Meniere’s disease affects about 150/100,000 Americans and often affects the most productive years of life. The disease can incapacitate an individual by repetitive episodes of vertigo, hearing loss and tinnitus. A laddered approach to management of our patients exists at the Ear Institute of Illinois. Generally speaking, early in the disease an individual may respond to a low sodium diet. However, today, if one does not quickly respond to a low sodium diet, there are other options to try to prevent the episodes of vertigo. These options consist, for example, of either steroid injections into the middle ear or gentamicin injections, so called intra-tympanic (IT) treatment or middle ear perfusion. If intratympanic treatments are ineffective, an endolymphatic shunt operation (see below) may be tried to stop the attacks of vertigo. For the most severe cases, vestibular nerve section (see below) is an option. The last two operations are used when hearing is still serviceable (which means that the hearing loss can be improved with a hearing aid). When hearing is not serviceable, a labyrinthectomy is the best alternative, and is helpful in the majority of cases.
Surgery to Decrease Fluid Pressure
Endolymphatic shunt placement drains excess inner ear fluid (endolymph) from the inner ear. It is believed that Meniere’s disease is due to periods of increased fluid pressure in the inner ear. The endolymphatic shunt procedure is performed under general anesthesia with an operative time of approximately one hour. Most people go home the day of surgery. At the time of surgery, an incision is made behind the ear, and a plastic shunt tube is placed into the endolymphatic sac of the inner ear. The shunt allows excess inner ear fluid (which is less than 7 microliters of fluid) to drain into the bony cavity (mastoid) behind the ear.
A shunt operation usually is advised when hearing is relatively good in the involved ear. Further permanent loss of hearing occurs in less than 5% of patients. Total loss of hearing in the operated ear occurs in less than 1% of cases.
Surgery to Cut the Balance (Vestibular) Nerve
Section (cutting) of the vestibular nerve may be advised when hearing is good in the involved ear. Similar to endolymphatic shunt surgery, vestibular nerve section results in permanent loss of hearing occurs in less than 5% of patients and total loss of hearing in the operated ear in less than 1% of cases. The operation is performed under general anesthesia and usually requires 4-7 days of hospitalization. Through an incision behind the ear, a portion of the mastoid bone is removed and the balance nerve is cut. In the majority of cases, the hearing remains the same after surgery. In some cases, the hearing is temporarily reduced for several weeks after surgery. The symptom of vertigo is eliminated in approximately 93 – 95% of cases. Persistent unsteadiness, however, may continue for weeks or months until the opposite ear stabilizes the balance system.
Surgery to Destroy the Balance Organ
Transmastoid labyrinthectomy is advised only when the hearing is poor. The operation results in total loss of hearing in the operated ear. This operation is performed under general anesthesia and requires hospitalization for approximately 3-4 days. Through an incision behind the ear, a portion of the mastoid bone is removed, and the inner ear balance chambers are removed.
Vertigo is eliminated in approximately 97 – 98% of cases. Persistent unsteadiness, however, may continue for a period of weeks or months until the opposite ear stabilizes the balance system.
Transcanal (oval window) labyrinthectomy
Oval window labyrinthectomy usually is advised only when the hearing is poor. It results in total loss of hearing in the operated ear and a temporary increase in dizziness. This operation is usually performed under general anesthesia through the ear canal and requires 3-4 days of hospitalization. It consists of removing fluid and nerve endings from the inner ear.
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