Surgery for Ménière's disease

Pullens B, Giard JL, Verschuur HP, van Benthem PP

Published Online:

January 20, 2010

Ménière's disease is characterised by recurrent attacks of three major symptoms: vertigo (rotational dizziness), deafness and tinnitus (ringing of the ears), and/or aural fullness, all of which are discontinuous and variable in intensity. The symptoms of Ménière's disease are thought to be caused by excess pressure in the fluids of the inner ear which leads to sudden attacks of vertigo and hearing loss. A number of surgical procedures, of varying levels of invasiveness, have been developed to reduce the symptoms of Ménière's disease, but it is not clear whether or not these are effective. The surgical interventions can be categorised as two types: one type of surgical intervention aims to affect the natural history of the disease, with conservation of vestibular function. The other type aims to relieve symptoms by abolishing vestibular function. Both types of surgical intervention are considered in this review. Despite an extensive search the review authors only found two randomised controlled trials studying surgical interventions for Ménière's disease. Both of these trials, involving a total of 59 patients, studied endolymphatic sac surgery; one comparing it to placebo surgery and the other to a different type of surgery. Neither trial detected a significant difference between the treatment and control group.

Abstract (click to read)

Background:

Ménière's disease is characterised by three major symptoms: vertigo, deafness, and tinnitus or aural fullness, all of which are discontinuous and variable in intensity. A number of surgical modalities, of varying levels of invasiveness, have been developed to reduce the symptoms of Ménière's disease, but it is not clear whether or not these are effective.

Objectives:

To assess the effectiveness of surgical options for the treatment of Ménière's disease. All surgical interventions used in the treatment of Ménière's disease, either to alter the natural history of the disease or to abolish vestibular function, were considered for this review.

Search strategy:

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 25 February 2009.

Selection criteria:

Randomised or quasi-randomised controlled studies of a surgical modality versus a placebo therapy in Ménière's disease.

Data collection and analysis:

Two authors independently assessed trial quality and extracted data. Study authors were contacted for further information.

Main results:

The only surgical intervention which has been evaluated in randomised controlled trials and met the inclusion criteria was endolymphatic sac surgery. We identified two randomised trials, involving a total of 59 patients; one comparing endolymphatic sac surgery with ventilation tubes and one with simple mastoidectomy. Neither study reported any beneficial effect of surgery either in comparison to placebo surgery or grommet insertion.

Authors' conclusions:

The two trials included in this review provide insufficient evidence of the beneficial effect of endolymphatic sac surgery in Ménière's disease.

This record should be cited as:

Pullens B, Giard JL, Verschuur HP, van Benthem PP. Surgery for Ménière's disease. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD005395. DOI: 10.1002/14651858.CD005395.pub2

Assessed as up to date:

February 25, 2009

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Ear, Nose and Throat Disorders Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective is surgery for the treatment of Menière’s disease?

Bottom line:

The only surgical intervention which has been evaluated in randomised controlled trials (RCTs) is endolymphatic sac surgery. Two trials, involving a total of 59 patients, were included in the review, 1 comparing endolymphatic sac surgery with ventilation tubes and 1 with simple mastoidectomy. One study lasted 9 years, the other 12 months. Neither study reported any beneficial effect of surgery.

Caveat:

Due to the different ways the outcome measures were obtained, and because not all the required data were reported, it was not possible to perform a meta-analysis. In total, 70% of participants in both the endolymphatic sac surgery groups and the comparator experienced some relief of complaints. There is no evidence to choose 1 surgical technique over another.

Context:

Menière’s disease is characterised by 3 major symptoms: vertigo, deafness, and tinnitus or aural fullness, all of which are discontinuous and variable in intensity. A number of surgical modalities, of varying levels of invasiveness, have been developed to reduce the symptoms of Menière’s disease, but it is not clear whether or not these are effective.

Cochrane Systematic Review:

Pullens B et al. Surgery for Menière’s Disease. Cochrane Reviews 2010, Issue 1. Article No. CD005395. DOI: 10.1002/14651858. CD005395.pub2. This review contains 2 studies involving 59 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Ear, nose, & throat > Ear > Meniere’s disease

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

More like this

Copyright © 2012 - The Cochrane Collaboration