Surgical treatment of Ménière's disease

Surgical treatment of Ménière's disease is used in severe forms of this disease and the absence of the effect of nonoperative treatment. This type of baking pursues only one goal - getting rid of painful bouts, while the sufferings of the patient make him sacrifice an already poor hearing on the causal ear. There are several principal approaches to the surgical treatment of Ménière's disease:

1. operations aimed at eliminating or preventing the hydrops by creating drainage holes in the endolymphatic space through which the endolymph could flow into various "reservoirs" and from there be removed naturally; these methods include the following options for draining the endolymphatic space:
   1. drainage of the endolymphatic sac with the direction of the endolymph or into the cells of the mastoid process, or into the subarachnoid space; the efficiency of the operation is small, since drainage holes and shunts are short-lived, and seizures appear after a while;
   2. fenestration of a cochlea with drainage or bypass is to form a hole in the area of the cape (the main cochlea) with penetration of the membranous part of the cochlea into the ductus cochlearis and the introduction of a drainage tube into it;
   3. operation of shunting the cochlea through its window; as a shunt used polyethylene or metal tubes (diameter 0.8-1 mm, length 4 mm), the distal end of which is sealed, and the wall is perforated with small holes to expose the endolymph to the perilymphatic space;
2. operations aimed at normalizing hemodynamics in the inner ear and reflex blocking pathological impulses from the affected labyrinth; such operations include resection of the Basilica and the plexus plexus, operations on the sympathetic cervical ganglia and cervical sympathetic trunk:
   1. Resection of the basal cell consists in opening the tympanum with endaural tympanotomy, exposing the basal cell and resection of its part with a length of 5-8 mm;
   2. operations on the plexus plexus - a crosswise intersection of it (according to J.Lempert) or circular excision of it together with a mucoperiodial flap (according to IB Soldatov, while, as noted by IB Soldatov et al. (1980), is subject to mandatory removal and a section of the muckeroper in the region of the upper edge of the cochlear window, where the most constant branches of the Basilica are located;
3. destructive methods are characterized by considerable radicality and the greatest postoperative effect, however they are the most traumatic; these methods pursue the goal of total deactivation of the causal labyrinth; indications for the application of these methods are the ineffectiveness of trephination and shunting of the labyrinth, the neuritic form of Meniere's disease in the absence of vestibular apparatus excitability, with suspicion of the retro-labyrinthine cause of the disease; with partial preservation of the auditory function resort to an isolated intersection of the vestibular portion of the pre-cochlear nerve.

[1], [2], [3], [4], [5], [6],

Destructive methods of treatment of Ménière's disease

Destructive methods of treatment of Meniere's disease include labyrinectomy with removal of the node of the vestibule or translabyrinth transection of the root of the pre-cochlear nerve (with hearing loss of III-IV degree). In these operations, the auditory function is completely lost on the operated ear, however, repeated attacks of labyrinthopathy, but in a significantly reduced form, are not ruled out.

At present, methods of surgical intervention on the pre-cochlear nerve are developed and applied, with the isolation and intersection of only the vestibular portion of it, using the technique of intraoperative monitoring of the impulse of this nerve and operating under video control.

In addition, the operation of microvascular decompression of the vestibular nerve with extracranial access through MMW is widespread. The essence of the operation is to remove sympathetic fibers and arterioles, braiding the trunk of the nerve. In the foreign literature, the high efficiency of this operation is noted.

[7], [8], [9], [10], [11]

Non-surgical blocking and destructive methods of treatment of Ménière's disease

The method of L.Coletli (1988). After removing the base of the stirrup and expiration of the endolymph, a salt crystal is placed in the vestibule, and the defect in the window formed after removing the base of the stapes is covered with a flap from the vein wall. According to the author, this method prevents the occurrence of new seizures, significantly reduces or eliminates the ear noise in the operated ear.

Method of cryosurgical destruction of the labyrinth W. House (1966)

This method of treatment consists in affecting the membranous labyrinth in the projection of the space between the windows of the vestibule and the cochlea after preliminary thinning in this area of the medial wall of the drum cavity for more effective exposure to the cold factor by means of a special cryoapplicator. The effective temperature of the coolant is -80 ° C with a double exposure of 1 min. According to the author, a positive result was obtained in 70-80% of cases.

The method of ultrasonic destruction of the labyrinth M.Arslana (1962)

G.Portmann and M.Portmann (1976) proposed a transmeal way of ultrasound signaling at a maximum power of 1.25 W / cm ², 2 sessions of 10 min per week, 12 sessions in all. The results are assessed as very satisfactory.