Mediterr J Otol 2005:1(1):8-13.

Disabling vertigo in Meniere’s disease: Which treatment?

Trabalzini F, Babighian G.

U.O.A. di Otochirurgia Azienda Ospedaliera di Padova Padova, Italy. franco.trabalzini@sanita.padova.it

OBJECTIVES: We evaluated the effectiveness of diverse treatment options in patients with disabling vertigo due to unilateral Ménière’s disease.

PATIENTS AND METHODS: This retrospective study included 169 patients (78 males, 91 females; mean age 50.1 years; range 23 to 80 years) who were treated for recurrent peripheral vertigo from January 1990 to January 2000. All the patients were classified in accordance with the AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery) 1995 criteria. Intratympanic application of gentamicin was used in 29 patients who refused surgery or where surgery was contraindicated. Endolymphatic sac surgery was performed in 20 patients with a disability defined in level 4 of the AAOHNS Functional Level Scale. Labyrinthectomy, either transcanal or transmastoid, was performed in eight patients whose hearing function was absent or not useful in the affected ear. Vestibular nerve section (VNS) was performed in 112 patients who had a good general condition, a serviceable hearing in the diseased ear, and a real disability affecting social and professional activities. In the first years, it was performed through the retrolabyrinthine approach (18 patients) and in the latter years through the retrosigmoid approach (94 patients). Hearing levels were assessed before and 4 to 10 weeks after treatment and vertigo control rates were determined between 18 to 24 months after treatment. The overall follow-up period ranged from 24 to 93 months.

RESULTS: With gentamicin, vertigo improved significantly in 86.2% of the cases (class A 48.3, class B 37.9), but at the expense of impairment in hearing in 41.3%. With endolymphatic sac surgery, deterioration in hearing was 10%. Improvement in vertigo control was 65% at the end of a two-year follow-up period. Nine patients whose follow-up period was nine years showed a remarkable decrease in vertigo control. All the patients who underwent labyrinthectomy had vertigo control, with a complete hearing loss. The most beneficial treatment was VNS, in terms of both complete control of vertigo spells (98.3%; class A 92.9, class B 5.4%) and preservation of hearing (93.8%). None of the patients in this group required a revision procedure.

CONCLUSION: For disabling vertigo in Ménière’s disease, VNS is of choice if hearing is worthy of preservation. In patients with unilateral non-useful hearing labyrinthectomy may be considered. In elderly patients and/or in those with a poor health condition, intratympanic gentamicin seems to be the most appropriate option.