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Therapeutic strategies in the treatment of Menière's disease: the Italian experience

  • Nicola QuarantaEmail author
  • P. Picciotti
  • G. Porro
  • B. Sterlicchio
  • G. Danesi
  • P. Petrone
  • Giacinto Asprella Libonati
Otology
  • 96 Downloads

Abstract

Purpose

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.

Methods

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%).

Results

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.

Conclusion

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.

Keywords

Menière Questionnaire Medical therapy Surgery 

Notes

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.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Otolaryngology Unit, Department of BMS, Neuroscience and Sensory OrgansUniversity of BariBariItaly
  2. 2.Department of Head and Neck Surgery, OtorhinolaryngologyCatholic University of Sacred HeartRomeItaly
  3. 3.Division of Ear, Nose, and Throat, and Skull Base MicrosurgeryOspedali RiunitiBergamoItaly
  4. 4.UOSD Otolaryngology, Ospedale San GiacomoBariItaly
  5. 5.UOSD “Vestibologia E Otorinolaringoiatria” Presidio Ospedaliero “Giovanni Paolo II”PolicoroItaly

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