When is Surgery Recommended for Ménière’s Disease?
Ménière’s disease is a debilitating condition. Some patients will not respond to medical treatment, in which case surgery will be considered as a last resort. If you are experiencing severe attacks of ménière’s disease and previous treatments have not helped, you may be part of the 10-20 per cent of patients who are recommended for surgery.
The decision to proceed is a personal one, and is based on a number of factors. The debility suffered from vertigo attacks varies among patients and often relates to their lifestyle and expectations. Being selected for surgery depends more on the patient’s capacity than how frequent their attacks are.
What Surgical Treatments are Available?
There are two main forms of surgical treatment for ménière’s disease. Each procedure carries its own advantages, risks and long-term results, so patients and their families are advised to carefully assess treatments and to be aware that there is no perfect treatment for ménière’s disease.
The two most common surgical options are:
- Vestibular Nerve Section (VNS) to destroy the balance mechanism of the inner ear and, in most cases, permanently cure vertigo attacks; and
- Labyrinthectomy and Cochlear Implantation to disable the balance mechanism and rehabilitate hearing with a cochlear implant.
Vestibular Nerve Section (VNS) and Labyrinthectomy
This procedure involves cutting the balance nerve to the affected ear while preserving the hearing nerve. The patients selected for VNS usually have residual, sometimes fluctuating hearing loss. Labyrinthectomy is recommended for patients with hearing loss that is not improved with hearing aids.
The patients who cannot undergo this type of procedure include:
- Those with no hearing or balance in the opposite ear;
- Those with central nervous system disease such as stroke;
- Those in poor health; and
- Aged patients.
Surgery may also not be an option for patients with hip, knee or back disorders that affect their balance.
The patient is monitored closely for one night following surgery. Pain relief and anti-nausea medication are required in the first 24-48 hours as dizziness usually occurs. Patients are encouraged to get out of bed on the second or third day to begin balance rehabilitation. The majority of patients are home by the fifth to seventh day.
Hearing can be noticeably worse following VNS in up to four per cent of cases Most patients experience no change but hearing will worsen over time in the natural progression of ménière’s. Cochlear implantation with Labyrinthectomy is used to rehabilitate hearing, often very effectively.
The major risks of VNS include facial nerve damage, and leakage of spinal fluid, although these are rare.
Other Surgical Options
When disabling attacks of vertigo occur and there is no evidence of disease in the opposite ear, there are a number of so-called ‘destructive’ procedures that can be carried out to relieve vertigo in patients without hearing.
When patients are carefully assessed before surgery, surgical destruction of the labyrinthe almost always relieves vertigo.
There is great controversy regarding the assessment and reporting of results following surgery for ménière’s disease. The assessment of surgery requires careful, standardised studies and long term evaluation, which is frequently missing from many studies of ménière’s disease.
The fact that surgeons are still undecided with regard to the correct operation can be confusing and frustrating for the patient, however the team will carefully consider your individual case of ménière’s disease and provide expert advice in the best surgical option for you.