Meniett Device Research Articles

Positive pressure therapy for Ménière's disease.

Ménière's disease is a condition that causes recurrent episodes of vertigo, associated with hearing loss and tinnitus. It is often treated with medication, but different interventions are sometimes used. Positive pressure therapy is a treatment that creates small pressure pulses, generated by a pump that is attached to tubing placed in the ear canal. It is typically used for a few minutes, several times per day. The underlying cause of Ménière's disease is unknown, as is the way in which this treatment may work. The efficacy of this intervention at preventing vertigo attacks, and their associated symptoms, is currently unclear. To evaluate the benefits and harms of positive pressure therapy versus placebo or no treatment in people with Ménière's disease. The Cochrane ENT Information Specialist searched the Cochrane ENT Register; CENTRAL; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 September 2022. We included randomised controlled trials (RCTs) and quasi-RCTs in adults with a diagnosis of Ménière's disease comparing positive pressure therapy with either placebo or no treatment. We excluded studies with follow-up of less than three months. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vertigo (assessed as a dichotomous outcome - improved or not improved), 2) change in vertigo (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) change in hearing, 6) change in tinnitus and 7) other adverse effects. We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: We included three studies with a total of 238 participants, all of which compared positive pressure using the Meniett device to sham treatment. The duration of follow-up was a maximum of four months. Improvement in vertigo A single study assessed whether participants had an improvement in the frequency of their vertigo whilst using positive pressure therapy, therefore we are unable to draw meaningful conclusions from the results. Change in vertigo Only one study reported on the change in vertigo symptoms using a global score (at 3 to < 6 months), so we are again unable to draw meaningful conclusions from the numerical results. All three studies reported on the change in the frequency of vertigo. The summary effect showed that people receiving positive pressure therapy had, on average, 0.84 fewer days per month affected by vertigo (95% confidence interval from 2.12 days fewer to 0.45 days more; 3 studies; 202 participants). However, the evidence on the change in vertigo frequency was of very low certainty, therefore there is great uncertainty in this estimate. Serious adverse events None of the included studies provided information on the number of people who experienced serious adverse events. It is unclear whether this is because no adverse events occurred, or whether they were not assessed and reported. AUTHORS' CONCLUSIONS: The evidence for positive pressure therapy for Ménière's disease is very uncertain. There are few RCTs that compare this intervention to placebo or no treatment, and the evidence that is currently available from these studies is of low or very low certainty. This means that we have very low confidence that the effects reported are accurate estimates of the true effect of these interventions. Consensus on the appropriate outcomes to measure in studies of Ménière's disease is needed (i.e. a core outcome set) in order to guide future studies in this area and enable meta-analyses of the results. This must include appropriate consideration of the potential harms of treatment, as well as the benefits.

Long-term effect of transtympanic intermittent pressure therapy using a tympanic membrane massage device for intractable meniere’s disease and delayed endolymphatic hydrops

Background A 12-month follow-up study showed that middle ear pressure treatment with a transtympanic membrane massage (TMM) device had a similar effect to a Meniett device. Objectives The effects of pressure treatment with a TMM device were retrospectively compared to the effects of treatment with a Meniett device in patients with Meniere’s disease (MD) and delayed endolymphatic hydrops (DEH) who were followed for a minimum of 24 months. Materials and Methods Twenty-seven patients were treated with the TMM device and 14 patients were treated with a Meniett device. The insertion of a transtympanic ventilation tube was necessary for the Meniett device but not for the TMM device. Results In patients treated with the TMM and Meniett devices, the frequency of vertigo significantly improved at 19–24 months after treatment. The distribution of vertigo at 19–24 months after treatment did not differ between the patients treated with the two types of devices. Pressure treatment for 8 months or more was suitable to achieve remission. Conclusions and Significance Middle ear pressure treatment for 8 months or more with a TMM or Meniett device was equally effective and provided minimally invasive treatment options for intractable MD and DEH.

