内耳麻酔法によるメニエール病の治療

抄録

Therapeutic results of inner ear anesthesia were evaluated in 35 patients with medication resistant Menière's disease. A mixture of 0.5 ml 4% lidocaine and 2 mg dexamethasone was transtympanically injected into the middle ear cavity. Since this inner ear anesthesia therapy transiently depresses labyrinthine function, the patient has to be hospitalized. The injection was performed 4 times at 4-day intervals. The criteria for evaluating the therapeutic effect on vertigo were recommended by the committee of the Japanese Society of Equilibrium Research. This is a revised version of the criteria for evaluation by AAO-HNS, by changing the 2 year observation period in AAO-HNS to 1 year. In this method, the frequency of vertigo after treatment was compared with that before treatment. A numeric value was calculated by dividing the mean monthly frequency of vertigo for one year after treatment by the mean monthly frequency of vertigo for 6 months before treatment and multiplying by 100. The results were categorized into 5 grades and complete recovery was seen in 37%, substantial recovery in 46%, limited recovery in 6%, insignificant change in 9% and deterioration in 3%. A positive effect from treatment including complete and substantial recovery was seen in 83%. A sig-nificant correlation between the hearing level and therapeutic effects was recognized. Improvement of the healing level by 10 dB or more was seen in 6 patients, changes within±10 dB were seen in 26, decrease by 10 dB or more was seen in 3. So no change was seen in 74%. The positive effect of inner ear anesthesia on tinnitus was 83% immediately after treatment, and 69% one year after treatment. Consequently, inner ear anesthesia appears to be a valuable treatment well worth trying prior to surgical therapy for resistant Meniere's disease.