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Latest Research on Meniere's
     
Otol Neurotol. 2008 Jan;29(1):29-32.
Meniett device for Ménière's disease: use and compliance at 3 to 5 years.
Mattox DE, Reichert M.
Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA. douglas.mattox@emoryhealthcare.org

OBJECTIVE: To review the continued use of the Meniett device 2 and 3 years after the device's initial prescription. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: Patients fitting American Academy of Otolaryngology-Head and Neck Surgery criteria for Ménière's disease who had failed conventional medical therapy between February 2002 and April 2004 and who were ready for surgical intervention. INTERVENTION: Patients used the Meniett device as a nonsurgical alternative for Ménière's management. OUTCOME MEASURES: Continued use or non-use of the device. RESULTS: Twenty-three patients were prescribed and obtained the Meniett device in the study interval. At 2 years of minimum follow-up, there were 21 evaluable patients. Eleven patients (52%) continued to use the device and have good control of vertiginous symptoms at 2+ years. Four patients (19%) were asymptomatic at 1 year and discontinued the use of the device. Six patients (29%) had no impact on their Ménière's symptoms and stopped using the device within the first 3 months. At 3 years of minimum follow-up, there were 19 evaluable patients; of whom, 63% were either using the device or had become asymptomatic. No complications were attributable to the device. CONCLUSION: We conclude that the Meniett device is a useful minimally invasive alternative in the management of Ménière's disease. Among these patients who had failed previous medical management, 71% and 63% required no additional intervention beyond the Meniett device at a minimum of 2 and 3 years of follow-up, respectively. Most patients who failed to gain benefit did so early on in therapy.

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Otol Neurotol. 2008 Jan;29(1):33-8.
Longitudinal results with intratympanic dexamethasone in the treatment of Ménière's disease.
Boleas-Aguirre MS, Lin FR, Della Santina CC, Minor LB, Carey JP.
Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.

OBJECTIVE: To assess patient satisfaction with vertigo control using intratympanic (IT) dexamethasone (12 mg/mL) for medically refractory unilateral Ménière's disease. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral neurotology clinic. PATIENTS: One hundred twenty-nine subjects diagnosed with unilateral Ménière's disease still having vertigo despite medical therapy. INTERVENTION: IT dexamethasone injections as needed to control vertigo attacks. MAIN OUTCOME MEASURE: A Kaplan-Meier time-to-event method was used to determine the rate of "survival," meaning sufficient satisfaction with vertigo control that the subject did not wish to have subsequent ablative treatment. "Failure" was defined as poor control and the choice to proceed to ablative treatment. RESULTS: Acceptable vertigo control ("survival") was achieved in 117 (91%) of 129 subjects. Vertigo control required only one dexamethasone injection in 48 (37%), 2 injections in 26 (20%), 3 injections in 18 (14%), and 4 injections in 10 (8%). More than 4 injections were needed in 15 subjects (21%). Of 12 failures (9%), 9 occurred within 6 months of the first IT dexamethasone injection. Follow-up data for 2 years were available for 96 subjects. Of these, 87 (91%) had vertigo control with IT dexamethasone, of whom 61 (70)% required no further injections after 2 years, 23 (26%) continued to receive IT dexamethasone injections, and 3 (3%) chose IT gentamicin treatment. CONCLUSION: IT dexamethasone injection therapy on an as-needed outpatient basis can provide vertigo control that is satisfactory in patients with Ménière's disease. The Kaplan-Meier method addresses the need for an outcome measure suited to repeated treatments and variable lengths of follow-up. However, due to the retrospective nature of this study, the presence of bias caused by loss of subjects from follow-up cannot be ruled out.

