メニエール病の治療成績に関する検討

抄録

Inner ear anesthesia was performed in 110 patients with Meniere's disease refractory to medication. The criteria for the evaluation of the therapeutic effect were AAOO (1972), AAO-HNS (1985), and Sakata's (1987) which have different evaluation periods. With AAOO, 7% of the patients were class A, 33% class B, 8% class C and 52% class D. AAOO requires an evaluation period ten times the average interval between attacks, so the periods of evaluation are long and there were 19% indeterminable cases. AAO-HNS is expressed by a numerical score, and 48% of the patients scored 0, 33% scored 1 to 40, 7% scored 41 to 80, 9% scored 81 to 120 and 3% scored>120. With Sakata's criteria, 52% of the patients had an excellent response, 34% a good response, 9% were unchanged and 3% were worse. The average evaluation period was 21.8±18.8 months (mean±SD) for the AAOO group, 24 months for the AAO-HNS and 9.5±3.3 months for the Sakata group. Only a 4% difference in the apparent rate of complete suppression of vertigo was observed between the Sakata group with an evaluation period of about 10 months and the AAO-HNS group with an evaluation period of 24 months. Thus an observation period of about 10 months yields results similar to that of one of 24 months. In addition to setting an evaluation period for determining the effect of treatment in Meniere's disease, seasonal variations of vertigo attacks should also be considered. We conclude that an observation period of one year is optimal for evaluating treatment in Meniere's disease. Inner ear anesthesia had an effectiveness rate of 81% in the treatment of vertigo according to AAO-HNS criteria, and one of 61% in the treatment of tinnitus. Inner ear anesthesia should be considered for patients with Meniere's disease as a conservative treatment before a decision is made to perform surgery.