Trends and Recent Directions in Meniere's Disease
The purpose of this page is to put recent ideas that are in the scientific press into a format that is easier to follow for
Meniere's patients. This may include papers presented at scientific meetings and symposia and papers published in journals and books.
This information should help keep patients aware of what advances are occurring in the field.
Please be aware that recent observations can often be controversial and it can often take years for a finding to be replicated by the scientific community.
Many treatments which initially appear promising never gain widespread appeal for reasons which may never be published.
Removal of part of the endolymphatic sac as a treatment for Meniere's disease
Endolymphatic sac surgeries have been controversial for a long time, but some patients do seem to gain benefit from them. In the past, the justification for these surgeries has been that the role of the endolymphatic sac is to reabsorb endolymph. It was thought that the sac wasn't doing its job properly in the Meniere's patient, which
resulted in a build-up of endolymph (endolymphatic hydrops) and this caused the symptoms of the disease. Prior surgeries have been directed at helping the sac to work better, by either a "decompression" procedure (removing some of the bone from around it) or by inserting a shunt, which is a tube through which the endolymph could escape.
Now, one physician in Australia has found that surgically damaging (ablating) a portion of the endolymphatic sac gave better control of vertigo compared with decompression or shunt procedures. Although these observations may be surprising to some, they are in reasonable agreement with our present understanding of what the endolymphatic sac is doing.
We now believe that the sac does not simply reabsorb endolymph. Instead, we now think it can reabsorb OR secrete endolymph as required. In the normal state, it appears to be balanced between these two possibilities
(i.e. not doing anything) and probably contributes little to the maintenance of endolymph. It is only when an endolymph volume
disturbance occurs that it switches on to reabsorb the excess, or to secrete more, as required.
It is possible that the endolymphatic hydrops of some patients may be because the endolymphatic sac is secreting
endolymph when it should not be. Thus the sac may be causing the hydrops, by secreting when there is already a volume
excess. If this is so, then damaging the endolymphatic sac
may be an appropriate procedure. It is also possible that endolymphatic shunts and decompresssions also act by partially
damaging the endolymphatic sac, thereby reducing its capacity to secrete volume.
Reference: Gibson, WPR (1999) Removal of the extraosseous portion of the endolymphatic sac. In: Meniere's Disease ED; Harris J.P. Kugler Publications, The Netherlands, pp361-368.
Use of tympanostomy tubes as a treatment for Meniere's disease
Tympanostomy tubes (also called ventilation tubes or grommets) are little hollow tubes that are popped through the eardrum for the treatment of middle ear infections. They are commonly used in children
and in adults can be placed as an office procedure. They remain in place for a while, then usually come out on their own, and the hole through the eardrum then heals up. In 1988, Montandon et al. reported that vertigo in Meniere's patients was controlled by placing a ventilation tube in the eardrum of the affected ear.
Since then other reports have supported the observation. Thomsen et al. (1998) compared the use of tympanostomy tubes with endolymphatic sac surgery in two groups of patients and found no significant differences between the two groups, indicating that tympanostomy tubes were as effective as an endolymphatic sac surgery.
As the tympanostomy procedure is far less invasive and can be "reversed", it would seem preferable.
One reservation in the use of this technique has been the lack of scientific explanation for how it would work.
However, there are a number of possible explanations, including possible changes in movements of the eardrum induced
by swallowing and low-frequency sound, and changes in the oxygen and carbon dioxide levels in the middle ear space which can influence the cochlear fluids.
References:
Montandon, P. Guillemin P. Hausler, R. (1988) Treatment of Meniere's disease by means of minor surgical procedures. In: Meniere's Disease. Editor: Nadol, J.B.jr. Kugler & Ghedini Publications, pp503-508.
Thomsen, J. Bonding P., Becker, B., Stage, J., Tos, M (1998) The non-specific effect of endolymphatic sac surgery in treatment of Meniere's disease. Acta Otolaryngol. 118, 769-773.