Surgery for Menière’s Disease

Abstract

Menière’s disease is a chronic disease of unknown cause, with a capricious natural course. It is characterized by bouts of vertigo, accompanied by fluctuating sensorineural hearing loss, tinnitus and/or aural fullness. This disease can be invalidated. Endolymphatic hydrops of the inner ear due to an imbalance of fluid production and absorption is thought to be the pathophysiological substrate. A broad range of therapies has been suggested, due to the high variability in the expression of the disease and poor quality of the evidence to support these therapies. We suggest a clinical algorithm for treatment of the disease. If conservative management of the disease fails, then we suggest perfusion of the middle ear with dexamethasone when hearing is functional, followed by gentamicin when repeated injections have failed, or when hearing is non-functional. Selective neurectomy of the vestibular nerve is a therapy of last resort. Endolymphatic sac surgery and labyrinthectomy are not advised by this author, based on the lack of high-level evidence supporting their use.