Surgical Management of Meniere's Syndrome

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Surgical Management of Meniere's Syndrome
April 14, 1994
Glenn Knox, M.D.

Although the underlying etiology of Meniere's syndrome is unknown, a consistent histopathologic finding is hydrops (dilatation) of the endolymphatic spaces. The hydrops presumably results from a malfunction of the resorptive function of the endolymphatic sac. The classic constellation of symptoms includes: fluctuating hearing loss, episodic vertigo, tinnitus, and a sensation of fullness in the ear. These symptoms, however, do not necessarily develop simultaneously and many patients do not develop them at all.

Subcategories of Meniere's syndrome describe these other conditions; for instance, cochlear hydrops (fluctuating hearing loss alone) or vestibular hydrops (vestibular symptoms without hearing loss). In most patients, Meniere's syndrome is ultimately self-limited; over time the patient suffers deterioration of hearing and a gradual subsiding of the episodic dizzy spells. This evolution, however, may require 1 to 2 decades. In the interim, the patient's lifestyle may be severely impaired.

A few patients cannot be adequately managed by medical means alone and surgical intervention must be considered. The surgical procedures for Meniere's disease may be categorized as those designed to alter the function of the vestibular system and those that ablate the vestibular system either with or without preservation of hearing.

Case Presentation

A 58-year-old white female noted the onset of fluctuating right hearing loss, right tinnitus and vertigo eight years prior to presentation. For the first 5 years her symptoms were controlled with sodium restriction and diuretics. Three years prior to presentation she began to experience intense episodic vertigo associated with nausea and vomiting. Two years prior to presentation she underwent a right endolymphatic shunt procedure with some relief of her symptoms. After a 6-month period the vertigo and dizziness returned. She underwent a revision of the endolymphatic shunt 1 year prior to presentation, again followed by initial relief and then recurrence of symptoms. She was referred to The Methodist Hospital for further evaluation. Preoperative evaluation showed predominantly low-frequency sensorineural hearing loss in the right ear, with a PTA of 45 and a PBmax of 40%. Left ear showed a PTA of 10 and PBmax of 100%. ENG showed right unilateral weakness. ABR was normal bilaterally. The patient underwent a right middle cranial fossa vestibular nerve section. Postoperatively the patient did well and has been free of vertiginous episodes.

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