| Abstract: | Ménière's disease is more common than was generally believed in the past. Stahle has calculated the incidence of Ménière's disease in Sweden. Using the same incidence for the United States, there ought to be 97,000 hospitalized inpatients with Ménière's disease of all ages in the whole population. The increased understanding of inner ear physiology and pathology during the past decade has changed the indication for operation towards an early intervention for preserving the hearing function. For the purposes of analyzing results, patients with Ménière's disease were divided into the following classes according to the hearing loss only: 1. Near normal hearing (no more than 10 db loss at 500, 1,000, 2,000). 2. Ascending audiogram, fluctuating (500 more than 10 db more than 2,000). 3. Flat audiogram, fluctuating (500 not 10 db different than 2,000). 4. Flat audiogram, non-fluctuating (500 not 10 db different than 2,000). 5. Other, more extreme hearing loss, non-fluctuating (2,000 10 db more than 500). In this study, 33 patients with early Ménière's disease had a subarachnoid endolymphatic shunt operation. Two patients belonged to Class 1 and 31 patients to Class 2. All had well-visualized vestibular aqueducts on polytomography and most had a positive glycerin test done in conjunction with transtympanic electrocochleography. During the first postoperative year, two patients in Class 2 improved to Class 1 (normal hearing). The other 29 in Class 2 remained in Class 2. None was worse as regards hearing. Most were completely relieved or improved as regards vertigo. Early surgical drainage in Ménière's disease is effective and safe and should be performed prior to irreversible dilatation of the membranous labyrinth. Patients in Classes 3, 4, and 5, with excessive and widespread hydrops of the membranous labyrinth, should have a vestibular nerve section. |