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ORL J Otorhinolaryngol Relat Spec. 2008;70(1):32-40; discussion 40-1. Epub 2008 Feb 1.
Do viruses cause inner ear disturbances?
Pyykko I, Zou J.
Department of Otolaryngology, University of Tampere, Tampere, Finland. ilmari.pyykko@pshp.fi

The association of viral infection to inner ear disease is controversial. Experiments on animals show that several viruses are capable of causing hearing loss, if applied into the perilymph. Some of these have specific affinity to the cellular type of the inner ear, as sensory epithelia and cochlear nerve. Some viruses as adenoviruses and Coxsackie virus B have specific CAR receptors that are identified in different cell types, whereas other act by attaching onto nonspecific cellular surface receptors. Some viruses such as varicella zoster virus (VZV) do not cause disease in rodents. We assessed 273 patients with clinical, serological, neuro-otologic and endoscopic evaluations. Of the 273 patients, 43 served as control subjects. The patients either had Ménière's disease (n = 158), recurrent vertigo of unknown etiology (n = 56), or hearing loss (n = 17). Antibodies against neurotropic and common viruses were evaluated. VZV, influenza B, CBV5 and RSV titers were significantly elevated in patients with inner ear disease when compared with the control group. In analyzing the internal relationship, VZV and influenza B were intercorrelated. We did not find a correlation between hearing loss and viral titers. In conclusion, VZV, Coxsackie virus B5 and influenza B virus may be the main causes of inner ear disorder. The spiral and Scarpa's ganglion are potential sites harboring viral DNA for possible latent infection. (c) 2008 S. Karger AG, Basel

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ORL J Otorhinolaryngol Relat Spec. 2008;70(1):21-6; discussion 26-7. Epub 2008 Feb 1.
Intratympanic application of an antiviral agent for the treatment of Ménière's disease.
Guyot JP, Maire R, Delaspre O.
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Geneva, Switzerland. jean-philippe.guyot@hcuge.ch

It has been suggested that Ménière's disease is part of a polyganglionitis in which symptoms result from the reactivation of neurotropic virus within the internal auditory canal, and that intratympanic applications of an antiviral agent might be an efficient therapy. In 2002, we performed a pilot study ending with encouraging results. Control of vertigo was achieved in 80% of the 17 patients included. We present here a prospective, double-blind study, with a 2-year follow-up, in 29 patients referred by ENT practitioners for a surgical treatment after failure of a medical therapy. The participation in the study was offered to patients prior to surgery. A solution of ganciclovir 50 mg/ml or of NaCl 9% was delivered for 10 consecutive days via a microwick inserted into the tympanic membrane in the direction of the round window or through a ventilation tube. One patient was withdrawn from the study immediately after the end of the injections. He could not complete the follow-up period, because of persisting vertigo. As he had received the placebo, he was then treated with the solution of ganciclovir. Symptoms persisted and he underwent a vestibular neurectomy. Among the remaining 28 patients, surgery could be postponed in 22 (81%). Surgery remained necessary to control vertigo in 3 patients from the group that received the antiviral agent, and in 3 from the control group. Using an analogical scale, patients of both groups indicated a similar improvement of their health immediately after the intratympanic injections. The scores obtained with a 36-item short-form health survey quality of life questionnaire and the Dizziness Handicap Inventory were also similar for both groups. In conclusion, most patients were improved after the intratympanic injections, but there was no obvious difference between the treated and control groups. The benefit might be due to the middle ear ventilation or reflect an improvement in the patients' emotional state. (c) 2008 S. Karger AG, Basel

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Acta Otolaryngol. 2007 Nov;127(11):1136-41.
Meniett therapy may avoid vestibular neurectomy in disabling Meniere's disease.
Barbara M, Monini S, Chiappini I, Filipo R.
II Medical School, University La Sapienza, Rome, Italy. maurizio.barbara@uniroma1.it

CONCLUSION: In those patients for whom vestibular neurectomy has been selected due to the disabling recurrence of vertigo spells, Meniett therapy has been shown to allow avoidance of this surgical procedure in a fairly high percentage of patients with Meniere's disease (MD). Our data would also support a better result when pressure treatment is acting on MD of short duration. OBJECTIVE: To test the possibility that low pressure treatment (Meniett) could avoid vestibular neurectomy in patients with MD that was refractory to medical treatment. PATIENTS AND METHODS: The setting was a tertiary referral centre in a university hospital. Thirty-six MD patients, for whom vestibular neurectomy was indicated, underwent Meniett treatment and composed a group in which a long-term (>2 years) follow-up was achieved. Additionally, different durations of MD ('young' and 'old' MD) were distinguished and analysed separately. RESULTS: Twenty-five patients (69.4%) were treated satisfactorily by using Meniett treatment and therefore avoided vestibular neurectomy. In half of them only one cycle of treatment was necessary.