Effects of transtympanic intermittent pressure therapy using a new tympanic membrane massage device for intractable Meniere’s disease and delayed endolymphatic hydrops: a prospective study

Background The retrospective study showed that the effect of the middle ear pressure treatment by the tramstympanic membrane massage (TMM) device was similar to that of the Meniett device. Objectives The new TMM device named EFET device was prospectively evaluated in patients with Meniere’s disease (MD) and delayed endolymphatic hydrops (DEH) and we compared the effects to the Meniett device. Materials and methods 23 ears of 19 patients were treated with an EFET device, and 17 ears of 15 patients were treated with the Meniett device. All patients suffering from intractable MD and DEH were treated for 4 months. The insertion of a transtympanic ventilation tube was necessary for the Meniett device, but not the EFET device. Results In patients treated by the EFET and Meniett devices, the frequency of vertigo significantly improved after treatment. The distribution of vertigo outcomes at 4 months after treatment did not differ between patients treated with the both devices. Conclusions and significance Middle ear pressure treatment by the EFET device is effective and provides minimally invasive options for intractable MD and DEH like the Meniett device.

Current Management Practices in Ménière's Disease.

To evaluate current trends in managing Ménière's disease (MD) by both general otolaryngologists and otologists/neurotologists and discuss treatment modalities. Cross-sectional study. Survey of physicians. An electronic questionnaire was disseminated to all members of American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Eight hundred and sixty members replied for a response rate of 14.5% for generalists and 35% for neurotologists. Thirty-nine percent of respondents think that diet and lifestyle changes are effective in controlling symptoms in more than 50% of their MD patients. Overall, 72.8% of respondents used hydrochlorothiazide/triamterene (HCTZ/TAT) "often" or "always" with neurotologists using HCTZ/TAT more often than generalists (p < 0.001). Half of neurotologists used IT steroids "often" or "always," compared with only 10% of generalists (p < 0.001). Endolymphatic sac procedures are the most common surgeries and are used more often by neurotologists than by generalists (p < 0.001). The Medtronic Meniett device is used more by neurotologists (p < 0.001) but it is not commonly used overall (69.2% "never" use). Many options are available for the treatment of MD. Neurotologists tend to use a wider variety of medications in their treatment protocols than generalists. Neurotologists tend to perform surgical interventions more frequently than generalists. Our evidence shows significant heterogeneity for treatment of Ménière's disease among otolaryngologists. A guideline that outlines appropriate therapeutic options, dosing, and treatment escalation is warranted.

Meniett device in meniere disease: Randomized, double-blind, placebo-controlled multicenter trial.

To evaluate the efficacy of portable Meniett low-pressure pulse generator (Medtronic Xomed, Jacksonville, FL) in Meniere disease. Randomized, double-blind, placebo-controlled, multicenter trial carried out in 17 academic medical centers. One hundred twenty-nine adults presenting Meniere disease (American Academy of Otolaryngology-Head and Neck Surgery criteria) not controlled by conventional medical treatment were included. The protocol included three phases: 1) placement of a transtympanic tube and evaluation of its effect (if resolution of symptoms, the patient was excluded); 2) randomization: 6-weeks treatment with Meniett (Medtronic Xomed) or placebo device; 3) removal of the device and 6-week follow-up period. The evaluation criteria were the number of vertigo episodes (at least 20 minutes with a 12-hour free interval) and the impact on daily life as assessed by self-questionnaires. Ninety-seven patients passed to the second phase of the study: 49 and 48 patients received the Meniett (Medtronic Xomed) or the placebo device, respectively. In the placebo group, the number of vertigo episodes decreased from 4.3 ± 0.6 (mean ± standard error of the mean) during the first phase to 2.6 ± 0.5 after 6 weeks of treatment, and to 1.8 ± 0.8 after the removal of the device. Similar results were observed in the Meniett device (Medtronic Xomed) group: 3.2 ± 0.4 episodes during the first phase, 2.5 ± after 6 weeks of Meniett device (Medtronic Xomed) treatment, and 1.5 ± 0.2 after the third phase. An improvement of symptoms was evidenced in all patients, with no difference between the Meniett (Medtronic Xomed) and the placebo device groups. The decrease in the number of vertigo episodes could be explained by an effect of the medical care. 1b. Laryngoscope, 2016 127:470-475, 2017.

