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Tram Anh D, Takakura H, Nakazato A, Morita Y, Shojaku H. Long-term effects of middle ear pressure therapy with the EFET01 device in patients with Ménière's disease and delayed endolymphatic hydrops in Japan. Acta Otolaryngol 2023; 143:840-844. [PMID: 37995205 DOI: 10.1080/00016489.2023.2284336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/05/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Long-term efficacy of middle ear pressure therapy (MEPT) with the EFET01 device in patients in Japan with definitive Ménière's disease (MD) and delayed endolymphatic hydrops (DEH) was evaluated. OBJECTIVE To examine the effects of reducing vertigo attacks and improving hearing of MD and DEH patients by using MEPT with the EFET01 device for two years after treatment. MATERIAL AND METHODS A retrospective study was conducted of 32 MD patients and 2 DEH patients treated by MEPT with the EFET01 device from December 2018 to April 2021. According to Japan Society for Equilibrium Research (JSER) guidelines, patients were investigated for the frequency of vertigo attacks and change in hearing levels during a period of 6 months before to 18-24 months after start of treatment. RESULTS The frequency of vertigo attacks significantly decreased in both MD and DEH patients, and hearing level has remained stable in the majority of our patients after treatment. CONCLUSION Our study clarified that MEPT with the EFET01 device was effective in controlling vertigo symptoms of MD and DEH. It should be considered a safe option for patients failing medical treatment. SIGNIFICANCE The efficacy of MEPT with the EFET01 was shown over a 2-year follow-up period.
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Affiliation(s)
- Do Tram Anh
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Hiromasa Takakura
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Akira Nakazato
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Yuka Morita
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Hideo Shojaku
- Department of Collaborative Research Laboratory of Medical Device Innovation, Faculty of Medicine, University of Toyama, Toyama, Japan
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Shojaku H, Takakura H, Asai M, Fujisaka M, Ueda N, Do TA, Tsubota M, Watanabe Y. Long-term effect of transtympanic intermittent pressure therapy using a tympanic membrane massage device for intractable meniere's disease and delayed endolymphatic hydrops. Acta Otolaryngol 2021; 141:977-983. [PMID: 34689678 DOI: 10.1080/00016489.2021.1989485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A 12-month follow-up study showed that middle ear pressure treatment with a transtympanic membrane massage (TMM) device had a similar effect to a Meniett device. OBJECTIVES The effects of pressure treatment with a TMM device were retrospectively compared to the effects of treatment with a Meniett device in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) who were followed for a minimum of 24 months. MATERIALS AND METHODS Twenty-seven patients were treated with the TMM device and 14 patients were treated with a Meniett device. The insertion of a transtympanic ventilation tube was necessary for the Meniett device but not for the TMM device. RESULTS In patients treated with the TMM and Meniett devices, the frequency of vertigo significantly improved at 19-24 months after treatment. The distribution of vertigo at 19-24 months after treatment did not differ between the patients treated with the two types of devices. Pressure treatment for 8 months or more was suitable to achieve remission. CONCLUSIONS AND SIGNIFICANCE Middle ear pressure treatment for 8 months or more with a TMM or Meniett device was equally effective and provided minimally invasive treatment options for intractable MD and DEH.
