Surgical
Treatment
If medical therapy fails, surgical
treatment may be indicated. Two distinct strategies have been
employed. One approach is directed toward increasing the absorption of
endolymph (the fluid in the hearing and balance canals of the inner
ear), since there is an excess of endolymph in patients with Ménière's
Disease. The other approach aims at decreasing the inner ear's
vestibular balance function in order to reduce symptoms of vertigo.
Endolymphatic sac surgery
In principle, endolymphatic sac surgery is a non-destructive, surgical
manipulation of the endolymphatic sac aimed at increasing fluid
drainage from the inner ear. The effectiveness of this approach
varies.1
Vestibular nerve section
This surgical technique decreases vestibular function to control
symptoms of vertigo, either by denervation or destruction of the
affected ear. It is a more serious and costly operation, which
includes the risk of meningitis and a leak of spinal fluid. In 95% of
cases, control of vertigo is achieved. Hearing is preserved in over
90% of cases.
Chemical labyrinthectomy
This treatment has recently become widely used because of its
associated low cost and low risk.2
For unilateral cases, intratympanic gentamicin reduces vertigo by
decreasing peripheral vestibular function on the affected side, but
with a 30% risk of hearing loss. For bilateral cases, intramuscular
streptomycin has been used.3
All destructive procedures result in decreased vestibular function on
the treated side, which many patients consider a fair exchange once
central compensation has stabilized their balance function.
Labyrinthectomy
In cases where hearing can be sacrificed or is already lost, surgical
removal of the labyrinth (the balance organs of the inner ear) has a
95% success rate in eliminating major vertigo attacks. After this
surgery is performed, the hearing and balance functions of the
operated ear are completely and permanently destroyed. The unoperated
ear will provide hearing and balance, as long as it is not affected by
the disease or other conditions.
1. Thomsen J., Bretlau P., Tos M.,
Johnsen N.J. 1981. Placebo effect in surgery for Ménière's disease.
A double-blind, placebo-controlled study on endolymphatic sac shunt
surgery. Arch Otolaryngol 107:271-277.
2. Hellstrom S., ödkvist L.M. 1994.
Pharmacologic labyrinthectomy. Otolaryngol Clin North Am 27:307-315.
3. LaRouere M J., Zappia J.J., Graham
M.D. 1993. Titration streptomycin therapy in Ménière's disease:
current concepts. Am J Otol Vol. 14:474-477.
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