难治性梅尼埃病手术控制眩晕的远期疗效观察

目的：观察难治性梅尼埃病手术控制眩晕的远期疗效。方法：施行内淋巴囊手术或经迷路进路前庭神经切断术治疗难治性梅尼埃病５４例,其中长期接受随访、资料完整者１２例。结果：随访８￣１３年,６例前庭神经切断术患者示再发作眩晕;６例内淋巴囊手术者,３例眩晕症状完全控制,３例基本控制。结论：肉淋巴囊手术及经迷路进行前庭神经切断术为控制难治性梅尼埃病患者眩晕的有效手段,对于有适应证的患者经迷路进路前庭神经切断术控     

梅尼埃病两种内淋巴囊手术方式的远期疗效观察

目的：评估与比较内淋巴囊乳突腔分流术（EMS）和内淋巴囊减压术（ESD）治疗梅尼埃病（MD）的远期疗效。方法：1994—06—2007—07采用内淋巴囊手术治疗原诊断为MD的患者59例,其中EMS34例,ESD25例,选择诊断符合MD诊断依据和疗效评估标准,术后2年以上、随访资料完整的23例24耳（分流术12例13耳,减压术11例11耳）进行回顾性总结。结果：EMS组12例13耳,随访3～14年,眩晕A级完全控制者9耳,B级基本控制4耳;ESD组11例11耳,随访2-14年,术后眩晕A级8耳,B级2耳,C级1耳。EMS组听力B级1耳（7．7％）,C级6耳,D级6耳;ESD组听力B级2耳（18．2％）,C级4耳,D级5耳。2组眩晕控制和听力改善差异无统计学意义。结论：EMS和ESD都是治疗MD的有效方法,对眩晕症状的控制效果满意,临床分期中晚期患者仍有疗效。     

Long-term results of endolymphatic sac drainage with local steroids for intractable Meniere's disease

Objectives

Meniere's disease is a common inner ear disease characterized by vertigo, hearing loss and tinnitus. Since Meniere's disease is thought to be triggered by an immune insult to inner ear hydrops, we examined endolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids for intractable Meniere's patients and observed long-term results from 2 years to over a decade until 13 years.

Methods

Between 1998 and 2009, we enrolled and assigned 286 intractable Meniere's patients to two groups: group-I (G-I) included patients who underwent endolymphatic sac drainage with steroid instillation and group-II (G-II) included those who declined endolymphatic sac drainage. Definitive spells and hearing improvement in these two groups were determined for 2–13 years after treatment.

Results

According to the established criteria, vertigo was completely controlled in 88% of patients in G-I in the 2nd year, in 73% in the 12th year and in 70% in the 13th year. These results in G-I were significantly better than those in G-II for 13 years after treatment. Hearing was improved in 49% of patients in G-I in the 2nd year, in 27% in the 12th year and in 25% in the 13th year. These results in G-I were significantly better than those in G-II for 12 years after treatment, but this was not significant in the 13th year.

Conclusions

Endolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids could improve long-term follow-up results of hearing as well as vertigo control. This means that the drainage with local steroids could also improve patients’ long-term quality in the prime of life.     

Ultrasound treatment of Meniere's disease. Long-term follow-up of 356 advanced cases.

Twelve years' experience of ultrasound treatment of 356 patients is presented. For evaluating the results a new multifacetted scoring system was developed, where each individual patient was evaluated on the basis of four parameters. According to this evaluation 71% of the patients improved after the operation, while 29% remained unchanged or deteriorated. Because of lack of improvement, 42 patients underwent reoperation by different methods; in half of them ultrasonic irradiation was again used. The hearing deteriorated in about 40% of the patients, to which result the long observation times also contributed. The caloric response became reduced in 70% of the patients. Marked depression of the caloric response characterized the patients who were relieved of vertigo. Transient facial paralysis in 4 patients was the only complication.     

Longterm results of ultrasonic irradiation in Meniere's disease

Thirty-seven patients with Ménière's disease were treated with ultrasonic irradiation to the lateral and superior semicircular canals. In a longterm follow-up study, lasting alleviation of the vertiginous attacks was found in 24 out of 33 patients (72%). In most of the cases, hearing remained unchanged. It is suggested that the therapeutic effect is associated with a change in the endolymphatic drainage due to histological alterations in the labyrinth produced by ultrasound.     

Innovar treatment for Meniere's disease.

Patients with intractable vertigo due to clinical Meniere's disease were offered treatment with Innovar, a neurolept analgesic. The patients were from a single clinical practice, had failed conventional dietary and medical treatment and were eligible on clinical grounds for endolymphatic sac surgery. After a follow-up of 2-8 years, 58% of patients had long-lasting relief of vertigo. Hearing was not affected. Risk factors for a favorable response were male gender, fluctuating hearing, and early stage of the disorder. Innovar is a safe, cost-effective second-line therapy for patients with Meniere's disease who have failed conventional first-line medical therapy.     

