Release: Embargoed until September 24, 2000Contact: Kenneth Satterfield202-371-4517 (9/23-27)703-519-1563[email protected]
SURGEONS ARE OPTING FOR MORE CONSERVATIVE TREATMENTS FOR MENIERE'S DISEASE
Vestibular neurectomy used to be the procedure of choice; today, intratympanic therapy is growing in popularity
Washington, DC -- Meniere's disease is an affection characterized clinically by vertigo, nausea, vomiting, tinnitus, and progressive deafness due to swelling of the endolymphatic duct (a small membraneous canal, connecting with both the saccule and utricle of the membranous inner ear).
Treatment for this disease that affects thousands continues to evolve. At least ten years ago, the vestibular neurectomy (excision of a inner ear nerve segment) was the preferred surgical solution. Now, a new research study that analyzed current surgical solutions for this disease have found that otolaryngologist--head and neck surgeons are using more conservative procedures, specifically the intratympanic installation of medications such as steroids, gentamicin, and streptomycin.
The authors of the study, "Ten Year Evaluation of the Surgical Treatment of Meniere's Disease," are Herbert Silverstein, MD, William B. Lewis, MD, Seth I. Rosenberg, MD, and Lance E. Jackson, MD, all from Sarasota, FL. Their findings will be presented Wednesday, September 27, 2000, before the Annual Meeting/Oto Expo of the American Academy of Otolaryngology--Head and Neck Surgery Foundation, being held September 24-27, at the Washington, DC Convention Center.
Methodology: A questionnaire was sent to all members of the American Otological Society and the American Neurotology Society to learn the frequency, results, and complications of surgical procedures used to treat Meniere's disease. Patients included in the study were all residing in the United States and had undergone a surgical procedure for Meniere's disease since 1990. The questionnaire data was placed in an Excel Spreadsheet and statistically analyzed by use of a personal computer.
Results: Of the 700 surveys mailed, 137 (20 percent) were returned. Analysis of the data revealed:
--Eighty-one percent of the respondents perform vestibular neurectomy; 90 percent perform labyrinthectomy; 85 percent, endolymphatic sac surgery; and 72 percent use intratympanic therapy.
--The trend over a ten-year period indicated an increase in intratympanic therapy. The number of such procedures rose from less than 100 in 1990 to more than 900 in 1999. Fifty-four percent of respondents are treating more patients with this minimally invasive procedure.
--Early in the decade, there was an increase in endolymphatic sac surgery, while the number of other procedures remained constant. However, at the end of the ten year period, all procedures except intratympanic procedures were in decline.
--Endolymphatic surgery was associated with the lowest incidence of reduced postoperative hearing.
--As first-line surgical treatment, 55 percent of surgeons are using endolymphatic sac procedures, and 38 percent are choosing intratympanic gentamicin therapy.
Conclusions: The number of neurectomies performed for Meniere's disease has declined in the last ten years. It appears that surgeons are now selecting more conservative initial surgical approaches, choosing sac surgery and intratympanic gentamicin as first-line therapy. Neurectomy and labyrinthectomy are more often reserved for people who have failed the more conservative method and for those without hearing.
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