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Original Investigation |

Comparison of Second-Echelon Treatments for Ménière’s Disease

Gregory J. Basura, MD, PhD1; Giant C. Lin, MD1; Steven A. Telian, MD1
[+] Author Affiliations
1Division of Otology/Neurotology, Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2014;140(8):754-761. doi:10.1001/jamaoto.2014.1249.
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Importance  To compare the efficacy of treatments commonly offered to patients with Ménière’s disease who fail conservative medical therapy including diuretics and a sodium-restricted diet.

Objectives  This study compared three second-echelon treatments: the Meniett device, endolymphatic sac decompression, and intratympanic gentamicin injections to determine their comparative effectiveness and capacity to mitigate against the necessity of a surgical labyrinthectomy.

Design, Setting, and Participants  Retrospective observational study at an academic tertiary care center. Patients with Ménière’s disease who failed primary medical management were evaluated after treatment with a Meniett device (n=20), endolymphatic sac decompression (n=23) or intratympanic gentamicin injections (n=17). Cases were included if auditory and vertigo control data were available before and a minimum of two years after treatment, in patients without previous otologic surgery or intratympanic injections. Average age ranged from 54 to 75 years.

Interventions  Use of the Meniett device, endolymphatic sac shunt decompression surgery or intratympanic gentamicin injections using variable doses and injection schedules.

Main Outcomes and Measures  Proportion of patients with vertigo control and hearing preservation by a modified version of the AAO-HNS criteria after second-echelon treatment, thus not requiring definitive labyrinthectomy.

Results  Despite endolymphatic sac surgery demonstrating a longer duration (61 months) prior to labyrinthectomy, no differences were found between the 3 treatment options in terms of patients going on to definitive labyrinthectomy or in the number of months of symptom relief following treatment. There was also no difference in residual auditory perception across the 3 groups.

Conclusions and Relevance  No significant therapeutic differences were found between the studied second-echelon treatments for symptom relief of Ménière’s disease.

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Figure 1.
Results Based on the Modified American Academy of Otolaryngology–Head and Neck Surgery Guidelines for Diagnosis and Evaluation of Therapy in Ménière’s Disease2

Data represent the percentage of patients within each treatment group and their classification of symptom control. Class A denotes complete symptom relief after treatment. Class B denotes improved symptoms, with only intermittent recurrences. Class C denotes failure of symptom control, resulting in the pursuit of an alternative treatment. ELS indicates endolymphatic sac surgery.

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Figure 2.
Speech Reception Thresholds

Shown are pretreatment and posttreatment speech reception thresholds (SRTs) across the treatment groups. ELS indicates endolymphatic sac surgery.

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Figure 3.
Word Discrimination Scores

Shown are pretreatment and posttreatment word discrimination scores (WDSs) across the treatment groups. ELS indicates endolymphatic sac surgery.

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Figure 4.
Standardized Auditory Outcomes

The scattergrams of each individual’s hearing results are provided per new published standards26 for reporting of auditory data, demonstrating the pretreatment and posttreatment effects on the speech reception thresholds (SRTs) and word discrimination scores (WDSs). The open circles represent pretreatment levels, and the filled circles represent posttreatment hearing outcomes for each respective patient, as indicated by the connecting line between the circles. In the posttreatment results, the trends are toward better or worse hearing outcomes depending on changes in SRT and WDS. ELS indicates endolymphatic sac surgery.

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Figure 5.
Disease-Free Survival Following Treatment

Shown are Kaplan-Meier curves comparing the fraction of transmastoid labyrinthectomy–free survival in patients from each of the 3 treatment groups. No significant differences were found between the groups. ELS indicates endolymphatic sac surgery.

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