What is the best treatment for Meniere's disease?
Meniere’s disease is a chronic condition that manifests as hearing loss, vertigo, and ringing in the ears. Various surgical options are available for refractory Meniere’s disease that does not respond to medications or if the symptoms of the disease are severe.
The various surgical procedures for Meniere’s disease include:
Endolymphatic sac surgery
The endolymphatic sac plays a role in regulating fluid levels in the inner ear. During the procedure, doctors remove a small amount of bone from around the endolymphatic sac. This helps reduce the pressure of the fluid in the sac.
Doctors will perform the surgery in either of the two ways:
- Osseous labyrinthectomy (drilling out the bone and removing all labyrinth)
- Destroying some of the soft tissue in the inner ear
The procedure destroys the part of the ear that helps with balancing as well as the part that helps you hear. It is performed only if your hearing power is severely compromised in the ear affected by Meniere’s disease.
Vestibular nerve section/vestibular neurectomy
The procedure involves cutting off nerve fibers (vestibular nerve) that help you to balance. The procedure does not affect your hearing ability.
What makes you unfit for the surgery?
Doctors will evaluate you to know if you are in good health and able to withstand surgery and anesthesia. They will obtain a thorough history and perform a careful physical examination before the procedure. The following conditions are considered as contraindications for the surgery:
What is the success rate of the surgery?
The success rate of the surgery for Meniere’s disease depends on the type of surgery performed. Endolymphatic sac surgery controls vertigo in 6 to 9 times out of every 10 patients. It can improve the hearing over time and carries a low risk of hearing loss as well.
Labyrinthectomy and vestibular nerve sectioning have success rates of about 95-98%. However, they have a greater risk of hearing loss.
Trans tympanic injection of medications is a relatively new surgical approach, and its efficacy is still not established. Success rates near 90% have been reported.
What are the risks of the surgery?
Surgery for Meniere’s disease can cause potentially serious complications, but it is rare. They depend on the type of surgery or approach used. Your doctor will explain the specific risks involved in your surgery. The possible complications include:
- Hearing loss
- Facial paralysis
- Hematoma (pooling of blood)
- Cerebrospinal fluid (CSF) leakage
- Taste disturbance
- Mouth dryness
- Otitis media
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Bogaz EA, Cavallini da Silva AF, Ribeiro DK, et al. Meniere’s Disease Treatment. In: Bahmad F Jr. ed. Up to Date on Meniere's Disease. IntechOpen; 2017. https://www.intechopen.com/books/up-to-date-on-meniere-s-disease/meniere-s-disease-treatment
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