Positive pressure therapy for Meniere's syndrome/disease with a Meniett device: a systematic review of randomised controlled trials.

Incidence rates of Meniere's syndrome/disease vary considerably from 157 per 100 000 in the United Kingdom to 15 per 100 000 in the United States. A wide range of treatments are used for the treatment of the condition with no consensus on the most effective intervention. To assess the effectiveness of the Meniett device in reducing the frequency and severity of vertigo in Meniere's syndrome/disease. The Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific abstracts; ICTRP and additional sources for published and unpublished trials were searched. The date of the last search was 13th May 2014. Four randomised controlled trials (RCTs) were identified that compared the efficacy of the Meniett device versus a placebo device in patients with Meniere's 'disease' as defined by the AAOO criterion. Two review authors independently assessed study eligibility and risk of bias and extracted data. The outcome data were dichotomous for all the included trials. The four RCTs compared 123 patients with the Meniett device against 114 patients with the placebo device from four RCT's over a follow-up period of 2 weeks to 4 months. There was a significant overall 61% reduction in the frequency of vertigo in both groups (mean no vertigo days per month of 8-3). However, this reduction was not significantly different between the two groups in any study or on meta-analysis [mean difference in vertigo-free days between Meniett and placebo device of 0.77 days over a 1-month period (95% CI - 0.82, 1.83) P = 0.45]. There were also no substantive data to support a greater reduction in the severity of the vertigo or any other outcome with the Meniett device compared with the placebo device. No evidence was found to justify the use of the Meniett device in Meniere's syndrome/disease.

Positive pressure therapy for Ménière's disease or syndrome.

Positive pressure therapy for Ménière's disease or syndrome.

Treatment of Menière’s Disease

Diagnosis of Menière's disease is made with a characteristic patient history, including discrete episodes of vertigo lasting 20min or longer, accompanied by sensorineural hearing loss, which is typically low frequency at first, aural fullness, and tinnitus. Workup includes audiometry, a contrast enhanced MRI of the internal auditory canals, and exclusion of other diseases that can produce similar symptoms, like otosyphilis, autoimmune inner ear disease, perilymphatic fistula, superior semicircular canal syndrome, Lyme disease, multiple sclerosis, vestibular paroxysmia, and temporal bone tumors. A history of migraine should be sought as well because of a high rate of co-occurrence (Rauch, Otolaryngol Clin North Am 43:1011-1017, 2010). Treatment begins with conservative measures, including low salt diet, avoidance of stress and caffeine, and sleep hygiene. Medical therapy with a diuretic is the usual next step. If that fails to control symptoms, then the options of intratympanic (IT) steroids and betahistine are discussed. Next tier treatments include the Meniett device and endolymphatic sac surgery, but the efficacy of both is controversial. If the above measures fail to provide symptomatic control of vertigo, then ablative therapies like intratympanic gentamicin are considered. Rarely, vestibular nerve section or labyrinthectomy is considered for a patient with severe symptoms who does not show a reduction in vestibular function with gentamicin. Benzodiazepines and anti-emetics are used for symptomatic control during vertigo episodes. Rehabilitative options for unilateral vestibular weakness include physical therapy and for unilateral hearing loss include conventional hearing aids, contralateral routing of sound (CROS) and osseointegrated hearing aids.

Systematic review and meta-analysis of Meniett therapy for Meniere's disease.

