gms | German Medical Science

Introduction: Etiology of Meniere's disease (MD) has not been fully understood; its natural disease course varies substantially; in some cases two ears are involved. Currently available surgical treatments tend to compromise vestibular functions. To date, there are no well-established treatments and the efficacy is inconsistent.

Methods: This study, which has been premised on evidence-based resources, real-world studies and specialist consensus, employed an individualized and step-wise treatment strategy that combines medications (vestibular function-regulating agents), surgical operations (conservation and ablation of vestibular functions) and rehabilitative therapies (pre-rehabilitative and rehabilitative therapy of vestibule). The strategy has been put into clinical application nation-wide through a multiple-setting cooperation program and has been systematically tested and improved. This strategy is designed to maximally conserve inner ear functions. With this strategy, we advocate conservative and minimally-invasive approaches, emphasizing repeated courses of intratympanic dexamethasone injection (RCITD) and, if necessary, recommending the modified titration for intratympanic gentamicin injection (MTITG). We integrated triple semicircular canal occlusion (TSCO) into the treatment protocol of MD. The treatment mode was stepped up according to the response of the patient, with effort made to avoid or delay ablative operations. The notion of vestibular rehabilitation dominates the entire treatment course.

Results: Our results showed that, with RCITD, MTITG and TSCO, the vertigo control rate (class A+B) was respectively 92.1%, 90% and 96.6%.

Conclusions: This strategy could achieve a compromise between vertigo control and conservation of vestibular functions.

Unterstützt durch: Institute of Otorhinolaryngology,Tongji Medical College, HUST； Department of Otorhinolaryngology,Union Hospital of Tongji Medical College, HUST

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