Nabi Shahin, Parnes Lorne S
Department of Otolaryngology, University of Western Ontario, London Health Sciences Centre, University Hospital, London, Ontario, Canada.
Curr Opin Otolaryngol Head Neck Surg. 2009 Oct;17(5):356-62. doi: 10.1097/MOO.0b013e3283304cb3.
Bilateral Ménière's disease treatment can be extremely challenging and, like its unilateral variant, remains highly controversial. There are few articles in the literature that have focused specifically on the treatment of bilateral Ménière's disease, despite significant numbers of unilateral cases evolving toward bilaterality - a process which complicates management and is not simple to foresee. This study reviews the most up-to-date concepts in its diagnosis and treatment, with a special focus on recent advances.
Recent advances in electrocochleography, vestibular-evoked myogenic potential, and intratympanic gadolinium-based contrast agent MRI may have the potential to diagnose bilateral endolymphatic hydrops, and predict unilateral to bilateral Ménière's disease progression. Although more prospective studies are necessary, recent studies show that intermittent pressure therapy (Meniett device), intratympanic steroids, and endolymphatic sac surgery appear to be efficacious and well tolerated nonablative management options. Moreover, triple semicircular canal occlusion surgery has recently been used successfully in Ménière's disease.
Bilateral Ménière's disease can be challenging to diagnose via clinical suspicion and pure-tone audiometry alone. Therefore, adjunctive diagnostic tools including electrocochleography, vestibular-evoked myogenic potential, and intratympanic gadolinium-based contrast agent MRI are of even greater value, and may predict progression to bilaterality - allowing better optimization of treatment. Ablative treatments are relatively contraindicated due to the risks of bilateral vestibular and cochlear hypofunction. Nonablative treatments such as the Meniett device, intratympanic steroids, and endolymphatic sac surgery appear to be efficacious, and useful alternatives after conservative measures fail. Systemic aminoglycoside therapy is reserved for only the most severe and intractable cases.
双侧梅尼埃病的治疗极具挑战性，与单侧梅尼埃病一样，仍存在很大争议。尽管有大量单侧病例会发展为双侧病变，这一过程会使治疗变得复杂且难以预测，但文献中专门针对双侧梅尼埃病治疗的文章却很少。本研究回顾了其诊断和治疗的最新概念，特别关注了近期的进展。
耳蜗电图、前庭诱发肌源性电位以及鼓室内钆基造影剂磁共振成像的最新进展可能有助于诊断双侧内淋巴积水，并预测单侧梅尼埃病向双侧发展的进程。尽管还需要更多的前瞻性研究，但近期研究表明，间歇性压力疗法（Meniett 装置）、鼓室内注射类固醇以及内淋巴囊手术似乎是有效的且耐受性良好的非破坏性治疗选择。此外，三半规管阻塞手术最近已成功应用于梅尼埃病的治疗。
仅通过临床怀疑和纯音听力测定来诊断双侧梅尼埃病可能具有挑战性。因此，包括耳蜗电图、前庭诱发肌源性电位以及鼓室内钆基造影剂磁共振成像在内的辅助诊断工具具有更大的价值，并且可能预测向双侧发展的进程，从而更好地优化治疗。由于存在双侧前庭和耳蜗功能减退的风险，破坏性治疗相对禁忌。非破坏性治疗，如 Meniett 装置、鼓室内注射类固醇以及内淋巴囊手术，似乎是有效的，并且在保守治疗失败后是有用的替代方法。全身用氨基糖苷类药物治疗仅适用于最严重和难治的病例。
