ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Ménière’s Disease: A Diagnosis of Exclusion with Controversial Therapies

by Jennifer Decker Arevalo, MA • January 1, 2008

  • Tweet
  • Email
Print-Friendly Version

Otolaryngologists are increasingly using office-based intratympanic perfusion11 to deliver high concentrations of medication directly to the inner ear cavity with minimal side effects. The aminoglycoside antibiotic, gentamicin, is most often used, even though it is an ototoxin. Usually four injections are given over a period of a month, but some otolaryngologists are successfully switching to a low-dose gentamicin protocol of only one or two shots per month.4 The procedure itself, done with either single or multiple injections, is low-risk and simple to perform, but is considered destructive, as it can leave patients with little or no balance function. Even though studies show an efficacy at about 80% to 90% for vertigo control, authors report substantial worsening of hearing in up to 25% of patients.12,13

You Might Also Like

  • Ménière’s Disease-Don’t Blame the Patient
  • BPPV: State of the Art in Diagnosis And Treatment
  • Salivary Gland Malignancies: Diagnosis and Treatment of a Rare and Challenging Cancer
  • Intratympanic Drug Therapy Effective for Ménière’s Disease
Explore This Issue
January 2008

Endolymphatic sac decompression involves removal of petrous bone from around the endolymphatic sac, whereas shunting requires the placement of a synthetic shunt to drain endolymph into the mastoid. Both procedures appear to reduce pressure, control vertigo, and stabilize hearing acuity equally.13

Even though this is a time-tested surgical operation, there is still some controversy due to a 1981 Danish study that suggested that outcomes from this procedure were no different than a sham procedure and were just a placebo effect, said Dr. Megerian. Almost two-thirds of my patients find that it controls their vertigo and I am very pleased with the results. The best thing is you don’t burn any bridges; if it isn’t successful, you can still use intratympanic gentamicin.

Other generally well-accepted therapies include vestibular nerve section and labyrinthectomy. In vestibular neurectomy, the diseased vestibular nerve is clipped where it leaves the inner ear and goes to the brain. This procedure often requires a neurosurgical approach (middle fossa or retrosigmoid performed through a small craniotomy) and is considered riskier than intratympanic gentamicin injections. Even though vertigo attacks are eliminated in about 95% to 98% of cases and hearing is preserved in the surgically treated ear about 95% of the time, patients are often reluctant to undergo this invasive treatment.13

There has been a dramatic reduction in the number of vestibular nerve sections or ‘Dandy operation’ as it is sometimes called, since the introduction of intratympanic gentamicin, said Dr. Megerian.

A labyrinthectomy is an old operation that is only recommended for a select group of patients who have lost all usable hearing on the affected side, failed other interventions or determined that vestibular nerve section is too dangerous for their situation, he continued.

Pages: 1 2 3 4 5 6 7 | Single Page

Filed Under: Departments, Head and Neck, Medical Education, Otology/Neurotology, Practice Focus Tagged With: cancer, CT, debate, diagnosis, guidelines, hearing loss, meniere's, radiation, research, steroids, tinnitus, treatment, tumor, vertigoIssue: January 2008

You Might Also Like:

  • Ménière’s Disease-Don’t Blame the Patient
  • BPPV: State of the Art in Diagnosis And Treatment
  • Salivary Gland Malignancies: Diagnosis and Treatment of a Rare and Challenging Cancer
  • Intratympanic Drug Therapy Effective for Ménière’s Disease

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Experts Delve into Treatment Options for Laryngopharyngeal Reflux
    • Otolaryngologists Have a Major Role to Play in Treating COVID-19 Long-Haulers
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Podcasts Becoming More Popular Method of Education for Otolaryngologists
    • How to Embrace Optimism in the Midst of the COVID-19 Pandemic
    • Tips on How to Approach Conversations with Patients about the COVID-19 Vaccine
    • Steps You Should Take to Protect Your Voice and Hearing During Telemedicine Sessions
    • Routine Postoperative Adjunct Treatments Unnecessary for Idiopathic Cerebrospinal Fluid Leaks

Polls

Have you spoken with your patients about receiving the COVID-19 vaccine?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2021 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.