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Affiliation(s)
- Hideo Shojaku
- Department of Otolaryngology, University of Toyama, Toyama, Japan
| | | | - Masatsugu Asai
- Department of Otolaryngology, University of Toyama, Toyama, Japan
| | - Michiro Fujisaka
- Department of Otolaryngology, University of Toyama, Toyama, Japan
| | - Naoko Ueda
- Department of Otolaryngology, University of Toyama, Toyama, Japan
| | - Tram Anh Do
- Department of Otolaryngology, University of Toyama, Toyama, Japan
| | - Masahito Tsubota
- Department of Otolaryngology, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
| | - Yukio Watanabe
- Department of Otolaryngology, University of Toyama, Toyama, Japan
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Shojaku H, Aoki M, Takakura H, Fujisaka M, Asai M, Tsubota M, Ito Y, Watanabe Y. Effects of transtympanic intermittent pressure therapy using a new tympanic membrane massage device for intractable Meniere's disease and delayed endolymphatic hydrops: a prospective study. Acta Otolaryngol 2021; 141:907-914. [PMID: 34520288 DOI: 10.1080/00016489.2021.1942979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The retrospective study showed that the effect of the middle ear pressure treatment by the tramstympanic membrane massage (TMM) device was similar to that of the Meniett device. OBJECTIVES The new TMM device named EFET device was prospectively evaluated in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) and we compared the effects to the Meniett device. MATERIALS AND METHODS 23 ears of 19 patients were treated with an EFET device, and 17 ears of 15 patients were treated with the Meniett device. All patients suffering from intractable MD and DEH were treated for 4 months. The insertion of a transtympanic ventilation tube was necessary for the Meniett device, but not the EFET device. RESULTS In patients treated by the EFET and Meniett devices, the frequency of vertigo significantly improved after treatment. The distribution of vertigo outcomes at 4 months after treatment did not differ between patients treated with the both devices. CONCLUSIONS AND SIGNIFICANCE Middle ear pressure treatment by the EFET device is effective and provides minimally invasive options for intractable MD and DEH like the Meniett device.
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Affiliation(s)
- Hideo Shojaku
- Department of Otolaryngology, University of Toyama, Toyama, Japan
| | - Mitsuhiro Aoki
- Department of Otolaryngology, University of Gifu, Gifu, Japan
| | | | - Michiro Fujisaka
- Department of Otolaryngology, University of Toyama, Toyama, Japan
| | - Masatsugu Asai
- Department of Otolaryngology, University of Toyama, Toyama, Japan
| | - Masahito Tsubota
- Department of Otolaryngology, Kanazawa Medical University Himi Municipal Hospital, Kanazawa, Japan
| | - Yatsuji Ito
- Department of Otolaryngology, University of Gifu, Gifu, Japan
| | - Yukio Watanabe
- Department of Otolaryngology, University of Toyama, Toyama, Japan
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Wang SJ, Yang H, Yao YY, Gu HY, Lin LL, Zhang C, Luo J. The Clinical Benefit of Device Therapy for Meniere's Disease in Adults: Systematic Review and Meta-Analysis. J Int Adv Otol 2019; 15:121-129. [PMID: 31058601 DOI: 10.5152/iao.2019.5937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This study aimed to assess the clinical benefit of device therapy on controlling the symptoms of Meniere's disease (MD). MATERIALS AND METHODS We searched PubMed, Embase, the Cochrane Library, China National Knowledge Internet, and Wanfang Data before January 13, 2018. We selected randomized controlled clinical trials, case-controlled studies, and cohort studies that dealt with outcomes of device therapy for the treatment of MD. RESULTS Sixteen trials met our inclusion criteria. The use of device therapy resulted in improved vertigo control, which was described as a reduction in the number of vertigo days by month (weighted mean difference [WMD]: 3.15, 95% confidence interval [CI]: 2.00-4.31), in the number of vertigo episodes by month (WMD: 7.37, 95% CI: 2.40-12.35), and in the vertigo visual analog score (WMD: 41.51, 95% CI: 34.68-48.34). In addition, the overall complete vertigo control (class A) rate was 50% (95% CI: 37%-64%). The device therapy also reduced the number of sick days by month (WMD: 4.56, 95% CI: 2.15-6.97), and the functional level improved (WMD: 2.66, 95% CI: 2.15-3.17). The electrocochleographic parameters decreased. The device therapy proved beneficial for hearing changes (WMD: 3.19, 95% CI: 0.66-5.71). No publication bias was found in the funnel plot and the results of Egger's test. CONCLUSION This study showed that the device therapy might reduce vertigo attacks and sick days in patients with MD. Additionally, the function level and hearing level may improve after the device therapy. In addition, the decrease in electrocochleographic parameters showed that inner ear electrophysiology improved after device therapy.