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Eur Arch Otorhinolaryngol. 2007 Nov 23 [Epub ahead of print]
Treating common ear problems in pregnancy: what is safe?
Vlastarakos PV, Nikolopoulos TP, Manolopoulos L, Ferekidis E, Kreatsas G.
ENT Department, Hippokrateion General Hospital of Athens, 114 Vas. Sofias Av., Athens, 11527, Greece.

In everyday practise, more than 80% of pregnant women receive one at least medication, often for ENT causes. The aim of the present paper is to review the literature on safety and administration of medical treatment for ear diseases, in pregnant women. The literature review includes Medline and database sources. Electronic links, related books and written guidelines were also included. The study selection was as follows: controlled clinical trials, prospective trials, case-control studies, laboratory studies, clinical reviews, systematic reviews, metanalyses, and case reports. The following drugs are considered relatively safe: beta-lactam antibiotics (with dose adjustment), macrolides (although the use of erythromycin and clarithromycin carries a certain risk), and acyclovir. Non-selective NSAIDs (until the 32nd week), nasal decongestants (with caution and up to 7 days), intranasal corticosteroids, with budesonide as the treatment of choice, first generation antihistamines, or cetirizine (third trimester) and loratadine (second and third trimester) from the second generation, H(2) receptor antagonists (except nizatidine) and proton pump inhibitors (except omeprazole), can be used to relieve patients from the related symptoms. Meclizine and dimenhydrinate, as antiemetics in vertigo attacks; metoclopramide, vitamin B(6) and ginger rhizome, alternatively. Low-dose diazepam and diuretics in severe cases of Meniere's disease (with caution). Systemic administration of prednisone and prednisolone can be considered in selected cases. By contrast, selective COX-2 inhibitors, betahistine and vasodilating agents are contraindicated in pregnancy. Since otologic and neurotologic manifestations during pregnancy tend to seriously affect the quality of life of the expectant mothers, ENT surgeons should familiarise themselves with the basic guidelines and safety precautions for any related medication, in order to provide appropriate treatment.

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Curr Allergy Asthma Rep. 2007 Nov;7(6):451-6.
Allergy and Ménière's disease.
Derebery MJ, Berliner KI.
House Ear Institute, Clinical Studies Department, 2100 West Third Street, 5th Floor, Los Angeles, CA 90057, USA. jderebery@hei.org

Ménière's disease (MD), which by definition is idiopathic, has been ascribed to various causes, including both inhalant and food allergies. Patients with MD report higher rates of allergy history and positive skin or in vitro tests compared to a control group of patients with other otologic diseases and to the general public. Recent immunologic studies have shown higher rates of circulating immune complexes, CD4, and other immunologic components in patients with MD compared to normal controls. Published treatment results have shown benefit from immunotherapy and/or dietary restriction for symptoms of MD in patients with both allergy and MD.

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Otol Neurotol. 2007 Oct 12 [Epub ahead of print]
Long-Term Vertigo Control in Patients After Intratympanic Gentamicin Instillation for Ménière's Disease.
Bodmer D, Morong S, Stewart C, Alexander A, Chen JM, Nedzelski JM.
*Universitässpital Basel, HNO Klinik, Basel, Switzerland; and †Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