To perform a systematic review and meta-analysis of micropressure treatment for Meniere's disease (MD). Medline, Ovid, Web of Science, and Cochrane Library search of the literature from January 1996 to December 2012. Systematic literature review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria required definitive diagnosis of unilateral MD, treatment with Meniett device, vertigo control results, and hearing results before and after treatment. Randomized controlled trials and other types of case-control studies were included. Improvements in vertigo, American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) functional score, and pure tone average (PTA) were assessed. Funnel plots were used to detect bias and Q test was used to assess for heterogeneity. Random effects model was used for meta-analysis. T test was used to assess for significance. Of 113 abstracts screened, 18 studies met criteria for review and 12 were used for meta-analysis. Eight studies reported hearing evaluation and the improvement in PTA after Meniett treatment was significant (P = 0.0085). Data could not be combined for AAO-HNS functional score due to heterogeneity. However, there was a trend toward improvement. Of six studies reporting frequency of vertigo, Meniett treatment significantly reduced frequency of vertigo (P = < .0001). Much of the data used in the analysis was derived from retrospective or level 4 studies. The average follow-up was only 5 months, and there were low number of patients in the treatment and control groups. The Meniett device is a safe, nondestructive treatment for patients' refractory to medical therapy for MD.

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The effect of middle ear pressure treatment with the Meniett device and tympanic membrane massage (TMM) device for intractable vertigo in patients with Meniere's disease was reviewed. Pressure treatment with the Meniett device is induced after the ventilation tube is placed. Three double-blinded clinical trials and five long-term follow-up studies showed improvement in patients' vertigo. No complication were reported in the previous studies. The effect of the TMM device was reported to be similar to that of the Meniett device. Both the Meniett and TMM devices are minimally invasive treatments for middle ear pressure recommended as second-line treatment for intractable vertigo in patients with Meniere's disease.

Meta‐analysis of Meniett Therapy for Ménière's Disease

Objectives: Evaluate the efficacy of Meniett micropressure treatment for Ménière’s disease by performing a meta-analysis of all relevant treatment studies. Methods: Systematic review of the English literature using Medline, Ovid, and Cochrane library from January 1996 to December 2012. We selected all studies for which the Meniett micropressure device was used to treat patients with definitive unilateral Ménière’s disease. We did not include isolated case reports and general reviews. Random and fixed models were used to estimate overall effect size. Results: Of 80 abstracts screened for relevancy, 18 studies were selected for further review. For hearing, only 9 studies reported pure tone average (PTA) pre- and post-Meniett application. The difference in PTA between pre- and post-micropressure device application was not significant ( P = 0.72). Seven studies reported American Academy of Otolaryngology (AAO) functional score pre- and post-treatment. Analysis shows significant improvement of AAO functional score after treatment ( P = 0.04). Eight studies reported frequency of vertigo before and after treatment. The treatment was found to be significant in reducing frequency of vertigo ( P &lt; 0.0001). Conclusions: The Meniett device appears to be a safe, non-destructive treatment alternative for patients refractory to initial medical therapy for Ménière’s disease. The overall body of literature on the efficacy of the Meniett device is sparse and is an obvious limitation of this analysis, yet the data obtained will help to enlighten practitioners on the usefulness of the Meniett device.

Intermittent pressure therapy of intractable Meniere's disease and delayed endolymphatic hydrops using the transtympanic membrane massage device: a preliminary report

Conclusion. Middle ear pressure treatment by the tympanic membrane massage (TMM) device as well as the Meniett device is effective and provides minimally invasive options for intractable vertigo in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH). Objective: The effects of the TMM device were evaluated according to the criteria of the Japan Society for Equilibrium Research (1995) in patients with MD and DEH and compared to those in patients treated with the Meniett device. Methods: Twelve ears of 10 patients (MD 8; DEH 2) were treated with the TMM device, while 16 ears of 15 patients (MD 11; DEH 4) were treated with the Meniett device. All the patients had failed to respond to medical treatment including diuretics before each pressure treatment, and were followed up for more than 12 months after treatment. Tympanotomy is necessary before treatment for the Meniett device, not but for the TMM device. Results: With both devices, the frequency of vertigo after treatment was significantly lower than before treatment (p < 0.05). The time course of vestibular symptoms with the TMM device was not significantly different from that with the Meniett device (p > 0.05). No complications were directly attributable to treatment with the TMM device.

