THE SURGICAL TREATMENT OF MÉNIÈRE’S DISEASE: IS THERE CONSENSUS?

Resumo

Introduction: Ménière's disease (MD) affects the vestibulocochlear apparatus with impaired quality of life. Treatment is initially based on symptomatic therapy and, in chronic progressive cases, the surgical alternative is the last option for symptom control. Material and Methods: This research consists of a literature review on theoretical frameworks, including books and articles published in English and Portuguese. The databases were "Scielo" and "PubMed". Results: The keywords were used "Ménière" associated with the word "disease" and “surgery” in the last 10 years. The research has been done in recent publications and considered relevant to the topic under discussion. Discussion and Conclusion: MD corresponds to about 7% of vestibular disorders characterized by recurrent crisis of vertigo associated with transient hearing loss, tinnitus and fullness of hearing. It is usually unilateral and may be incomplete (presenting only one or two symptoms) and is related to increased endolymph pressure (edolymphatic hydrops), but with no identified etiologic cause. The disease has a slow and benign course, however some cases can lead to deafness. The first line of treatment is to administer medications for the symptoms. For cases that progress to become clinically incapacitating and refractory to drug treatment, surgical intervention is recommended (5-10%). The main objective is the reduction of vertigo in quantity and severity, and in the background the prevention of hearing loss. The procedures are classified into conservatives, when the endolymphatic sac is decompressed with the option of using or not shunts preserving the vestibulocochlear nerve; and not conservative when performing mechanical or chemical labyrintectomy and vestibular neurectomy. No shunt decompression results in improvement of vertigo in 94.3% and preservation or improvement of hearing in 88% and is therefore considered a good option, however recent studies compare the efficacy of treatment with placebo effect, and there are currently no well-controlled controlled studies that may eliminate doubts about the procedure. There’s no consensus about how to treat surgically Ménière’s disease, so it’s up to the physician to manage each case. Knowledge of this condition during the clinical examination is essential to suspicion and clinical diagnosis as well as pharmacological and non pharmacological and surgical (if necessary) in order to ensure the well-being, quality of life of patients.