A Historical Perspective on Surgical Manipulation of the Membranous Labyrinth for Treatment of Meniere's Disease

Kersbergen, Calvin J.; Ward, Bryan K.

doi:10.3389/fneur.2021.794741

Cited by 4 publications

(4 citation statements)

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“…The context which allowed the rise of sympathectomy in the early 20th century is neither an isolated nor outdated phenomenon. 66 There remains a crucial need for physicians to consider rigorously the scientific origins and validity of their treatment practices. As it pertains to the history of treatments for MD, perhaps the current use of betahistine should be reassessed.…”

Section: Discussionmentioning

confidence: 99%

“…Premature excitement toward a plausible hypothesis can easily result in unnecessary procedures and potential harm to the patient. The context which allowed the rise of sympathectomy in the early 20th century is neither an isolated nor outdated phenomenon 66 . There remains a crucial need for physicians to consider rigorously the scientific origins and validity of their treatment practices.…”

Section: Discussionmentioning

confidence: 99%

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Historical Therapies for Suspected Autonomic Dysregulation in Meniere's Disease

Jung¹,

Perdomo²,

Ward

2023

The Laryngoscope

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ObjectiveThis narrative review examines how speculative belief that the autonomic nervous system causes Meniere's Disease (MD) led otolaryngologists to adopt invasive surgical procedures and medical treatments still offered today.Data SourcesGoogle Scholar, PubMed.Review MethodsA comprehensive literature review (1860–2022) was performed using the terms “Meniere AND (sympathetic OR sympathectomy OR vasomotor OR cervical ganglion),” returning 5360 items. All abstracts were briefly reviewed, relevant publications selected for further study, and key articles discussed by all authors. As it became clear that betahistine was related to the historical narrative, an additional search was performed using “Betahistine AND Meniere AND (vasomotor OR sympathetic OR sympathectomy OR cervical ganglion OR autonomic),” which yielded 336 results.ResultsIn the 19th and 20th centuries, growing knowledge of human anatomy led the scientific community to speculate that autonomic dysregulation caused many medical conditions. Excessive sympathetic mediated vasomotor changes were thought to cause hypertension, ischemia, and tissue damage. Clinicians applied the hypothesis to MD, assigning the sympathetic nervous system responsible for vertigo secondary to paroxysmal vasospasm and for hearing loss to poor cochlear nutrition. Despite limited animal experiments and isolated clinical observations, otolaryngologists performed sympathectomies, and, in the 1970s, replaced the procedure with betahistine as an alternative medical treatment.ConclusionPremature excitement about a plausible hypothesis led to unnecessary and unwarranted operations. Despite absent evidence of sympathetic overactivation in MD, surgeons eagerly adopted sympathectomies, and later betahistine. Rigorous evaluation of the validity of these treatment practices is needed.Level of EvidenceLevel 5 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Historical Therapies for Suspected Autonomic Dysregulation in Meniere's Disease

Jung¹,

Perdomo²,

Ward

2023

The Laryngoscope

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“…The treatment is complicated since hearing, vertigo control, tinnitus, and suppression are all intertwined, and thus, are tricky to treat separately. Both pharmacologic and surgical treatment may be effective for some patients and ineffective for others [ 24 , 25 ]; however, there is no current cure for Meniere’s disease, which is especially crucial for sensorineural hearing loss. For surgical therapy, patients and doctors sometimes find a clinical course difficult to decide on.…”