Long-term effects of the Meniett device in Japanese patients with Meniere's disease and delayed endolymphatic hydrops reported by the Middle Ear Pressure Treatment Research Group of Japan

Conclusion: The Meniett device is a minimally invasive and safe treatment that may be used to provide longer-term reduction of vestibular symptoms in patients with delayed endolymphatic hydrops (DEH) as well as those with Meniere's disease (MD). Objective: The effects of the Meniett device were evaluated in patients with a diagnosis of definite MD or DEH according to the 1995 AAO-HNS criteria. Methods: Twenty-nine ears of 28 patients with MD and 5 ears of 5 patients with DEH (ipsilateral type 4, contralateral type 1) were treated with the Meniett device by the Middle Ear Pressure Treatment Research Group of Japan. All of the patients had failed to respond to medical treatment including diuretics before the pressure treatment. Results: Sixteen (57%) patients with MD and all five (100%) patients with DEH remained entirely free from vertigo spells; nine (32%) patients with MD responded with a significant decrease in the frequency of vertigo spells. In regard to hearing, 25 ears (74%: MD, n = 21; ipsilateral DEH, n = 4) had stable hearing levels; only 4 ears (12%: MD, n = 3; contralateral DEH, n = 1) showed a significant hearing improvement. No complications were attributable to the Meniett device.

Bilateral Ménière's disease

Bilateral Ménière's disease treatment can be extremely challenging and, like its unilateral variant, remains highly controversial. There are few articles in the literature that have focused specifically on the treatment of bilateral Ménière's disease, despite significant numbers of unilateral cases evolving toward bilaterality - a process which complicates management and is not simple to foresee. This study reviews the most up-to-date concepts in its diagnosis and treatment, with a special focus on recent advances. Recent advances in electrocochleography, vestibular-evoked myogenic potential, and intratympanic gadolinium-based contrast agent MRI may have the potential to diagnose bilateral endolymphatic hydrops, and predict unilateral to bilateral Ménière's disease progression. Although more prospective studies are necessary, recent studies show that intermittent pressure therapy (Meniett device), intratympanic steroids, and endolymphatic sac surgery appear to be efficacious and well tolerated nonablative management options. Moreover, triple semicircular canal occlusion surgery has recently been used successfully in Ménière's disease. Bilateral Ménière's disease can be challenging to diagnose via clinical suspicion and pure-tone audiometry alone. Therefore, adjunctive diagnostic tools including electrocochleography, vestibular-evoked myogenic potential, and intratympanic gadolinium-based contrast agent MRI are of even greater value, and may predict progression to bilaterality - allowing better optimization of treatment. Ablative treatments are relatively contraindicated due to the risks of bilateral vestibular and cochlear hypofunction. Nonablative treatments such as the Meniett device, intratympanic steroids, and endolymphatic sac surgery appear to be efficacious, and useful alternatives after conservative measures fail. Systemic aminoglycoside therapy is reserved for only the most severe and intractable cases.

