Therapeutic strategies in the treatment of Menière's disease: the Italian experience
- 96 Downloads
Ménière's disease (MD) is an inner ear disorder of unknown etiology, whose pathological substrate is the endolymphatic hydrops. Different treatments have been proposed; however, evidence of their effectiveness is lacking. The aim of this study was to evaluate by a questionnaire which medical and surgical treatments are used in Italy for the treatment of MD and to compare them with those proposed in other countries.
An electronic questionnaire of 40 questions was formulated and sent to Italian otolaryngologist (ENT) divided into two groups: Group 1 (“generalists” 60.8%) and Group 2 (“neurotologist- NO” 39.2%).
One hundred and twenty five ENT replied. Treatment of the acute phase, apart from symptomatics, was based on diuretics that are prescribed by 83.5% of respondents, steroids, prescribed by 66.7%, and vasodilators, prescribed by 22%. In the intercritical phase, 87.2% of respondents recommended low-salt diet, 78.4% of respondents prescribed betahistine, and 52.8% diuretics. Statistical analysis did not show correlation neither with the declared specialization nor with the number of patients treated. In case of failure of medical treatment, IT gentamicin was suggested by 48.8% of the respondents and IT steroids by 40.8%. Statistical analysis showed that generalists prefer IT steroids and NO IT gentamicin (p 0.019). In case of failure of both medical treatment and IT treatment, vestibular neurectomy was indicated by 58.4% of the respondents, 6.4% indicated endolymphatic sac surgery, and 2.4% surgical labyrinthectomy.
In Italy, the treatment of MD stand on a gradual approach that starts from the dietary-behavioral changes and a pharmacological therapy based on betahistine. In refractory cases, IT treatment initially with steroids and, therefore, with gentamicin allows the control in vertigo in the majority of cases. In case of failure of IT treatment, VNS is the surgery of choice.
KeywordsMenière Questionnaire Medical therapy Surgery
Compliance of ethical standards
Conflict of interest
No conflict of interests of any of the authors.
Human and animal rights statement
This article does not contain any studies with human participants performed by any of the authors.
- 4.Celestino D, Ralli G (1991) Incidence of Ménière’s disease in Italy. Am J Otol 12(2):135–138Google Scholar
- 9.Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A, Classification Committee of the Barany Society; Japan Society for Equilibrium Research; European Academy of Otology, and Neurotology (EAONO); Equilibrium Committee of the American Academy of Otolaryngology-Head, and Neck Surgery (AAO-HNS); Korean Balance Society (2015) Diagnostic criteria for Menière's disease. J Vestib Res 25(1):1–7Google Scholar
- 13.Smith WK, Sankar V, Pfleiderer AG (2005) A national survey amongst UK otolaryngologists regarding the treatment of Menière’s disease. J Laryngol Otol 119:102–105Google Scholar
- 16.Angelborg C, Klockhoff I, Larsen HC, Stahle J (1982) Hyperosmotic solutions and hearing Menière's disease. Am J Otol 3(3):200–202Google Scholar
- 19.Adrion C, Fischer CS, Wagner J, Gürkov R, Mansmann U, Strupp M, BEMED Study Group (2016) Efficacy and safety of betahistine treatment in patients with Menière's disease: primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial). BMJ 352:6816CrossRefGoogle Scholar
- 21.Teggi R, Gatti O, Sykopetrites V, Quaglieri S, Benazzo M, Bussi M (2014) Association of cinnarizine and betahistine in prophylactic therapy for Ménière's disease with and without migraine. Acta Otorhinolaryngol Ital 34(5):349–353Google Scholar
- 22.Albera R, Ciuffolotti R, Di Cicco M, De Benedittis G, Grazioli I, Melzi G, Mira E, Pallestrini E, Passali D, Serra A, Vicini C (2003) Double-blind, randomized, multicenter study comparing the effect of betahistine and flunarizine on the dizziness handicap in patients with recurrent vestibular vertigo. Acta Otolaryngol 123(5):588–593CrossRefGoogle Scholar
- 24.Novotný M, Kostrica R (2002) Fixed combination of cinnarizine and dimenhydrinate versus betahistine dimesylate in the treatment of Ménière's disease: a randomized, double-blind, parallel group clinical study. Int Tinnitus J 8(2):115–123Google Scholar
- 27.Lange G (1977) The intratympanic treatment of Menière's disease with ototoxic antibiotics A follow-up study of 55 cases (author's transl). Laryngol Rhinol Otol (Stuttg) 56(5):409–414Google Scholar