Alternobaric and hyperbaric oxygen therapy in the immediate and long-term treatment of Menière's disease

Medical and noninvasive therapy for Meniere's disease

Nonoperative therapy continues to be the mainstay of treatment of patients suffering from Meniere disease. Despite extensive research, the exact pathogenesis of Meniere disease remains elusive. The poorly understood nature of this condition has made it nearly impossible to develop treatments that are curative. Most modern treatments are aimed at controlling symptoms. This article reviews the various nonoperative treatments that have been used to treat Meniere disease historically as well as outlining the authors' clinical treatment paradigm.

Meniett therapy may avoid vestibular neurectomy in disabling Meniere's disease

CONCLUSION

In those patients for whom vestibular neurectomy has been selected due to the disabling recurrence of vertigo spells, Meniett therapy has been shown to allow avoidance of this surgical procedure in a fairly high percentage of patients with Meniere's disease (MD). Our data would also support a better result when pressure treatment is acting on MD of short duration.

OBJECTIVE

To test the possibility that low pressure treatment (Meniett) could avoid vestibular neurectomy in patients with MD that was refractory to medical treatment.

PATIENTS AND METHODS

The setting was a tertiary referral centre in a university hospital. Thirty-six MD patients, for whom vestibular neurectomy was indicated, underwent Meniett treatment and composed a group in which a long-term (>2 years) follow-up was achieved. Additionally, different durations of MD ('young' and 'old' MD) were distinguished and analysed separately.

RESULTS

Twenty-five patients (69.4%) were treated satisfactorily by using Meniett treatment and therefore avoided vestibular neurectomy. In half of them only one cycle of treatment was necessary.

Clinical characteristics of delayed endolymphatic hydrops: long-term results of hearing and efficacy of hyperbaric oxygenation therapy

CONCLUSION

Diuretics significantly improved hearing in patients with contralateral-type DEH, whereas they did not inpatients with ipsilateral-type DEH.

OBJECTIVE

We report a review of 26 cases of DEH treated in recent 6 years.

PATIENTS AND METHODS

The study group comprised 22 contralateral and 4 ipsilateral types of DEH. The efficacy of diuretics on the improvement in hearing was examined quantitatively. The efficacy of hyperbaric oxygenation therapy (HBO) on hearing was examined in six patients.

RESULTS

The general properties of these cases were similar to those reported previously, except for the high proportion of patients with contralateral-type DEH. Diuretics significantly improved the hearing of patients with contralateral-type DEH. In contrast, no significant improvement by diuretics was noted in ipsilateral-type DEH.

Effects of hyperbaric therapy on function and morphology of Guinea pig cochlea with endolymphatic hydrops

OBJECTIVE

The objective of this study was to investigate the effect on experimental endolymphatic hydrops in guinea pigs after hyperbaric therapy.

BACKGROUND

The histopathologic character of Ménière's disease is the presence of endolymphatic hydrops. Endolymphatic hypertension could be one of the factors resulting from endolymphatic hydrops. Some treatments of Ménière's disease are aimed toward preventing the endolymphatic hypertension. Exposure to pressure change has risen in recent years.

METHODS

Thirty-two guinea pigs were operated on the right ears to induce endolymphatic hydrops by obliterating the endolymphatic sac through an extradural posterior cranial fossa approach. After 5 weeks' survival, 12 guinea pigs were put into a chamber with an absolute atmospheric pressure of 2.2 for 3 weeks (90 minutes once a day 5 times a week). We observed the morphologic and functional changes in guinea pig cochleae of the pressure group, 4-week hydrops group (n = 10), 8-week hydrops group (n = 10), and the normal group (n = 10). We measured the hearing threshold of the auditory brainstem response, the 70-dB SPL action potential (AP) latency, the ratio of 70-dB SPL summating potential magnitude to action potential magnitude (-SP/AP) of the electrocochleogram, and the maximum scala media area (SMA) ratio, respectively.

