NCBI database from 1970 to 2013. Articles on sac decompression and mastoid shunt (with and without silastic) were included. Included studies had to report data using the 1985 or 1995 American Academy of Otolaryngology-Head and Neck Foundation (AAO-HNS) guidelines, describe surgical technique in detail, include a minimum of 10 patients, and have minimum 12 months of follow-up. Endpoints were vertigo control and hearing preservation using AAO-HNS guidelines. Analysis included short-term (>12 mo) and long-term (>24 mo) follow-up. Data analysis was performed using MedCalc 12.7.0. Each article was weighted according to the number of patients treated. Analysis of pooled proportion was performed, and Freeman-Tukey transformation was used to correct for probable variance. A t test (of proportions) was performed to compare differences between groups. Endolymphatic sac surgery (sac decompression or mastoid shunt) is effective at controlling vertigo in the short term (>1 yr of follow-up) and long term (>24 mo) in at least 75% of patients with Ménière's disease who have failed medical therapy. Sac decompression and mastoid shunting techniques provide similar vertigo control rates. Mastoid shunting, with and without silastic, also provides similar vertigo control rates. Non-use of silastic, however, seems to maintain stable or improved hearing in more patients compared to silastic sheet placement. The data suggest that, once the sac is opened, placing silastic does not add benefit and may be deleterious.
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    ABSTRACT: Bei Patienten mit Schwindel ist die erste und klinisch wichtigste Frage, die an den Neurologen gestellt wird, ob es sich um ein zentrales oder peripheres Schwindelsyndrom handelt. Diese Unterscheidung ist in mehr als 90 % der Fälle durch die systematische Erhebung der Anamnese (Frage nach Art, Dauer, Auslösern der Schwindelbeschwerden und den Begleitsymptomen) und die körperliche Untersuchung möglich. Insbesondere bei akuten Schwindelbeschwerden hat sich hier ein 5-schrittiges Vorgehen bewährt: 1. Abdecktest mit der Frage nach einer vertikalen Divergenz (,,skew deviation“) als zentrales Zeichen und einer Komponente der ,,ocular tilt reaction“ (OTR), 2. Untersuchung mit und ohne Frenzel-Brille zur Differenzierung zwischen peripherem vestibulären Spontannystagmus und zentralem Fixationsnystagmus, 3. Untersuchung der Blickfolge, 4. Untersuchung der Blickhaltefunktion (insbesondere Blickrichtungsnystagmus entgegen der Richtung eines Spontannystagmus), 5. Kopfimpulstest mit der Frage nach einem Defizit des vestibulookulären Reflexes (VOR). In Bezug auf die Therapierbarkeit von Schwindelsyndromen sind in den letzten 10 Jahren erhebliche Fortschritte in der medikamentösen Therapie erzielt worden: Kortison bei der akuten Neuritis vestibularis, Betahistin als Hochdosis- und Langzeittherapie bei M. Menière, Carbamazepin bei Vestibularisparoxysmie sowie Aminopyridine bei Downbeat- und Upbeat-Nystagmus sowie episodischer Ataxie Typ 2.
    HNO 09/2013; 61(9). DOI:10.1007/s00106-013-2746-8 · 0.54 Impact Factor
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    ABSTRACT: The indications for surgical treatment of labyrinthine vertigo associated with severe impairment and a lack of response to medication are heterogeneous. Due to different therapeutic goals and success parameters, the results of treatments can only be compared to a limited extent. This overview of the current literature and procedures performed by the author contains recommendations for indications and outlines the risks associated with operative therapy of vestibular vertigo. Results of function-preserving and ablative therapies are compared. Surgical treatment of Menière's syndrome (non-idiopathic) using tympanostomy tubes is indicated in cases of increased middle ear pressure; Meniere's disease (idiopathic) in its early stages can be treated with the endolymphatic shunt operation to preserve hearing and balance functions and where these techniques fail, with vestibular neurectomy for preservation of hearing or with cochleosacculotomy in the case of deafness. Rare indications are intractable benign paroxysmal positional vertigo and superior semicircular canal dehiscence syndrome (SCDS). The function preservation success rate in cases of Meniere's syndrome and disease is 70-88 %, ablative procedures are effective in > 90 % of cases and occlusion of the superior or posterior canals is successful in > 95 % of patients.
    HNO 09/2013; 61(9):752-61. · 0.54 Impact Factor