OBJECTIVES:: To assess long-term vertigo symptom control in patients after intratympanic gentamicin instillation for incapacitating unilateral Méniére's disease. To analyze whether an absent caloric response, as analyzed using electronystagmography after gentamicin treatment, is a good predicator of long-term symptom control. Finally, to quantify the patient's perception of long-term posttreatment handicap. STUDY DESIGN:: A retrospective study from a single institution. All patients underwent a similar fixed-dose and duration protocol of drug instillation. METHODS:: Patients were enrolled in this study, and initial outcomes were assessed according to the American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium Guidelines for Reporting Treatment Results in Méniére's Disease (1985 and 1995). In this study, only those patients treated more than 5 years previous were considered. One hundred thirty-two patients were eligible for inclusion. All patients underwent hearing testing and electronystagmography, including caloric testing before and after treatment. Posttreatment handicap and long-term vertigo control were assessed using the Dizziness Handicap Index questionnaire expanded with 5 questions specific for Méniére's disease. RESULTS:: Analysis of results is based on the 63 patients who responded. Forty-four were vertigo-free, whereas 14 continued to experience some degree of vertigo. On average, they described 5 episodes in the immediate 24 months before the study. Of the 44 patients who were asymptomatic, 35 had an absent caloric response. Of the 14 patients who realized some vertigo, 12 had an absent caloric response posttreatment. Of the 63 responders, 44 filled in the Dizziness Handicap Index. Of the 19 who did not, 17 reported that they were vertigo-free. CONCLUSION:: Our current protocol achieves complete or substantial vertigo control in most patients. A significant caloric response reduction has been a consequence in almost all patients, although an absent caloric response is not invariably a predictor of long-term symptom control. Finally, patient-perceived handicap in this long-term follow-up is consistent with that of others followed for a much shorter duration in that those who were vertigo-free volunteered a significantly lower score.

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Am J Otolaryngol. 2007 Sep-Oct;28(5):289-93.
Intratympanic gentamicin: a 1-day protocol treatment for unilateral Meniere's disease.
De Stefano A, Dispenza F, De Donato G, Caruso A, Taibah A, Sanna M.
Clinica ORL, Università G. d'Annunzio, Chieti-Pescara, Italy.

PURPOSE: The objective of this study was to assess the usefulness of low-dose intratympanic gentamicin administration in patients with Meniere's disease (MD). MATERIALS AND METHODS: We carried out a retrospective review of the charts of 55 patients with definite MD in accordance with the AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery) Diagnostic Scale who were treated at Gruppo Otologico (Piacenza, Rome, Italy). The treatment protocol consisted of 3 intratympanic injections of gentamicin at a 12-hour interval between each administration. RESULTS: Results were resumed in accordance with AAO-HNS criteria and showed complete control of vertigo spells in 60% (class A), good control in 16% (class B), moderate control in 4% (class C), poor control in 16% (class D), and no control in 4% (class E) of the patients. Audiological assessment showed unchanged thresholds in 61%, improvement in 22%, and worsening in 17% of the cases. CONCLUSION: Administration of gentamicin is a good alternative to medical and surgical procedures in the treatment of intractable MD. One-day treatment allows for adequate control of vertigo attacks without compromising hearing and quality of life and with reduced costs.

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Laryngoscope. 2007 Sep 28 [Epub ahead of print]
Treatment of Ménière's Disease by Low-Dosage Intratympanic Gentamicin Application: Effect on Otolith Function.
Helling K, Schönfeld U, Clarke AH.
From the Department of Otorhinolaryngology (k.h.), Johannes Gutenberg University Medical School, Mainz, Germany, and Charité, University Medicine Berlin (u.s., a.h.c.), Campus Benjamin Franklin, Germany.

OBJECTIVES:: The intratympanic application of a low dosage of gentamicin is increasingly favored as treatment for Ménière's disease. While posttreatment observations have confirmed a long-term success of the therapy of vertigo attacks, clear differences in the posttreatment recovery interval can be observed. In addition to differences in central-vestibular compensation, the degree of peripheral vestibular damage, i.e., to the saccule, utricle, and semicircular canal ampullae, varies among patients. This study provides comprehensive pre- and posttreatment results from unilateral functional tests of the individual vestibular receptors and of the cochlea in patients with Ménière's disease. STUDY DESIGN:: Prospective clinical study. METHODS:: Nineteen patients with unilateral Ménière's disease were treated by intratympanic application of gentamicin by injection of 0.3 mL (12 mg) through the tympanic membrane under local anesthesia. Tests were performed immediately previous to treatment and subsequently in the periods 4 to 8 weeks and 12 to 16 weeks after treatment. Unilateral saccular function was tested by means of acoustic-click, vestibular-evoked myogenic potentials (VEMP), and unilateral utricular function by subjective visual vertical (SVV) during unilateral centrifugation. Bithermal caloric testing was performed to assess unilateral semicircular canal function. RESULTS:: Prior to gentamicin treatment, the caloric response from the diseased ear was normal in 3 patients, below normal in 14 patients, and in 2 cases almost completely absent. VEMP responses could be recorded bilaterally in 13 patients; while in 6, no VEMPs could be measured from the diseased ear. Utricular function measured by SVV estimation was found to be normal in 11 patients and marginally abnormal in 2 patients. In six cases, the SVV was clearly underestimated duringcentrifugation of the diseased side. The posttreatment findings demonstrate that VEMPs were absent in all treated patients, and the caloric response was abnormally low in all but one case. In contrast, only 12 of 19 patients produced abnormal SVV responses. CONCLUSION:: The results demonstrate that incremental, intratympanic application of gentamicin effectively eliminates semicircular canal and saccular function. In contrast, utricular function appears to be maintained in 30 to 40% of cases.