RESULTS

The average 70-dB SPL-SP/AP magnitude of right ears (0.29 +/- 0.09) and the average maximum SMA ratio (2.23 +/- 0.20) in the pressure group were significantly less than that in the 8-week hydrops group (0.69 +/- 0.15 and 4.04 +/- 0.52, respectively) with the same survival time (p < 0.05). The results in the pressure group were almost as similar as that in the 4-week hydrops group (0.29 +/- 0.13 and 2.22 +/- 0.20, respectively) (p > 0.05). The average hearing threshold of ABR of right ears in the pressure group (36.67 +/- 14.30-dB SPL) was lower than that of the 8-week hydrops group (44 +/-1 4.30-dB SPL), but the difference was insignificant (p > 0.05). The average 70-dB SPL AP latency of right ears in the pressure group was not significantly different from those of the 8-week hydrops group, the 4-week hydrops group, or the normal group (p > 0.05).

CONCLUSIONS

Our findings suggest hyperbaric therapy can significantly suppress the development of endolymphatic hydrops and improve cochlear function in guinea pigs. This study provided strong evidence for the development of pressure treatment of Ménière's disease without destroying the inner ear.

Sudden Hypoacusis Treated with Hyperbaric Oxygen Therapy: A Controlled Study

The term sudden hypoacusis describes a hearing loss of rapid onset and unknown origin that can progress to severe deafness. Of the many therapeutic protocols that have been proposed for treating sudden hypoacusis, hyperbaric oxygen therapy (HOT) plays a leading role. We studied 50 patients who had been referred to our ENT unit within 48 hours of the onset of sudden hypoacusis. We randomly assigned 30 of these patients to undergo once-daily administration of HOT for 10 days; the other 20 patients were treated for 10 days with an intravenous vasodilator. Response to therapy in all patients was evaluated by calculating the mean hearing threshold at frequencies between 500 and 4, 000 Hz and by assessing liminal tonal audiometry results recorded at baseline and 10 days after the cessation of treatment. These results, plus the findings of other audiologic and otoneurologic examinations, revealed that the patients in the HOT group experienced a significantly greater response to treatment than did those in the vasodilator group, regardless of age and sex variables. Significantly more patients in the HOT group experienced a good or significant response. In both groups, patients with pantonal hypoacusis responded significantly better than did those with a milder condition. Based on our findings, coupled with the fact that oxygen therapy is well tolerated and produces no side effects, we conclude that HOT should be considered the preferred treatment for patients with sudden hypoacusis.

A review of medical treatment for Ménière's disease

A review of the literature on drug therapy for Ménière's disease was made using Medline to search for all publications between January 1978 and September 1998. A total of 152 publications were identified that specifically dealt with medical treatment for Ménière's disease. Only betahistine and diuretics appear to have proven efficacy in double-blind studies on the long-term control of vertigo. No treatment has a proven beneficial effect on hearing levels or on the long-term evolution of the disease. Recent publications have proposed a role for the intratympanic use of medication, mainly aminoglycosides, for control of vertigo. We conclude this review by proposing a strategy for the medical treatment of Ménière's disease.

Does evidence-based medicine exist in the treatment of Menière's disease? A critical review of the last decade of publications

Debate surrounding the need for evidence-based research in all fields of otolaryngology has recently emerged. A review of English language articles dealing with the treatment of Menière's disease published from 1989 to 1999 was performed. The papers were classified according to article type (observational studies, non-clinical studies, controlled trials, randomised controlled trials) and according to the grade of evidence that was offered. A total of 128 publications were reviewed, of which only three were randomised controlled trials and a further three were well-designed controlled studies without randomization. The majority of papers were non-experimental clinical descriptive studies or case series. Data from this review would suggest that more comprehensive evidence-based studies are required in order to settle areas of confusion surrounding treatment of this relapsing condition

Large vestibular aqueduct syndrome treated by hyperbaric oxygen

We report the case of a 14-year-old girl with a large vestibular aqueduct (LVA) in whom hyperbaric oxygen (HBO) therapy was effective for the treatment of sensorineural hearing loss. The patient was referred to Nagoya University Hospital for the treatment of hearing loss on 14 September, 1998, because her right hearing level had declined abruptly on 22 August, 1998, and had not changed for 3 weeks since then in spite of steroid and prostaglandin therapy. Her audiogram revealed bilateral profound deafness of more than 110 dB. She had had profound hearing loss on the left side since she was 9 years old. HBO therapy was performed on 22 occasions from 17 September until 19 October, 1998. During the HBO therapy, her right hearing ability returned almost to the level determined prior to the abrupt loss, 60 dB. We therefore recommend HBO therapy for the treatment of sensorineural hearing loss associated with large vestibular aqueduct syndrome if the hearing ability does not recover following conventional treatment.