Clinical long-term effects of Meniett pulse generator for Meniere's disease

Conclusion. According to this long-term study, the Meniett pulse generator is a safe, effective, and non-destructive therapy that can reduce vertiginous symptoms and associated functional handicap and partly show an improvement of hearing in medically intractable and active Meniere's disease. Moreover, we recommend considering it before attempting any surgical or chemical vestibular ablation procedure. Objective. To evaluate the long-term efficacy and safety of transtympanic pressure treatment in the management of recalcitrant vertigo in Meniere's disease. Patients and methods. This was a cross-sectional case study of 22 consecutive patients with medically active and intractable Meniere's disease who opted to try the Meniett pulse generator between July 2005 and March 2008. Eighteen of these patients were followed up for over 24 months. A standard ventilation tube was inserted in the affected ear. The treatment period with the Meniett pulse generator was 2 months in clinic, then the follow-up was a mean of 28 months. Patients indicated on the symptom report card and six-point functional scale the maximum level of vertigo, activity, and stress. Hearing was assessed utilizing pure tone average thresholds (PTAs) and the vestibular caloric test was performed. Results. For 18 patients, the changes on the vertigo visual analog scale (VAS) and six-point functional scale before and after treatment with the Meniett device were statistically significant (p<0.05). No changes in vestibular function were noted. In all, 13 and 10 of 18 patients, respectively, showed a significant PTA increase of 10 dB or more at 2 months and 12 months after treatment with the Meniett device. Nine of 17 patients showed a significant PTA increase of 10 dB or more at 24 months after the treatment. There were no complications during the 28-month follow-up.

The Effect of the Meniett Device in Patients With Ménière's Disease

To review our long-term experience with the Meniett device in patients who failed medical management to analyze its efficacy in controlling vertigo and its impact on the functional level of the patient. Retrospective case review with long-term follow-up of patients receiving the Meniett device at our institution between May 2002 and April 2005. Tertiary referral center. Patients who failed medical therapy for Ménière's disease and opted to receive the Meniett over chemical labyrinthectomy, surgical labyrinthectomy, endolymphatic shunt surgery, or vestibular nerve section. The Meniett is a small, portable, low-pressure pulse generator meant to be self-administered, requiring 5-minute sessions 3 times a day. Patient's current perception of usefulness of Meniett device for controlling vertigo and current level of Meniett treatment. Of 14 patients meeting the study criteria, 12 were able to be contacted, giving an average follow-up of 4 years. Three patients (25%) showed no benefit; 9 patients (75%) did respond to the Meniett and thought it had reduced the frequency and severity of their vertigo attacks. Seven patients (58%) continued to use the device on a daily basis; the other 2 patients (17%) went into remission 2 and 3 years after initiating treatment. The Meniett device is a minimally invasive, nondestructive treatment that may be used to provide longer-term reduction of vestibular symptoms in patients with Ménière's disease.

Meniett Device for Ménière's Disease

To review the continued use of the Meniett device 2 and 3 years after the device's initial prescription. Retrospective case series. Tertiary referral center. Patients fitting American Academy of Otolaryngology-Head and Neck Surgery criteria for Ménière's disease who had failed conventional medical therapy between February 2002 and April 2004 and who were ready for surgical intervention. Patients used the Meniett device as a nonsurgical alternative for Ménière's management. Continued use or non-use of the device. Twenty-three patients were prescribed and obtained the Meniett device in the study interval. At 2 years of minimum follow-up, there were 21 evaluable patients. Eleven patients (52%) continued to use the device and have good control of vertiginous symptoms at 2+ years. Four patients (19%) were asymptomatic at 1 year and discontinued the use of the device. Six patients (29%) had no impact on their Ménière's symptoms and stopped using the device within the first 3 months. At 3 years of minimum follow-up, there were 19 evaluable patients; of whom, 63% were either using the device or had become asymptomatic. No complications were attributable to the device. We conclude that the Meniett device is a useful minimally invasive alternative in the management of Ménière's disease. Among these patients who had failed previous medical management, 71% and 63% required no additional intervention beyond the Meniett device at a minimum of 2 and 3 years of follow-up, respectively. Most patients who failed to gain benefit did so early on in therapy.

