Odkvist L M, Arlinger S, Billermark E, Densert B, Lindholm S, Wallqvist J
Department of Otolaryngology, University Hospital, Linköping, Sweden.
Acta Otolaryngol Suppl. 2000;543:99-101.
Different medical and surgical methods have been tried in attempting to reduce endolymphatic pressure in Ménière's disease. Pressure treatment has a role on the treatment staircase, after pharmacological treatment and before destructive methods. Pressure chamber treatment has shown that some patients respond well to the treatment with diminishing inner ear symptoms and also some hearing improvement. Earlier studies have shown that electrocochlear measurements improve after local pressure treatment in the ear. The present study was a prospective randomized placebo controlled, multicentre clinical trial. 56 patients with active Ménière's disease, age 20-65 years, with a hearing loss of 20-65 dB PTA participated. A total of 31 patients completed 2 weeks use with an active apparatus (Meniett) and 25 patients completed the 2 weeks with the placebo gadget. Both machines were produced by Pascal Medical, Halmstad, Sweden. Two weeks before the start of treatment a grommet was placed in the tympanic membrane. A significant improvement concerning frequency and intensity of vertigo, dizziness, aural pressure and tinnitus was reported by the active group on the visual analogue scales (VAS) questionnaire. In the placebo group no change was the most common finding, followed by worsening of the symptoms and a few improvements. The function in professional and family life improved during active treatment and did not during placebo treatment. Pure-tone audiometry did not improve after placebo treatment, but improved at the frequencies 500 Hz and 1,000 Hz after active treatment. The study showed an improvement in the inner ear symptoms after Meniett treatment. The mechanism may be explained by the influence on the round window membrane pressure receptors or an endolymphatic flow out through the pressure release points, such as the endolymphatic duct and sac, thus activating the longitudinal flow. Other mechanisms are also possible.
为降低梅尼埃病的内淋巴压力，人们尝试了不同的医学和外科方法。在治疗阶梯中，压力治疗在药物治疗之后、破坏性方法之前发挥作用。压力舱治疗表明，一些患者对该治疗反应良好，内耳症状减轻，听力也有所改善。早期研究表明，耳部局部压力治疗后，电耳蜗测量结果有所改善。本研究是一项前瞻性随机安慰剂对照多中心临床试验。56例年龄在20至65岁之间、纯音听阈损失20至65dB的活动性梅尼埃病患者参与其中。共有31例患者使用有源设备（Meniett）完成了2周的治疗，25例患者使用安慰剂设备完成了2周的治疗。这两种设备均由瑞典哈尔姆斯塔德的帕斯卡医疗公司生产。治疗开始前两周，在鼓膜置入一个通气管。在视觉模拟量表（VAS）问卷中，有源治疗组报告眩晕、头晕、耳内压力和耳鸣的频率及强度有显著改善。在安慰剂组，最常见的情况是没有变化，其次是症状恶化，只有少数有所改善。在有源治疗期间，患者的职业和家庭生活功能有所改善，而在安慰剂治疗期间则没有。安慰剂治疗后纯音听力测定没有改善，但有源治疗后在500Hz和1000Hz频率处听力有所改善。该研究表明，Meniett治疗后内耳症状有所改善。其机制可能是对圆窗膜压力感受器的影响，或者是内淋巴通过压力释放点（如内淋巴管和内淋巴囊）流出，从而激活纵向流动。其他机制也有可能。
