Meniere's disease: Therapeutic options

Abstract

Meniere's disease (MD) is characterized by the triad of fluctuating hearing loss, episodic vertigo and tinnitus, and by endolymphatic hydrops found on postmortem examinations. Since the description of endolymphatic hydrops by Hallpike and Cairns, the physiopathology of Meniere's symptoms has been based on assumption that the pathologic lesion was the cause of the symptoms. Schuknecht proposed the theory of membranous rupture causing the mixing up of endolymph and perilymph leading to the occurrence of Meniere's symptoms. Lawrence confirmed this theory with research on experimental animals. In 1995 the AAO-HNS criteria defines "Possible MD (Grade D), Probable MD (Grade C), Definite MD (Grade B) and Certain MD (Grade A). In 1995 the Committee of Barany Society proposed a classification that is similar to the AAO-HNS criteria but includes only two categories: definite MD and probable MD. A variety of medical and surgical treatments has been developed to treat or control the symptoms. The treatment can be divided into non-destructive and destructive procedures. During the last 21st IFOS Congress in Paris in June 2017, an international consensus (ICON) Round Table joining six experts of MD from different continents was designed in trying to draw a minimal consensus, which could be summarized in an algorithm. This synthesis was highly challenging and only France and Japan have drawn a consensus or recommendation applicable in their countries. Scientific literature was assessed using the Level of Evidence classification (1 to 5) and recommendations were given following the grading of recommendations assessment, development and evaluation (GRADE) scoring system. In MD, the aim of the treatment is first to reduce the frequency, and secondarily the severity of the vertigo attack, with a minimal impairment of hearing function associated with a hearing and tinnitus improvement. The treatment is symptomatic and should always be related to the main complaint of the patient. At the beginning it should be conservative. The conservative treatments are used regardless of the hearing function, while destructive ones are preferentially used in patients with hearing loss. Concerning bilateral MD the treatment should always be conservative.