A case of delayed endolymphatic hydrops due to mumps viral infection treated with the Meniett device

Objective: We report a case of delayed endolymphatic hydrops due to complicating mumps virus infection that was treated with the Meniett device.Method: Case reports and a review of the world literature on delayed development of endolymphatic hydrops after mumps virus infection are presented.Results: The case of a woman who presented with unilateral, reversible sensorineural hearing loss following mumps infection and was successfully treated with the Meniett device is presented. This woman developed profound sensorineural hearing loss and intractable vertigo spells a few months after contracting mumps. In this case, the incubation period interval between the development of mumps infection and the diagnosis of DEH was only one year. DEH (Delayed endolymphatic hydrops) is a clinical entity characterized by profound sensorineural hearing loss in one ear during its early phase; after a prolonged period of time, DEH enters the late phase, which is characterized by different otologic symptoms. Although the most common causes of DEH are inflammation, trauma and other unidentified events during childhood, viral infections, including mumps, represent one of the known causes of DEH. Mumps infection sometimes represents a confirmed etiology of DEH Sometimes DEH can definitively be diagnosed as being caused by mumps infection.Conclusion: This is the first case report to demonstrate the efficacy of the Meniett device in the treatment of DEH due to complicating mumps infection.

Current Management of Ménière's Disease in an Only Hearing Ear

Ménière's disease in an only hearing ear is rare. Our objective is to define the current practice patterns for this problem. Clinically active members of the American Otological Society and the American Neurotology Society. Survey responses. Three hundred fifty-four surveys were sent out, and 165 were returned (48%). Ninety-nine percent recommended dietary modification as first line. Only 39% recommended oral corticosteroids. Second-line treatments were, in order of significance, the Meniett device (Medtronic ENT, Jacksonville, FL, USA), intratympanic corticosteroids, endolymphatic mastoid shunt, intratympanic gentamicin, and endolymphatic sac vein decompression. Interestingly, 71.5% of respondents would operate on an only hearing ear provided the appropriate circumstances. We have documented current practice patterns for treatment. Second-line treatments vary, but the Meniett is recommended most frequently, and further recommendations may not logically progress from least to most invasive. Many respondents eventually offer surgery.

Meniett Clinical Trial: Long-term Follow-up

To delineate 2-year efficacy of Meniett device therapy in people with classic, unilateral, Ménière's disease unresponsive to traditional medical treatment. A 2-year long-term unblinded follow-up after a prior randomized, placebo-controlled, multicenter clinical trial of the Meniett device for Ménière's disease. Follow-up was performed remotely by using diaries and questionnaires mailed to the data coordinating center by the participants. Those who failed to mail their diaries were interviewed by telephone. Sixty-one study participants agreed to use the Meniett device and report their symptoms for 2 years. All had active, unilateral cochleovestibular disease. Outcomes are available for 58 participants; 2 were unavailable for follow-up and 1 was excluded because of a concurrent condition that precluded Meniett device use. Participants were advised to adhere to a low-sodium diet, use the Meniett device 3 times daily, and maintain a patent tympanostomy tube in the affected ear. Diuretic and vestibular suppressant medications were used as needed. Outcomes were based on the participants' daily diary, questionnaires, and telephone interviews. Three different analyses were prepared: tracking of vertigo frequency throughout the study, comparison of vertigo frequency before and at the end of Meniett device use (American Academy of Otolaryngology-Head and Neck Surgery Foundation reporting guideline), and Kaplan-Meier estimates of vertigo remission and recurrence. Vertigo levels gradually improved for most but not all participants. American Academy of Otolaryngology-Head and Neck Surgery Foundation class A (remission) or class B (greatly improved) results occurred in 67% (39/58) of participants, and class F (dropped out to receive surgical therapy) results occurred in 24%. Of the 44 nondropout participants, 39 (89%) had American Academy of Otolaryngology-Head and Neck Surgery Foundation group A or B outcomes. People who went into remission were highly likely (80%) to remain in remission long term; participants who achieved remission (20/43; 47%) did so within the first year of follow-up. Use of the Meniett device was associated with a significant reduction in vertigo frequency in about two thirds of the participants, and this improvement was maintained long term. Therapy with the Meniett device is a safe and effective option for people with substantial vertigo uncontrolled by medical therapy.