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Affiliation(s)
- Shu Jia Wang
- Hubei University of Medicine, Taihe Hospital, Center for Evidence-Based Medicine and Clinical Research, Shiyan, China
| | - Hong Yang
- Department of Neurology, Hubei University of Medicine, Taihe Hospital, Shiyan, China
| | - Yang-Yang Yao
- Department of Rehabilitation Medicine, Hubei University of Medicine, Taihe Hospital, Shiyan, China
| | - Hui-Yun Gu
- Department of Rehabilitation Medicine, Hubei University of Medicine, Taihe Hospital, Shiyan, China
| | - Lu-Lu Lin
- Hubei University of Medicine, Taihe Hospital, Center for Evidence-Based Medicine and Clinical Research, Shiyan, China
| | - Chao Zhang
- Hubei University of Medicine, Taihe Hospital, Center for Evidence-Based Medicine and Clinical Research, Shiyan, China
| | - Jie Luo
- Department of Neurology, Hubei University of Medicine, Taihe Hospital, Shiyan, China
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Holmberg J, de Amesti M, Rosenbaum A, Winter M. Positive pressure therapy for Ménière’s disease. Medwave 2019; 19:e7610. [DOI: 10.5867/medwave.2019.03.7609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 12/28/2018] [Indexed: 11/27/2022] Open
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Covelli E, Volpini L, Atturo F, Benincasa AT, Filippi C, Tarentini S, Marrone V, Monini S, Vestri A, Barbara M. Delayed Effect of Active Pressure Treatment on Endolymphatic Hydrops. Audiol Neurootol 2017; 22:24-29. [DOI: 10.1159/000472245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/24/2017] [Indexed: 11/19/2022] Open
Abstract
Objective: To identify eventual correlations between the effect of low-pressure treatment and endolymphatic hydrops in Ménière patients. Material and Methods: The study group consisted of subjects affected by definite Ménière disease (2015) and a severe degree of disability, who received a ventilation tube with or without a low-pressure treatment before undergoing a surgical procedure (vestibular neurectomy). After the placement of the ventilation tube, the subjects were either left alone with the tube or received 1 month of self-administered low-pressure therapy with a portable device. In all subjects, an electrocochleography (ECochG) was performed and specific questionnaires - Dizziness Handicap Inventory (DHI) and Functional Scale Level (FSL) - were completed before starting either arm of treatment, at the end of treatment, and then 3 and 6 months later. Results: All selected subjects presented with an ECochG pattern that was indicative of endolymphatic hydrops before starting either treatment. At the end of pressure treatment, 80% showed symptomatic improvement while maintaining the hydropic ECochG pattern. At the 3-month control stage, the hydropic pattern resulted normalized (<0.5) in all the improved subjects. Conclusions: Although 1 month of low-pressure treatment provided a positive symptomatological outcome, normalization of the hydropic ECochG parameters occurred only at a later time. Therefore, it is possible to assume that endolymphatic hydrops could be concurrent with a non-symptomatic stage of Ménière disease, and that the anti-hydropic effect of the low-pressure treatment, if any, would present with a certain delay after its completion.
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Zhang SL, Leng Y, Liu B, Shi H, Lu M, Kong WJ. Meniett Therapy for Ménière's Disease. Otol Neurotol 2016; 37:290-8. [DOI: 10.1097/mao.0000000000000957] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ahsan SF, Standring R, Wang Y. Systematic review and meta-analysis of Meniett therapy for Meniere's disease. Laryngoscope 2014; 125:203-8. [PMID: 24913022 DOI: 10.1002/lary.24773] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS To perform a systematic review and meta-analysis of micropressure treatment for Meniere's disease (MD). DATA SOURCES Medline, Ovid, Web of Science, and Cochrane Library search of the literature from January 1996 to December 2012. REVIEW METHODS Systematic literature review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria required definitive diagnosis of unilateral MD, treatment with Meniett device, vertigo control results, and hearing results before and after treatment. Randomized controlled trials and other types of case-control studies were included. Improvements in vertigo, American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) functional score, and pure tone average (PTA) were assessed. Funnel plots were used to detect bias and Q test was used to assess for heterogeneity. Random effects model was used for meta-analysis. T test was used to assess for significance. RESULTS Of 113 abstracts screened, 18 studies met criteria for review and 12 were used for meta-analysis. Eight studies reported hearing evaluation and the improvement in PTA after Meniett treatment was significant (P = 0.0085). Data could not be combined for AAO-HNS functional score due to heterogeneity. However, there was a trend toward improvement. Of six studies reporting frequency of vertigo, Meniett treatment significantly reduced frequency of vertigo (P = < .0001). LIMITATIONS Much of the data used in the analysis was derived from retrospective or level 4 studies. The average follow-up was only 5 months, and there were low number of patients in the treatment and control groups. CONCLUSION The Meniett device is a safe, nondestructive treatment for patients' refractory to medical therapy for MD.