Section: Discussionmentioning

confidence: 99%

Hearing Benefits of Clinical Management for Meniere’s Disease

Zhang

Wei

Sun

et al. 2022

JCM

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Meniere’s disease is a progressive hearing–disabling condition. Patients can benefit from strict clinical management, including lifestyle and dietary counseling, and medical treatment. A prospective cohort study was carried out with 154 patients with definite Meniere’s disease, with an average age of 43.53 ± 11.40, and a male to female ratio of 0.97:1. The pure-tone thresholds of all 165 affected ears, over a one-year clinical management period, were analyzed. After one year, 87.27% of patients had improved or preserved their hearing at a low frequency, and 71.51% at a high frequency. The hearing threshold at frequencies from 250 Hz to 2000 Hz had improved significantly (p < 0.001, p < 0.001, p < 0.001, p < 0.01), and deteriorated slightly at 8000 Hz (p < 0.05). Of all the patients, 40.00% had a hearing average threshold that reached ≤ 25 dB HL after the clinical management period, among whom 27.27% were patients in stage 3. The restoration time was 2.5 (1.0, 4.125) months, with a range of 0.5–11.0 months, and the restoration time was longer for stage 3 than for stages 1 and 2 (u = −2.542, p < 0.05). The rising curves improved the most (p < 0.05), with most becoming peaks, whereas most peaks and flats remained the same. Patients who were initially in the earlier stages (95% CI 1.710~4.717, OR 2.840, p < 0.001), have an increased odds ratio of hearing by an average of ≤25 dB HL. Age (95% CI 1.003~1.074, OR 1.038, p = 0.031), peak curve (95% CI 1.038~5.945, OR = 2.484, p = 0.041), and flat curve (95% CI 1.056~19.590, OR = 4.549, p = 0.042), compared with the rising curve, increase the odds ratio of hearing on average by > 25 dB HL. Most patients can have their hearing preserved or improved through strict clinical management, and sufficient follow-up is also essential. Stage 3 patients also have the potential for hearing improvement, although the restoration time is longer than in the early stages. The initial hearing stage, age, and audiogram pattern are related to the hearing benefits.

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“…Manipulation on the inner ear to decompress the endolymphatic sac evolved in the 1920s, when Portmann drew parallels between glaucoma [ 17 ] which was later expanded by William House in the 1960s by inserting material for a permanent shunt into the subarachnoid space or mastoid [ 18 ]. A recent review from Kersbergen and Ward thoroughly depicts the history regarding surgical manipulation of the inner ear treating MD [ 19 ]. Furthermore, four types of surgical techniques have been introduced, ranging from the most minimal invasive option, endolymphatic sac decompression, over endolymphatic sac incision, endolymphatic – mastoid shunt to the most invasive technique, the endolymphatic – subarachnoid shunt.…”

Section: Introductionmentioning

confidence: 99%

Vestibular and audiometric results after endolymphatic mastoid shunt surgery in patients with Menière’s disease

Spiegel

Stoycheva

Weiss

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Treatment of Menière’s Disease (MD) comprises an array of both non-destructive and destructive treatment options. In patients who are therapy–refractory to non-destructive medical treatment, endolymphatic mastoid shunt surgery (EMSS) is both recommended and debated controversially. The aim of this study was to investigate safety in terms of hearing, vestibular function, complication rate, and efficacy with regards to vertigo control of EMSS in patients with MD according to the current diagnostic criteria of 2015. Methods Retrospective analysis of 47 consecutive patients with definite or probable MD with description of demographic parameters, pre- and postoperative MD treatment, pre- and postoperative audiometric (pure tone audiometry) and vestibular (caloric testing) results. The parameters were compared between patients with and without postoperative vertigo control. Results 31/47 patients (66.0%) had improved vertigo control postoperatively. Postoperative hearing and vestibular preservation were predominantly stable. No significant differences between patients with improved vertigo control and patients with no change or worse vertigo episodes were found. In the treatment refractory group, 4 patients required a revision EMSS and 6 a destructive MD treatment (5 gentamicin intratympanically, 1 labyrinthectomy). No peri- or postsurgical complications were reported. Conclusions EMSS was found to be beneficial in two thirds of the patients with definite or probable Morbus Menière and a safe procedure regarding hearing and vestibular preservation with no postoperative complications. Therefore, EMSS should be considered before inducing destructive treatment options, such as intratympanic gentamicin application or labyrinthectomy.

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A Historical Perspective on Surgical Manipulation of the Membranous Labyrinth for Treatment of Meniere's Disease

Cited by 4 publications

References 58 publications

Historical Therapies for Suspected Autonomic Dysregulation in Meniere's Disease

Historical Therapies for Suspected Autonomic Dysregulation in Meniere's Disease

Hearing Benefits of Clinical Management for Meniere’s Disease

Vestibular and audiometric results after endolymphatic mastoid shunt surgery in patients with Menière’s disease

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