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Rev Laryngol Otol Rhinol (Bord). 2007;128(1-2):33-6.
[Middle ear overpressure with Meniett in Menière disease: indications, results at short and middle terms in 53 cases]
[Article in French]
Faict H, Bouccara D.
Centre Hospitalier Robert Bisson, Service d'ORL et de Chirurgie Cervico Faciale, 14100 Lisieux, France. orl@ch-lisieux.fr

OBJECTIVES: To expose the results obtained at short and middle terms and the tolerance of over pressure treatment with Meniett in Menière disease. MATERIALS AND METHODS: A pressure treatment using Meniett device was initiated for 53 patients suffering of unilateral or bilateral active Menière's disease, despite medical treatment and physiotherapy. RESULTS: Retrospective analysis of the data demonstrate i) no complications due to the tympanostomy tube, ii) with a 4 months follow up after the treatment, a total control or reduction of vertigo in respectively 65% and 24.5% of the initially treated patients. CONCLUSION: The overpressure treatment with Meniett has been well tolerated. It can be repeated in case of recurrence of the symptoms. It is an interesting alternative for the treatment of Menière disease.

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Laryngoscope. 2007 Jun 29; [Epub ahead of print]
Long-Term Disability of Class A Patients With Ménière's Disease After Treatment With Intratympanic Gentamicin.
Boleas-Aguirre MS, Sánchez-Ferrandiz N, Guillén-Grima F, Perez N.
>From the Departments of Otorhinolaryngology (m.s.b.-a., n.p.) and Preventive Medicine (f.g.-g.), Clínica Universitaria de Navarra, University Hospital and Medical School, University of Navarra, Navarra, Spain; and the Department of Otorhinolaryngology (n.s.-f.), Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Spain.

OBJECTIVE:: The main objective of this study was to characterize the residual vestibular symptoms and disability in patients with Ménière's disease who had achieved complete control of vertigo through intratympanic gentamicin treatment. Furthermore, we assessed whether the Functional Level Score prior to treatment reflected the posttreatment symptoms and disability. STUDY DESIGN:: Prospective. SETTING:: Tertiary medical center. PATIENTS:: This study involved 103 patients with Ménière's disease treated with intratympanic gentamicin who, after a long-term follow up, have not suffered new vertigo spells and were not subject to any major modification in their treatment. METHODS:: At inclusion and at the last follow-up visit after a minimum of 3 years of ending the treatment, the clinical status (number of vertigo spells), the unsteadiness as well as the disability produced by the disease, symptoms of anxiety, and compensation were asked using specific questionnaires. The results before and after treatment were analyzed using nonparametric tests. RESULTS:: After a 5-year follow-up, complete control of vertigo was obtained in 81% of the patients with Ménière's disease who were treated with intratympanic gentamicin. Of them, 15.5% still complained of unsteadiness. A functional level of 6 or unsteadiness after treatment are related with a nonreduction in disability after long-term control of vertigo spells. CONCLUSIONS:: The efficacy of gentamicin administered intratympanically is high after long-term follow-up as shown by the disappearance of vertigo spells and by the reduction in disability, increase in perception of quality of life, and reduction in anxiety related to vestibular symptoms. Unsteadiness, although an infrequent complaint, determines a level of almost similar severity in those issues. Special care must be taken with patients with a Functional Level Scale score of 6 at the time of beginning treatment.