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Affiliation(s)
- Syed F Ahsan
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital; Henry Ford Health System, Detroit, Michigan, U.S.A
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Watanabe Y, Shojaku H, Junicho M, Asai M, Fujisaka M, Takakura H, Tsubota M, Yasumura S. Intermittent pressure therapy of intractable Meniere's disease and delayed endolymphatic hydrops using the transtympanic membrane massage device: a preliminary report. Acta Otolaryngol 2011; 131:1178-86. [PMID: 21838607 DOI: 10.3109/00016489.2011.600331] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Middle ear pressure treatment by the tympanic membrane massage (TMM) device as well as the Meniett device is effective and provides minimally invasive options for intractable vertigo in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH). OBJECTIVE The effects of the TMM device were evaluated according to the criteria of the Japan Society for Equilibrium Research (1995) in patients with MD and DEH and compared to those in patients treated with the Meniett device. METHODS Twelve ears of 10 patients (MD 8; DEH 2) were treated with the TMM device, while 16 ears of 15 patients (MD 11; DEH 4) were treated with the Meniett device. All the patients had failed to respond to medical treatment including diuretics before each pressure treatment, and were followed up for more than 12 months after treatment. Tympanotomy is necessary before treatment for the Meniett device, not but for the TMM device. RESULTS With both devices, the frequency of vertigo after treatment was significantly lower than before treatment (p < 0.05). The time course of vestibular symptoms with the TMM device was not significantly different from that with the Meniett device (p > 0.05). No complications were directly attributable to treatment with the TMM device.
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Affiliation(s)
- Yukio Watanabe
- Department of Otolaryngology, University of Toyama, Toyama, Japan
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Shojaku H, Watanabe Y, Mineta H, Aoki M, Tsubota M, Watanabe K, Goto F, Shigeno K. Long-term effects of the Meniett device in Japanese patients with Meniere's disease and delayed endolymphatic hydrops reported by the Middle Ear Pressure Treatment Research Group of Japan. Acta Otolaryngol 2011; 131:277-83. [PMID: 21319947 DOI: 10.3109/00016489.2010.526142] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The Meniett device is a minimally invasive and safe treatment that may be used to provide longer-term reduction of vestibular symptoms in patients with delayed endolymphatic hydrops (DEH) as well as those with Meniere's disease (MD). OBJECTIVE The effects of the Meniett device were evaluated in patients with a diagnosis of definite MD or DEH according to the 1995 AAO-HNS criteria. METHODS Twenty-nine ears of 28 patients with MD and 5 ears of 5 patients with DEH (ipsilateral type 4, contralateral type 1) were treated with the Meniett device by the Middle Ear Pressure Treatment Research Group of Japan. All of the patients had failed to respond to medical treatment including diuretics before the pressure treatment. RESULTS Sixteen (57%) patients with MD and all five (100%) patients with DEH remained entirely free from vertigo spells; nine (32%) patients with MD responded with a significant decrease in the frequency of vertigo spells. In regard to hearing, 25 ears (74%: MD, n = 21; ipsilateral DEH, n = 4) had stable hearing levels; only 4 ears (12%: MD, n = 3; contralateral DEH, n = 1) showed a significant hearing improvement. No complications were attributable to the Meniett device.
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Affiliation(s)
- Hideo Shojaku
- Department of Otolaryngology, University of Toyama, Japan.
