Surgery for Ménière's disease

 

Abstract

Background

Ménière's disease is characterised by three major symptoms: vertigo, deafness, and tinnitus or aural fullness, all of which are discontinuous and variable in intensity. A number of surgical modalities, of varying levels of invasiveness, have been developed to reduce the symptoms of Ménière's disease, but it is not clear whether or not these are effective.

Objectives

To assess the effectiveness of surgical options for the treatment of Ménière's disease. All surgical interventions used in the treatment of Ménière's disease, either to alter the natural history of the disease or to abolish vestibular function, were considered for this review.

Search methods

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 25 February 2009.

Selection criteria

Randomised or quasi-randomised controlled studies of a surgical modality versus a placebo therapy in Ménière's disease.

Data collection and analysis

Two authors independently assessed trial quality and extracted data. Study authors were contacted for further information.

Main results

The only surgical intervention which has been evaluated in randomised controlled trials and met the inclusion criteria was endolymphatic sac surgery. We identified two randomised trials, involving a total of 59 patients; one comparing endolymphatic sac surgery with ventilation tubes and one with simple mastoidectomy. Neither study reported any beneficial effect of surgery either in comparison to placebo surgery or grommet insertion.

Authors' conclusions

The two trials included in this review provide insufficient evidence of the beneficial effect of endolymphatic sac surgery in Ménière's disease.

 

Plain language summary

Surgery for Ménière's disease

Ménière's disease is characterised by recurrent attacks of three major symptoms: vertigo (rotational dizziness), deafness and tinnitus (ringing of the ears), and/or aural fullness, all of which are discontinuous and variable in intensity. The symptoms of Ménière's disease are thought to be caused by excess pressure in the fluids of the inner ear which leads to sudden attacks of vertigo and hearing loss. A number of surgical procedures, of varying levels of invasiveness, have been developed to reduce the symptoms of Ménière's disease, but it is not clear whether or not these are effective. The surgical interventions can be categorised as two types: one type of surgical intervention aims to affect the natural history of the disease, with conservation of vestibular function. The other type aims to relieve symptoms by abolishing vestibular function. Both types of surgical intervention are considered in this review. Despite an extensive search the review authors only found two randomised controlled trials studying surgical interventions for Ménière's disease. Both of these trials, involving a total of 59 patients, studied endolymphatic sac surgery; one comparing it to placebo surgery and the other to a different type of surgery. Neither trial detected a significant difference between the treatment and control group.

 

摘要

背景

梅尼爾氏症 (Meniere's disease) 的手術

梅尼爾氏症三個典型症狀：眩暈 (vertigo) ，耳聾 (deafness) ，耳鳴 (tinnitus) 或耳朵充塞感 (aural fullness) ，這三大症狀是間歇的而且強度各異。有許多侵入性程度不同的手術方式被發展出來，可是目前不清楚這些處置有沒有效果。

目標

評估手術方式在治療梅尼爾氏症的效果。所有用於梅尼爾氏症的手術方式，不論是改變梅尼爾氏症自然病程的發展，或是破壞前庭功能，在這篇回顧中都會列入考慮。

搜尋策略

我們搜尋了Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT 以及其它已發表或尚未發表的試驗。最近一次搜尋是在2009年2月25日。

選擇標準

比較針對梅尼爾氏症的手術跟安慰劑治療的隨機對照試驗或是準隨機對照試驗 (Randomised or quasirandomised controlled studies)

資料收集與分析

兩位作者獨立地評估試驗的品質及擷取結果，有聯繫文獻的作者以得到更多的資訊。

主要結論

惟一被隨機對照試驗評估過而且符合收納標準 (inclusion criteria) 的手術是內淋巴囊手術 (endolymphatic sac surgery) 。我們找到兩篇隨機試驗，總共包含59位病人，一個試驗是比較內淋巴囊手術跟使用通氣管 (ventilation tube) ，另一個試驗是比較內淋巴囊手術跟簡單乳突切除 (simple mastoidectomy) 。不論跟安慰手術比較或是跟通氣管置入 (grommet insertion) 比較，沒有任何文獻指出手術有益處。

作者結論

在這篇回顧收納的兩個試驗中，針對梅尼爾氏症施行內淋巴囊手術，沒有充分的證據顯示手術有益處。

翻譯人

本摘要由基隆長庚醫院沈芳瑩翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

梅尼爾氏症的手術：梅尼爾氏症病徵，是三個主要症狀反覆發作：眩暈 (旋轉性頭暈) ，耳聾，耳鳴 (耳朵鳴響) 以及/或耳朵充塞感，這三大症狀是間歇的而且強度各異。梅尼爾氏症的症狀，一般認為是起因於內耳液體壓力增大而導致突發性眩暈及聽力喪失。許多侵入性程度不同的外科手術被發展出來，試圖減輕梅尼爾氏症的症狀，可是並不清楚這些手術是否真的有效。手術方式可以分成兩種型態：一種手術方式是要影響梅尼爾式症自然病程發展同時保留前庭的功能；另一種手術方式是廢除前庭功能以減輕症狀。兩種手術方式在這篇回顧中都納入考慮。雖然這篇回顧的作者有做廣泛搜尋，可是只有找到兩篇隨機對照試驗是關於梅尼爾氏症手術的。這兩個試驗研究內淋巴囊手術，總共包含59位病人，一個試驗是跟安慰手術比較，另一個試驗是跟不同手術比較，不過沒有任何一個試驗發現治療組跟對照組有顯著差異。