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Acta Otolaryngol. 2007 Jun;127(6):605-12.
Intratympanic gentamicin therapy for intractable Ménière's disease.
De Beer L, Stokroos R, Kingma H.
Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Maastricht, Maastricht, The Netherlands.

CONCLUSIONS: Intratympanic gentamicin treatment using a low dose of gentamicin (approximately 21-24 mg per injection) applied at intervals of a minimum of 27 days, has been shown to be a successful treatment of vertigo. OBJECTIVES: The objective of this analysis was to evaluate the efficacy and side effects of intratympanic injections of gentamicin as treatment of intractable unilateral Ménière's disease. PATIENTS AND METHODS: This was a retrospective study in which 57 patients treated with intratympanic gentamicin for Ménière's disease were analysed. Patients received between 1 and 10 intratympanic injections of gentamicin in an outpatient setting. RESULTS: Six months after treatment, overall complete or substantial vertigo control was reported by 80.7% of our patients (VCC class A, 61.4%; class B, 19.3%). Unilateral caloric weakness increased from 50.1% to 79.8% after treatment, and complete caloric areflexia (30 degrees C and 44 degrees C) was induced in 38.6%. In this study hearing worsened (> 10 dB = SNHL) in only 15.8% of our patients (range 10-29 dB) and loss of word recognition (WR) scores worsened (>15%) in 31% of the patients. Only 1 injection was necessary in 49.1% of the patients, the remaining 50.9% needed 2, 3, 4, 6 or 10 injections, always with a time interval of a minimum of 27 days.

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Otol Neurotol. 2007 Apr 26; [Epub ahead of print]
Current Management of Ménière's Disease in an Only Hearing Ear.
Peterson WM, Isaacson JE.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A.

OBJECTIVE:: Ménière's disease in an only hearing ear is rare. Our objective is to define the current practice patterns for this problem. SUBJECTS:: Clinically active members of the American Otological Society and the American Neurotology Society. MAIN OUTCOME MEASURE:: Survey responses. RESULTS:: Three hundred fifty-four surveys were sent out, and 165 were returned (48%). Ninety-nine percent recommended dietary modification as first line. Only 39% recommended oralcorticosteroids. Second-line treatments were, in order ofsignificance, the Meniett device (Medtronic ENT, Jacksonville, FL, U.S.A.), intratympanic corticosteroids, endolymphatic mastoid shunt, intratympanic gentamicin, and endolymphatic sac vein decompression. Interestingly, 71.5% of respondents would operate on an only hearing ear provided the appropriate circumstances. CONCLUSION:: We have documented current practice patterns for treatment. Second-line treatments vary, but the Meniett is recommended most frequently, and further recommendations may not logically progress from least to most invasive. Many respondents eventually offer surgery.

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Otolaryngol Head Neck Surg. 2007 Mar;136(3):415-21.
Endolymphatic mastoid shunt versus endolymphatic sac decompression for Meniere's disease.
Brinson GM, Chen DA, Arriaga MA.
Wilmington ENT, Wilmington, NC.

OBJECTIVE: This study compares the efficacy of endolymphatic mastoid shunt (EMS) versus endolymphatic sac decompression (ESD) without sac incision for the treatment of Meniere's disease. STUDY DESIGN AND SETTING: The AAO-HNS Guidelines for the Diagnosis and Evaluation of Therapy in Meniere's disease were used to retrospectively identify suitable candidates for the study. All patients who failed medical management and underwent either endolymphatic-mastoid shunt (EMS) (n = 88) or endolymphatic sac decompression (ESD) (n = 108) were selected for review using the AAO-HNS guidelines. The study was carried out at a tertiary care neurotology private practice. RESULTS: EMS and ESD were equally effective in reducing the incidence and severity of vertigo attacks with significant improvement in 67 percent and 66 percent of patients, respectively. CONCLUSION: Both EMS and ESD are effective, nondestructive alternatives for patients who have failed medical management of Meniere's disease with similar long-term hearing outcomes. SIGNIFICANCE: This is the only study within the same institution using AAO-HNS guidelines comparing EMS versus ESD.