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Sismanis A. Surgical management of common peripheral vestibular diseases. Curr Opin Otolaryngol Head Neck Surg 2011; 18:431-5. [PMID: 20729736 DOI: 10.1097/moo.0b013e32833de79e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the latest developments in the surgical management of common peripheral vestibular disorders. RECENT FINDINGS Although surgery is indicated mainly for patients with Meniere's disease, other less common disorders such as benign paroxysmal positional vertigo, semicircular canal dehiscence, perilymphatic fistulae, fistulae of semicircular canals, VIII nerve vascular compression, chronic vestibular neuronitis, and dizziness following sudden sensorineural hearing loss may require surgical intervention when conservative management has failed. SUMMARY Surgery for vestibular disorders is less often indicated at present. Office-administered intratympanic gentamicin and steroid treatment have been found to be effective for control of vertigo in Meniere's disease. Side-effects of this treatment are overall acceptable. Surgery may be considered for Meniere's disease patients with good hearing who have failed intratympanic steroid treatment. Surgery is indicated for patients with debilitating dizziness associated with benign paroxysmal positional vertigo, semicircular canal dehiscence, vascular loop compression, and perilymphatic fistulae.
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Barbara M, Lazzarino AI, Biagini M, Costa M, Monini S. Influence of Meniett® treatment on hearing. Acta Otolaryngol 2010; 130:1256-9. [PMID: 20446875 DOI: 10.3109/00016481003782033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Meniett® treatment was not shown to avoid deterioration of hearing threshold in patients with Meniere's disease (MD), even when achieving a fairly good therapeutic outcome on vertigo control. OBJECTIVES To describe the effect of Meniett® treatment on hearing threshold in patients with MD. METHODS From a cohort of 55 patients with diagnosis of definitive MD, who underwent Meniett® treatment over the last decade, 27 were selected for the present study as having at least 2 years from the end of treatment. They all received the treatment for 1 month and underwent hearing evaluation as pure tone average (PTA) from 500 to 4000 Hertz at the time of diagnosis, immediately before the treatment, immediately after the treatment, and at the end of the follow-up. Vertigo control was assessed by applying the 1995 AAO-HNS criteria as well as by administration of the Dizziness Handicap Inventory (DHI) questionnaire. Statistical analysis was carried out using paired t test, Wilcoxon signed-rank tests, and multiple linear regressions. RESULTS PTA values increased on average by 7.1 dB (95% CI = 2.7-11.5; p = 0.003) during the time period from the beginning of the treatment to the end of the follow-up. Q scores decreased on average by 20.6 (95% CI = 8.8-32.4; p < 0.001) during the pre- and post-Meniett® time-span. These two outcomes appeared not to influence each other.
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Affiliation(s)
- Maurizio Barbara
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, Rome Italy.
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Abstract
PURPOSE OF REVIEW Bilateral Ménière's disease treatment can be extremely challenging and, like its unilateral variant, remains highly controversial. There are few articles in the literature that have focused specifically on the treatment of bilateral Ménière's disease, despite significant numbers of unilateral cases evolving toward bilaterality - a process which complicates management and is not simple to foresee. This study reviews the most up-to-date concepts in its diagnosis and treatment, with a special focus on recent advances. RECENT FINDINGS Recent advances in electrocochleography, vestibular-evoked myogenic potential, and intratympanic gadolinium-based contrast agent MRI may have the potential to diagnose bilateral endolymphatic hydrops, and predict unilateral to bilateral Ménière's disease progression. Although more prospective studies are necessary, recent studies show that intermittent pressure therapy (Meniett device), intratympanic steroids, and endolymphatic sac surgery appear to be efficacious and well tolerated nonablative management options. Moreover, triple semicircular canal occlusion surgery has recently been used successfully in Ménière's disease. SUMMARY Bilateral Ménière's disease can be challenging to diagnose via clinical suspicion and pure-tone audiometry alone. Therefore, adjunctive diagnostic tools including electrocochleography, vestibular-evoked myogenic potential, and intratympanic gadolinium-based contrast agent MRI are of even greater value, and may predict progression to bilaterality - allowing better optimization of treatment. Ablative treatments are relatively contraindicated due to the risks of bilateral vestibular and cochlear hypofunction. Nonablative treatments such as the Meniett device, intratympanic steroids, and endolymphatic sac surgery appear to be efficacious, and useful alternatives after conservative measures fail. Systemic aminoglycoside therapy is reserved for only the most severe and intractable cases.
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