Recent surgical advances and continued controversies in medically refractory Meniere's disease

Abstract

Purpose of reviewMeniere's disease is caused by hydropic changes in the endolymphatic system, and manifests as a collection of vertigo, hearing loss, tinnitus, and aural fullness. Although high-quality clinical practice guidelines exist for the diagnosis and initial management of Meniere's disease, there is no strong consensus for treatment of medically refractory Meniere's disease. This review summarizes treatment options and highlights controversies surrounding surgical treatment of Meniere's disease. Recent findingsIntratympanic steroid and intratympanic gentamicin injections continue to be widely used as in-office therapies in medically refractory Meniere's disease. Despite historical controversy surrounding the use of endolymphatic sac (ELS) surgery, the use of ELS decompression has been widely adopted by the international neurotologic community due to high vertigo control rate, coupled with low risk of audiovestibular loss. Wider decompression of the sac and surgical manipulation of the endolymphatic duct may impact outcome and are the subject of discussion. An emerging surgical technique called Triple Semicircular Canal Occlusion (TSCO) holds promise as a partially ablative procedure with high vertigo control rate in Meniere's disease. Cochlear implants may be placed in active Meniere's disease patients, or during an ablative surgery such as labyrinthectomy.

Triple semicircular canal occlusion with endolymphatic sac decompression for intractable Meniere’s disease

“…Frequent vertigo attacks is the most disabling symptom of MD, and often has a major negative impact on daily life and work. For patients who continue to experience disabling attacks, incapacitation, and unilateral involvement after 3–6 months of conservative management, treatment options include intratympanic gentamicin (ITG), intratympanic steroid (ITS), endolymphatic sac decompression (ESD), triple semicircular canal occlusion (TSCO), and vestibular nerve section ( 3 , 4 ).…”