There have been various surgical procedures for the treatment of Meniere's disease with a wide range of variation in the reported success rates which are the subject of much controversy.
The present paper is a review of the treatment for Meniere's disease by labyrinthectomy, endolymphatic shunt operation, and section of the eighth nerve.
Labyrinthectomy is performed in order to control vertigo. The effects are predictable, but residual hearing is sacrificed. A certain number of patients continue to experience unsteadiness postoperatively. Efficacy of partial labyrinthine destruction by ultrasound or cryosurgery is uncertain. Many patients develop permanent hearing loss and/or facial palsy without benefit from surgery.
Recently, control of vertigo with preservation of hearing has been of major concern in surgery. Vestibular neurectomy has been found to be effective in the control of vertigo. Hearing should theoretically not be affected in this procedure, but is often lost postoperatively.
A majority of inner ear specimens obtained from patients with Meniere's disease showed distention of the endolymphatic space. Perisacular fibrosis and loss of the epithelial layer are the common features while bilateral involvement has been seen in one-third of the cases. Epidural shunt operation is the most rational, safest procedure available and the chosen treatment to perform in the early stage, before the endolymphatic sac becomes fibrotic and hearing deteriorates. It is the safest procedure available, and can relieve the symptoms of vertigo with preservation of residual hearing.
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