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
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.