Menieres slides-050518

Treatment Controversies in Meniere’s Disease Shashidhar S. Reddy, MD, MPH Shawn D. Newlands, MD, PhD UTMB Otolaryngology Grand Rounds May 18, 2005

Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

History of Meniere’s ,[object Object],[object Object],[object Object],[object Object]

Definition of Meniere’s Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Committee on Hearing and Equilibrium Guidelines for Diagnoses and Evaluation of Therapy in Meniere’s Disease, AAOHNS Board of Directors March 1994

Definition of Meniere’s ,[object Object],Committee on Hearing and Equilibrium Guidelines for Diagnoses and Evaluation of Therapy in Meniere’s Disease, AAOHNS Board of Directors March 1994 >70 4 41-70 3 26-40 2 <=25 1 Four Tone Average dB Stage

Definition of Meniere’s ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Committee on Hearing and Equilibrium Guidelines for Diagnoses and Evaluation of Therapy in Meniere’s Disease, AAOHNS Board of Directors March 1994

Definition of Meniere’s ,[object Object],[object Object],Committee on Hearing and Equilibrium Guidelines for Diagnoses and Evaluation of Therapy in Meniere’s Disease, AAOHNS Board of Directors March 1994 E >120 F Secondary Treatment D 81-120 C 41 to 80 B 1 to 40 A 0 Class Numerical Value

Physiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Physiology ,[object Object],[object Object],[object Object],[object Object],Andrews, JC, Intralabyrinthine fluid dynamics: Meniere disease 12(5) Oct 2004 pp408-412

Pathophysiology ,[object Object]

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],Review Article: Minor, Lloyd et al , Meniere’s Disease, Current Opinion in Neurology 17(1) Feb2004

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],Rauch SD, et al Meniere’s syndrome and endolymphatic hydrops: double blind temporal bone study. Ann Otol Rhinol Laryngol 1989; 98:873-883

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Silverstein H., Smouha E. & Jones R. (1989) Natural history vs surgery for Ménière's disease. Otolaryngol. Head Neck Surg. 100, 6-16

Medical Management ,[object Object],[object Object]

Medical Management ,[object Object],[object Object],Brookes, G.B. The pharmacological treatment of Meniere’s disease. Clinical Otolaryngology 21(1) Feb1996, pp3-11

Medical Management ,[object Object],[object Object],[object Object],Shinkawa H. & Kimura R.S. (1986) Effect of diuretics on endolymphatic hydrops. Acta. Otolaryngol. (Stockh.)101, 43-52

Medical Management ,[object Object],[object Object],Ruckenstein M.J., Rutka J.A. & Hawke M. (1991) The treatment of Meniere's disease: Torok revisited. Laryngoscope101, 211-218

Medical Management ,[object Object],[object Object],[object Object],[object Object]

Medical Management ,[object Object],[object Object],[object Object],[object Object],James, AL, et al . Betahistine for Meniere’s disease or syndrome. Cochrane Database of Systematic Reviews (2) 2005

Medical Management ,[object Object],[object Object],[object Object],Silverstein, Herbert et al Dexamethasone inner ear perfusion for the treatment of meniere’s disease: a prospective, randomized, double-blind, crossover trial. American Journal of Otology. 1998. 19:196-201

Mechanical Management ,[object Object],[object Object],[object Object],[object Object]

Mechanical Management ,[object Object],[object Object],Gates GA. Green JD Jr. Tucci DL. Telian SA. The effects of transtympanic micropressure treatment in people with unilateral Meniere's disease. Archives of Otolaryngology -- Head & Neck Surgery. 130(6):718-25, 2004 Jun. Did not use standardized vertigo assesment Did not comment on severity of vertigo Did not give good data on objective testing

Intratympanic Therapy ,[object Object],[object Object],[object Object],[object Object]

Intratympanic Therapy ,[object Object],[object Object]

Intratympanic Gentamicin ,[object Object],[object Object],[object Object],[object Object]

Intratympanic Gentamicin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Martin E, Perez N: Hearing loss after intratympanic gentamicin therapy for unilateral Meniere’s Disease. Otol Neurotol 2003, 24:800-806

Intratympanic Gentamicin ,[object Object],[object Object],[object Object],[object Object],[object Object],Jackson, LE; Silverstein, H: Chemical perfusion of the inner ear. Otolaryngol Clin North Am 2002, 35:639-653

Intratympanic Gentamicin ,[object Object],[object Object],[object Object],[object Object],[object Object],Harner, Stephen et al : Long-term follow-up of transtympanic gentamicin for Meniere’s Syndrome. Otology & Neurotol 22:210-214, 2001

Intratympanic Gentamicin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Intratympanic Gentamicin ,[object Object],Chia, Stanley H, et al Intratympanic Gentamicin Therapy for Meniere’s Disease: a Meta-Analysis. Otology&Neurotol 25(4) July 2004 pp 544-552 Class A or B Vertigo Control

Intratympanic Gentamicin ,[object Object],[object Object],[object Object]

Endolymphatic Sac Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Endolymphatic Sac Surgery Coker, Newton J. et al Atlas of Otologic Surgery . W.B. Saunders 2001

Endolymphatic Sac Surgery ,[object Object],[object Object],[object Object],Thomsen, Jen et al . Placebo Effect in Surgery for Meniere’s Disease. Arch Otolaryngol – Vol 107, May 1981, pp271-277

Vestibular Nerve Section ,[object Object],[object Object],[object Object],[object Object]

Vestibular Nerve Section Coker, Newton J. et al Atlas of Otologic Surgery . W.B. Saunders 2001

Vestibular Nerve Section ,[object Object],[object Object],Hillman, Todd A, et al. Vestibular Nerve Section Versus Intratympanic Gentamicin for Meniere’s Disease. Laryngoscope 114:pp 216-224

Vestibular Nerve Section ,[object Object]

Other Ablative Surgeries ,[object Object],[object Object],[object Object]

Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Menieres slides-050518

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Menieres slides-050518