====== Meniere’s disease ======

===== Key concepts =====

● increased endolymphatic pressure

● clinical triad: vertigo, tinnitus & fluctuating hearing loss

● surgical options for the failure of medical management include endolymphatic shunt or selective vestibular neurectomy

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Probably due to a derangement of endolymphatic fluid regulation (a consistent finding is endolymphatic hydrops: increased endolymphatic volume and pressure with dilatation of endolymph spaces), with resultant fistulization into the perilymphatic spaces.

===== Surgical treatment =====

Reserved for incapacitating cases refractory to medical management. When functional hearing exists, procedures that spare hearing is preferred because of the high incidence of bilateral involvement. 

Procedures include:

1. endolymphatic shunting procedures: to the mastoid cavity (Arenberg shunt) or to subarachnoid
space. Reserved for cases with serviceable hearing. ≈ 65% success rate. If symptoms are relieved ≥1 year, then a recurrence would be treated by shunt revision, if <1 year then vestibular neurectomy

2. direct application of corticosteroids to the inner ear

3. nonselective vestibular ablation (in cases with a nonserviceable hearing on the side of
involvement)

a) surgical [[labyrinthectomy]]

b) middle ear perfusion with [[gentamicin]]

c) translabyrinthine section of the 8th nerve

4. selective vestibular neurectomy, in cases with serviceable hearing.