Natural History vs. Surgery for Meniere's Disease

Silverstein, Herbert; Smouha, Eric E.; Jones, Raleigh O.

doi:10.1177/019459988910000102

Cited by 196 publications

(102 citation statements)

References 8 publications

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“…Approximately the same results were obtained by Silverstein et al [10] in a control group of patients who declined surgery. These authors who concluded that endolymphatic sac surgery does not alter the natural course of vertigo control in Ménière’s disease.…”

Section: Discussionsupporting

confidence: 79%

Long-Term Outcome of Ménière’s Disease: Endolymphatic Mastoid Shunt versus Natural History

Quaranta

Marini

Sallustio³

1998

Audiol Neurotol

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This retrospective study evaluates the outcome of 38 patients with intractable Ménière’s disease with a minimum of 7 years follow-up. Twenty underwent endolymphatic-mastoid shunt (EMS) and 18 were offered surgery but declined (natural history, NH, group). At the last control, 85% of the patients who were operated on (EMS group) and 74% of the NH patients had complete or substantial control of vertigo. The difference between the two groups was not significant. However, it was significant at 2 and 4 years follow-up. At 2 years, EMS patients had complete or substantial control of vertigo in 65% of the cases, at 4 and 6 years in 85% of the cases. Only 32% of the NH patients had complete or substantial control of vertigo at 2 years. This percentage rose to 50% at 4 years and to 74% at 6 years. Hearing results in the two groups were not significantly different. Tinnitus disappeared or decreased in 56% of the EMS patients and in 18% of the NH patients. Sixty-seven percent of the EMS patients and 29% of the NH patients reported that their aural fullness was abolished. In conclusion, over the years, approximately 8 out of 10 of our patients with Ménière’s disease achieved complete or substantial control of vertigo; however, this reduction was observed earlier in EMS patients than in those who declined surgery.

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Section: Discussionsupporting

confidence: 79%

Long-Term Outcome of Ménière’s Disease: Endolymphatic Mastoid Shunt versus Natural History

Quaranta

Marini

Sallustio³

1998

Audiol Neurotol

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“…Multiple studies have found progressive reduction in vertigo spells leading to complete recovery within 2 years from onset [16,17] .…”

Section: Discussionmentioning

confidence: 99%

Response Over Time of Vertigo Spells to Intratympanic Dexamethasone Treatment in Meniere’s Disease Patients

Attrache¹,

Krstulovic²,

Guillen³

et al. 2016

Int Adv Otol

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OBJECTIVE:To assess the effectiveness and response over time of intratympanic dexamethasone on the symptoms of Meniere's disease. MATERIALS and METHODS:We performed a matched cohort study of 24 patients with Meniere's disease who were unresponsive to initial treatment and underwent 3 sessions of weekly intratympanic dexamethasone injections using a concentration of 16 mg/mL and 24 matched controls with the same characteristics with regard to vertigo spells. RESULTS:Compared with control subjects, intratympanic dexamethasone injections resulted in a decrease in the frequency of vertigo spells in the first 6-month period. In the dexamethasone-treated group, a ≥60% decrease in vertigo spells was achieved by 70.8% of patients in the first 6 months. Total remission was achieved by 20.8% of patients in the first 8 months, but after this, the effect tapered. A slight improvement in Tinnitus loudness and no changes in hearing levels were found. The stage of Meniere's disease, years from disease onset, and mean number of vertigo spells per month did not have any effects on the percentage of decrease in vertigo spells. CONCLUSION:Intratympanic dexamethasone temporarily reduces the frequency of vertigo spells during the initial months but does not remove the probability of having further spells in the future. This therapy provides a valuable tool to accomplish a rapid decrease in vertigo spells in subjects with Meniere's disease, and it is considered an alternative to chemical or surgical labyrinthectomy.

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“…For those 97 subjects with follow-up data at or beyond 2 years, the remission rate (needing no further intratympanic treatments) was 70%. Before the advent of intratympanic therapies, Silverstein et al (17) studied a group of patients with Ménière's disease who had failed medical therapy and were offered endolymphatic sac surgery or vestibular neurectomy. Of their 50 patients who declined any surgery, 57% had complete control of vertigo after 2 years, and 70% had complete control after 8.3 years.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Results With Intratympanic Dexamethasone in the Treatment of Ménière's Disease

Boleas-Aguirre

Lin²,

Santina³

et al. 2008

Otology &Amp; Neurotology

107

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Objective-To assess patient satisfaction with vertigo control using intratympanic (IT) dexamethasone (12 mg/mL) for medically refractory unilateral Ménière's disease.Study Design-Retrospective study. Setting-Tertiary referral neurotology clinic.Patients-One hundred twenty-nine subjects diagnosed with unilateral Ménière's disease still having vertigo despite medical therapy. Intervention-IT dexamethasone injections as needed to control vertigo attacks.Main Outcome Measure-A Kaplan-Meier time-to-event method was used to determine the rate of "survival," meaning sufficient satisfaction with vertigo control that the subject did not wish to have subsequent ablative treatment. "Failure" was defined as poor control and the choice to proceed to ablative treatment.Results-Acceptable vertigo control ("survival") was achieved in 117 (91%) of 129 subjects. Vertigo control required only one dexamethasone injection in 48 (37%), 2 injections in 26 (20%), 3 injections in 18 (14%), and 4 injections in 10 (8%). More than 4 injections were needed in 15 subjects (21%). Of 12 failures (9%), 9 occurred within 6 months of the first IT dexamethasone injection. Follow-up data for 2 years were available for 96 subjects. Of these, 87 (91%) had vertigo control with IT dexamethasone, of whom 61 (70)% required no further injections after 2 years, 23 (26%) continued to receive IT dexamethasone injections, and 3 (3%) chose IT gentamicin treatment.Conclusion-IT dexamethasone injection therapy on an as-needed outpatient basis can provide vertigo control that is satisfactory in patients with Ménière's disease. The Kaplan-Meier method addresses the need for an outcome measure suited to repeated treatments and variable lengths of follow-up. However, due to the retrospective nature of this study, the presence of bias caused by loss of subjects from follow-up cannot be ruled out.

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Natural History vs. Surgery for Meniere's Disease

Cited by 196 publications

References 8 publications

Long-Term Outcome of Ménière’s Disease: Endolymphatic Mastoid Shunt versus Natural History

Long-Term Outcome of Ménière’s Disease: Endolymphatic Mastoid Shunt versus Natural History

Response Over Time of Vertigo Spells to Intratympanic Dexamethasone Treatment in Meniere’s Disease Patients

Longitudinal Results With Intratympanic Dexamethasone in the Treatment of Ménière's Disease

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