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Otol Neurotol. 2007 Feb;28(2):145-51.
Auditory results after vestibular nerve section and intratympanic gentamicin for Meniere's disease.
Colletti V, Carner M, Colletti L.
ENT Department, University of Verona, Verona, Italy. vittoriocolletti@yahoo.com

OBJECTIVE: Hearing loss is a possible complication of vestibular neurectomy and intratympanic gentamicin administration in Meniere's disease. The aim of this study was to compare the incidence of this complication with the two treatments. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: The initial study population reviewed consisted of 24 patients receiving gentamicin injections and 209 patients undergoing vestibular nerve section. Comparison of data was performed among all 24 intratympanic gentamicin patients and the last 24 vestibular neurectomy patients operated on via the retrosigmoid approach. INTERVENTIONS: Intratympanic gentamicin administration (26-156 mg) and retrosigmoid vestibular neurectomy. MAIN OUTCOME MEASURE: Auditory and vertigo results were evaluated according to the American Academy of Otolaryngology 1995 criteria. RESULTS: The mean preoperative pure-tone average for patients undergoing vestibular nerve section was 48.5 dB, with a speech discrimination score of 85%. In these patients, the postoperative pure-tone average was 50.3 dB, and the speech discrimination score was 82%.Patients undergoing gentamicin injection had a mean pretreatment pure-tone average of 50.1 dB and a speech discrimination score of 87%. The posttreatment pure-tone average and discrimination score for the gentamicin group were 74.7 dB and 65%, respectively.The amount of postprocedure hearing loss was significantly greater in the gentamicin group (p = 0.03).Excellent control of vertigo (classes A and B) was obtained in 95.8% of the patients treated with vestibular nerve section and in 75% of the patients in the gentamicin group. CONCLUSION: Gentamicin administration and vestibular neurectomy are both effective for relieving vertigo in Meniere's disease. The incidence of hearing loss is significantly higher after gentamicin injection.

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Curr Opin Neurol. 2007 Feb;20(1):32-9.
Neuro-otological emergencies.
Seemungal BM.
Academic Department of Neuro-Otology, Division of Neuroscience and Mental Health, Imperial College London, Charing Cross Hospital, London, UK. b.seemungal@imperial.ac.uk

PURPOSE OF THE REVIEW: Physicians find acute vertigo a diagnostic challenge. This article review recent evidence outlining the clinical presentation of acute central and peripheral dizzy syndromes and suggest when clinicians may consider acute neuro-imaging. RECENT FINDINGS: Recent evidence highlights the difficulty that acute vertigo may sometimes pose to the clinician. For example, migrainous vertigo may have oculomotor abnormalities suggestive of either central neurological or peripheral vestibular dysfunction. Furthermore, vertebrobasilar stroke syndromes may mimic peripheral disorders such as vestibular neuritis, or when there is hearing involvement may be misdiagnosed as Meniere's disease. In addition to the need for identifying serious conditions in acute vertigo, recent evidence suggests that early steroid treatment in vestibular neuritis may improve long term outcome. Further trials regarding symptomatic outcome are required, however, before routine use of steroids can be recommended in this condition. SUMMARY: Recent findings have not made the assessment of acute vertigo any easier for the nonspecialist. Although the commonest vertigo syndromes are benign, serious conditions such as stroke may masquerade as a peripheral labyrinthine disorder and conversely benign conditions such as migrainous vertigo may have clinical characteristics of central disorders. These findings re-emphasize the need for a thorough clinical evaluation of the acutely dizzy patient.