Low-dose intratympanic gentamicin treatment of Meniere's disease

To control attacks of vertigo while preserving both hearing and labyrinthine function, low doses of gentamicin were instilled intratympanically in nine patients with intractable unilateral Meniere's disease. Each patient received six instillations of antibiotic of 4 mg each (total dose, 24 mg). Patients were then followed for 2–4 years. Long-term results of treatment are reported according to the American Academy of Otolaryngology-Head and Neck Surgery 1985 criteria. Of the nine cases, three experienced complete control of vertiginous attacks, while six received substantial control. Post-treatment hearing acuity was unaffected, although disability following treatment became worse in one patient, a 66-year-old man. Caloric responses after therapy were absent or severely reduced in three ears, moderately reduced in two ears and unchanged in four ears. In three patients, labyrinthine function was found damaged 4–8 days after administration of the last dose of drug. Overall, intratympanic instillations of low doses of gentamicin in patients with intractable Meniere's disease were found to control vertiginous attacks with less damage to the inner ear function than that reported in the literature.     

Longterm results of ultrasonic irradiation in Meniere's disease.

Thirty-seven patients with Ménière's disease were treated with ultrasonic irradiation to the lateral and superior semicircular canals. In a longterm follow-up study, lasting alleviation of the vertiginous attacks was found in 24 out of 33 patients (72%). In most of the cases, hearing remained unchanged. It is suggested that the therapeutic effect is associated with a change in the endolymphatic drainage dur to histological alterations in the labyrinth produced by ultrasound.     

Low-dose intratympanic gentamicin treatment of Meniere's disease

To control attacks of vertigo while preserving both hearing and labyrinthine function, low doses of gentamicin were instilled intratympanically in nine patients with intractable unilateral Meniere's disease. Each patient received six instillations of antibiotic of 4 mg each (total dose, 24 mg). Patients were then followed for 2–4 years. Long-term results of treatment are reported according to the American Academy of Otolaryngology-Head and Neck Surgery 1985 criteria. Of the nine cases, three experienced complete control of vertiginous attacks, while six received substantial control. Post-treatment hearing acuity was unaffected, although disability following treatment became worse in one patient, a 66-year-old man. Caloric responses after therapy were absent or severely reduced in three ears, moderately reduced in two ears and unchanged in four ears. In three patients, labyrinthine function was found damaged 4–8 days after administration of the last dose of drug. Overall, intratympanic instillations of low doses of gentamicin in patients with intractable Meniere's disease were found to control vertiginous attacks with less damage to the inner ear function than that reported in the literature.     

Pressure treatment versus gentamicin for Meniere's disease

Ménière's disease may be treated in different ways. After obtaining a case history and performing auditory and vestibular tests the diagnosis should be obvious. In terms of treatment, the first steps are to provide the patient with information, institute a low-salt diet and regulate internal medical disorders. The next step is pharmacological treatment using diuretics, betahistine and other drugs. Local pulsated pressure treatment in the ear canal has been used in a placebo-controlled study and showed significant improvement, primarily of vertigo, but also in terms of tinnitus and hearing. Hence, this form of treatment can be used in some phases of the disease. In more severe cases gentamicin treatment has proved successful; in the present study, vertigo was cured in all but 3 of 35 patients. On average, no extra hearing loss was caused: however, one ear became deaf, some ears showed improvement and some ears showed a certain degree of hearing loss. In cases of escalation of Ménière's disease, pressure treatment should be used initially, followed by gentamicin. These two methods of treatment are not in competition as they are used to treat different stages of the disease.     

Meniere's disease: results of a two and one-half-year study of etiology, natural history and results of treatment

The results of a two and one-half year study of 120 patients with Ménière's disease has revealed multiple but specific etiology for 36 percent of the patients: 1. allergy, 14 percent; 2. congenital or acquired syphilis, seven percent; 3. adrenal pituitary insufficiency, six percent; 4. myxedema, three percent; 5. stenosis of the internal auditory canal, three percent; and 6. trauma, acoustic or physical, three percent. Emotional or psychiatric factors are not involved in etiology of this disease. The vestibular and cochlear aqueduct on both temporal bones of patients with Ménière's disease could not be visualized in a significantly greater number than a normal control group suggesting an anatomic predisposition to the development of Ménière's disease. Preliminary immunologic viral investigation suggests the possibility of viral etiology in the remaining group considered idiopathic. Medical treatment with vasodilators is effective in many cases. The endolymphatic subarachnoid shunt operation was the treatment of choice for patients unresponsive to medical treatment and it is effective in controlling symptoms in 62 percent of cases. It is hoped that this study will encourage other investigators to criticize and help intensify our efforts to solve the questions remaining about Ménière's disease.     

Intratympanic gentamicin for unilateral Meniere's disease: results of therapy

Patients with Meniere's disease that remains refractory to conservative treatment have traditionally been subjected to ablative surgery. The purpose of this prospective study was to evaluate the use of intratympanic gentamicin in eliminating incapacitating vertigo, while preserving hearing. Over the past 8 years, 83 patients have received between 1 and 6 intratympanic injections of gentamicin in an out-patient setting, with duration of therapy titrated to individual symptom response and effect on hearing. Using established AAO-HNS guidelines, we present data on 50 patients who have a minimum of 2 years follow-up. Control or significant improvement of definitive Meniere's attacks was achieved in 92% of patients and hearing preserved or improved in 76%. Only one patient experienced profound sensorineural hearing loss. We feel this treatment option should be considered and offered to patients in whom medical treatment has failed.