International consensus (ICON) on treatment of Ménière's disease

Abstract

The recommendation is to change the lifestyle, to use the vestibular rehabilitation in the intercritic period and to propose psychotherapy. As a conservative medical treatment of first line, the authors recommend to use diuretics and Betahistine or local pressure therapy. When medical treatment fails, the recommendation is to use a second line treatment, which consists in the intratympanic injection of steroids. Then as a third line treatment, depending on the hearing function, could be either the endolymphatic sac surgery (when hearing is worth being preserved) or the intratympanic injection of gentamicin (with higher risks of hearing loss). The very last option is the destructive surgical treatment labyrinthectomy, associated or not to cochlear implantation or vestibular nerve section (when hearing is worth being preserved), which is the most frequent option.

Intratympanically administered steroid for progressive sensorineural hearing loss in Ménière’s disease

“…Before and 6-8 weeks after the treatment, pure tone audiometry was performed. Previously, before the IT treatment no other intratympanical therapy has been used; only conservative treatment based on international guidelines was performed to reduce the symptoms [17].…”

Do dietary factors significantly influence tinnitus?

“…[36][37][38] Salt is associated with fluid retention and it is currently believed that a low-salt diet may induce an increase in the plasma aldosterone concentration, possibly affecting the endolymph regulation and helping to maintain inner-ear homeostasis (endolymph absorption in the endolymphatic sac). 38,39 Recent international consensus statements mention a reduced-salt diet as a lifestyle change for MD management, 40,41 but there is currently no good supporting evidence for this common recommendation (Level 4 evidence). 42 The search yielded no systematic review and only a single randomised controlled trial.…”

Resultados y seguimiento de la rehabilitación vestibular

“…En la reciente revisión de Dunlap et al (2019) [5], se subrayan las intervenciones más novedosas de la RV. El Consenso Internacional sobre el tratamiento de la enfermedad de Ménière sugiere que la RV se ofrezca como una opción terapéutica entre las crisis de vértigo [12] y aunque en la revisión sistemática de Esch et al [13] no se encuentra suficiente evidencia para concluir un efecto positivo en la mejora del equilibrio y de la calidad de vida de quienes padecen esta patología, es una opción terapéutica segura y puede ser eficaz, particularmente en aquellos pacientes con riesgo de caídas y otras comorbilidades asociadas. En el trabajo sobre terapias emergentes que se publicó en el año 2018 a partir de las conclusiones del Congreso de Neurocirujanos, se establece la conveniencia de iniciar la RV antes de la cirugía del schwannoma del VIII par craneal, a fin de mejorar la movilidad postquirúrgica, particularmente si se combina con la ablación del vestíbulo mediante gentamicina en la fase preoperatoria [14].…”