Tenotomy of the middle ear muscles causes a dramatic reduction in vertigo attacks and improves audiological function in definite Meniere's disease

• Published in: Acta oto-laryngologica 2012-05, Vol.132 (5), p.491-497
• Main Authors: Loader, Benjamin, Beicht, David, Hamzavi, Jafar-Sasan, Franz, Peter
• Format: Article
• Language: English
• Subjects: AAO-HNS; Audiometry, Pure-Tone; aural fullness; Biological and medical sciences; Dizziness; ear surgery; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology; Ear, Middle - surgery; Female; Follow-Up Studies; Hearing - physiology; hearing loss; Humans; Male; Medical sciences; Meniere Disease - complications; Meniere Disease - physiopathology; Meniere Disease - surgery; Middle Aged; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Non tumoral diseases; Otorhinolaryngology. Stomatology; Stapedius - surgery; Surveys and Questionnaires; Tenotomy - methods; Tensor Tympani - physiopathology; Tensor Tympani - surgery; Time Factors; tinnitus; Treatment Outcome; Vertigo - etiology; Vertigo - physiopathology; Vertigo - surgery
• ISSN: 0001-6489; 1651-2251
• DOI: 10.3109/00016489.2011.642815

Abstract Conclusions: Because the presented data reveal an immediate and persistent reduction of vertigo and a clear improvement in hearing function and functional scales, we conclude tenotomy to be effective in unilateral, definite Meniere's disease - laying the foundation for future prospective, randomized controlled trials. Objectives: This study compares the unique long-term results of tenotomy of the stapedius and tensor tympani muscles in definite Meniere's disease refractory to medical treatment and presents a hypothesis on why tenotomy seems effective. Methods: This was an interventional cohort study. The study sample comprised 30 patients (15 males, 15 females; average age 57 ± 13.1 years) with definite Meniere's disease (AAO-HNS criteria, 1995). Patients were evaluated pre- and postoperatively using pure tone audiometry, AAO-HNS questionnaires regarding vertigo attacks, functional level scores, and tinnitus, and were followed up for 2-9 years. Postoperative values were calculated for the patient collective as a whole and consequently divided into three equal postoperative terms of 3 years each. Results: A statistically significant improvement of inner ear hearing levels postoperatively (p = 0.041) and a major reduction in vertigo attacks in all groups (p < 0.001) with complete absence of attacks in 26/30 patients was noted. Results remained constant up to 9 years postoperatively. Although tinnitus persisted, the intensity was lower overall (p = 0.013).