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Arch Otolaryngol Head Neck Surg. 2006 Dec;132(12):1311-6.
Meniett clinical trial: long-term follow-up.
Gates GA, Verrall A, Green JD Jr, Tucci DL, Telian SA.
Virginia Merrill Bloedel Hearing Research Center, University of Washington, School of Medicine, Seattle, WA 98195-7923, USA. ggates@u.washington.edu

OBJECTIVE: To delineate 2-year efficacy of Meniett device therapy in people with classic, unilateral, Meniere's disease unresponsive to traditional medical treatment. DESIGN: A 2-year long-term unblinded follow-up after a prior randomized, placebo-controlled, multicenter clinical trial of the Meniett device for Meniere's disease. SETTING: Follow-up was performed remotely by using diaries and questionnaires mailed to the data coordinating center by the participants. Those who failed to mail their diaries were interviewed by telephone. PARTICIPANTS: Sixty-one study participants agreed to use the Meniett device and report their symptoms for 2 years. All had active, unilateral cochleovestibular disease. Outcomes are available for 58 participants; 2 were unavailable for follow-up and 1 was excluded because of a concurrent condition that precluded Meniett device use. INTERVENTIONS: Participants were advised to adhere to a low-sodium diet, use the Meniett device 3 times daily, and maintain a patent tympanostomy tube in the affected ear. Diuretic and vestibular suppressant medications were used as needed. MAIN OUTCOME MEASURES: Outcomes were based on the participants' daily diary, questionnaires, and telephone interviews. Three different analyses were prepared: tracking of vertigo frequency throughout the study, comparison of vertigo frequency before and at the end of Meniett device use (American Academy of Otolaryngology-Head and Neck Surgery Foundation reporting guideline), and Kaplan-Meier estimates of vertigo remission and recurrence. RESULTS: Vertigo levels gradually improved for most but not all participants. American Academy of Otolaryngology-Head and Neck Surgery Foundation class A (remission) or class B (greatly improved) results occurred in 67% (39/58) of participants, and class F (dropped out to receive surgical therapy) results occurred in 24%. Of the 44 nondropout participants, 39 (89%) had American Academy of Otolaryngology-Head and Neck Surgery Foundation group A or B outcomes. People who went into remission were highly likely (80%) to remain in remission long term; participants who achieved remission (20/43; 47%) did so within the first year of follow-up. CONCLUSIONS: Use of the Meniett device was associated with a significant reduction in vertigo frequency in about two thirds of the participants, and this improvement was maintained long term. Therapy with the Meniett device is a safe and effective option for people with substantial vertigo uncontrolled by medical therapy.

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HNO. 2006 Nov 18; [Epub ahead of print]
[Low frequency fluctuating hearing loss without labyrinthine vertigo—a genuine disease? : A follow up study after 4 and 10 years.]
[Article in German]
Schaaf H, Hesse G.
Tinnitus Klinik Arolsen, Grosse Allee 3, 34454, Bad Arolsen, hschaaf@tinnitus-klinik.de.

BACKGROUND: Besides the typical attacks of dizziness, recurrent low-frequency sensory hearing loss-together with mostly low-frequency tinnitus-is also a characteristic sign of Meniere's disease. It is therefore often assumed to be a prodromal sign of Meniere's disease, even without dizziness.METHODS: During our longitudinal study, which was started in 1995, we reported that there were 81 patients with recurrent low-frequency hearing loss with no initial vertigo in the first suspense year of 1999. After a further 6 years, we investigated 46 (57%) of these original 81 patients in the second suspense year, 2005, for new components of vertigo, with the questions of development of Meniere's disease and further development of the patients' hearing ability and psychic situation in mind.RESULTS: In all, 12 (26%) of the 81 former patients suffered from vertigo, but only 4 (9%) had developed the typical signs of full-blown Meniere's disease with the typical labyrinthine vertigo. Of the 12 patients who suffered from vertigo, 6 (13% of the 81 with vertigo) were diagnosed with psychogenic vertigo, 1 (1%) suffered from benign and treatable paroxysmal positional vertigo and 1 (1%) had developed vertigo after acoustic neurinoma surgery.CONCLUSIONS: We conclude from our observations that, although almost every patient with Meniere's disease suffers from recurrent low-frequency hearing loss, only a few patients with recurrent hearing loss develop Meniere's disease. However, many patients with low-frequency sensory hearing loss develop anxiety leading to psychogenic dizziness in fearful expectation of "imminent" Meniere's disease. We found that26% of the patients had persisting bilateral normacusis in the low-frequency ranges, while 34% had unilateral hearing loss that was sufficiently severe to affect their lives and 39%, bilateral hearing loss; however, none of the patients became completely deaf.
 

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