Randomised or quasi‐randomised controlled studies of a surgical modality versus a placebo therapy in Ménière’s disease. Vestibular neurectomy involves the discrete sectioning of the nerve of balance near where it comes out of the brain. Ninety to 95 percent of vestibular neurectomies will result in cure of vertigo.
Ménière’s disease is a debilitating condition that affects the inner ear, causing symptoms such as vertigo, hearing loss, tinnitus, and a feeling of fullness in the ear. For some patients, conservative treatments like medication and lifestyle changes may not provide adequate relief, leading them to consider surgical options.
Neither study reported any beneficial effect of surgery either in comparison to placebo surgery or grommet insertion. As there was no appropriate control arm in this study (both groups received a potentially active intervention) it was not included in our review. We identified two further reviews that also included only these two RCTs (Devantier 2019; Lim 2015). We also identified two reviews that included non‐randomised studies (Ballard 2019; Gronlund 2021), therefore cannot be easily compared with our own review. All the evidence for this comparison was very uncertain, predominantly due to the very small study size (compounded by the high dropout rate over time) and wide confidence intervals for all effects seen.
Following the destruction of one balance organ, the initial spinning dizziness is followed by a period of general unsteadiness. In elderly patients, this can often take a long time to recover, and in a small number, the balance may never fully recover for all areas of vigorous activity. The search identified 85 references, of which 10 were retrieved in full text.
Bretlau 1989 stated that the patients were randomly allocated to each treatment group. The authors are grateful to Professor Malcolm Hilton, Royal Devon University Hospital NHS Trust, for peer review of both the protocol and this review, as well as the others in the Ménière’s disease series. We are also grateful to Brian Duncan for his consumer review of this review and the whole Ménière’s disease series. Thanks also to Anne Littlewood, Information Specialist with Cochrane Oral Health, for providing peer review comments on the draft search methods. Both studies were small and, as discussed above, we were unable to carry out meta‐analyses. Therefore, the total sample size for each of our outcomes of interest was small, and reduced the certainty of the evidence.
It affects about 1 in 2,000 people, usually occurring between the ages of 30 and 50 years. Usually only one ear is affected, although about 15% to 25% of people have some symptoms in the other ear during their lifetime. No, but if you have Ménière’s disease, you can reduce your risk the disease will worsen. Contact your healthcare provider if you suddenly develop dizzy spells that may be vertigo. If that’s your situation, ask your healthcare provider about monitoring your overall health for indications you’re developing Ménière’s disease. Healthcare providers know Ménière’s disease symptoms happen when endolymph, a fluid in your inner ear, builds up and disrupts the delicate process your body uses to manage balance and hearing.
We planned to assess clinical heterogeneity by examining the included studies for potential differences between studies in the types of participants recruited, interventions or controls used and the outcomes measured. However, no meta‐analysis was conducted in the course of this review. We pre‐specified time points of interest for the outcomes in this review. Where studies reported data at multiple time points, we planned to take the longest available follow‐up point within each of the specific time frames.
As it is not clear whether this relief of vertigo is permanent, authors are encouraged to report results up to four years after the treatment. In the current literature there is much controversy about the effectiveness of surgical procedures used to treat patients with Ménière’s disease, most of which are more or less harmful to the inner ear. This review aims to assess the effectiveness and safety of these different procedures.
Surgical Options for Ménière’s Disease
One common surgical procedure used to treat Ménière’s disease is called endolymphatic sac decompression. During this procedure, a surgeon creates a small opening in the bone behind the ear to relieve pressure from excess fluid in the inner ear. Another option is vestibular nerve section, where the vestibular nerve responsible for balance is partially or completely severed.
Success Rate of Ménière’s Surgery
The success rate of Ménière’s surgery can vary depending on the type of procedure performed and the individual patient’s response to treatment. Studies have shown that endolymphatic sac decompression has a success rate of around 70-90%, with most patients experiencing a significant reduction in vertigo episodes and other symptoms.
On the other hand, vestibular nerve section is considered to have a slightly higher success rate, with up to 95% of patients reporting an improvement in their symptoms after surgery. However, this procedure also carries a higher risk of complications such as hearing loss and imbalance.
It is important for patients considering Ménière’s surgery to discuss the potential risks and benefits with their healthcare provider and to carefully weigh their treatment options. While surgery can offer significant relief for many individuals suffering from severe Ménière’s disease, it is not without its risks and may not be suitable for everyone.
