Surgical treatment of morbus Menière (author's transl)

Abstract

Surgical treatment is only indicated if the medical treatment is not successful. From 409 patients an operation was only necessary in 90 cases. Only those operations for which there is a long period of experience were mentioned. The early stage of the disease with a fluctuating hearing loss is reversible. It is the stage in which saccotomy with myo-synangiosis is indicated. A follow-up study of about 5 years ago showed that vertigo disappeared in 48% of cases. The hearing remained unchanged in 48% and decreased in 52% of cases. The tinnitus was completely relieved in 8% and the fullness of the ear in 56%. One patient had a total hearing loss after the operation. The different techniques of saccus operations, including the endolymphatic shunts, had all the same results and seemed therefore not to be specific. In the late stage of the disease the neurectomy of the vestibular nerve by transtemporal approach is most successful, especially when it is combined with an excision of Scarpa's ganglion. A 5 year follow-up study of 52 cases showed that 94% were without vertigo. Hearing was improved in 16% and unchanged in 64%. The tinnitus was gone in 33% and the fullness of the ear in 47%. Complications were hearing loss in 4%, a transitory facial paralysis in 3% and an incomplete compensation of vestibular function in 20%. Compared with the labrinthectomy the translabyrinthine neurectomy is an advantage. The results are similar to those of the vestibular neurectomy with the exception of total hearing loss, but the translabyrinthine approach, or cochleo-vestibular neurectomy is only indicated in cases of complete deafness.