Nevoux J, Barbara M, Dornhoffer J, Gibson W, Kitahara T, Darrouzet V
Department of otology and neurotology, CHU de Bicetre, AP-HP, 94270 Le Kremlin-Bicêtre, France; Saclay university, Paris-Sud Medical School, 94270 Le Kremlin-Bicêtre, France.
Department of otology and neurotology, Sapienza university, Rome, Italy.
Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Feb;135(1S):S29-S32. doi: 10.1016/j.anorl.2017.12.006. Epub 2018 Jan 12.
To present the international consensus for recommendations for Ménière's disease (MD) treatment.
Based on a literature review and report of 4 experts from 4 continents, the recommendations have been presented during the 21st IFOS congress in Paris, in June 2017 and are presented in this work.
The recommendation is to change the lifestyle, to use the vestibular rehabilitation in the intercritic period and to propose psychotherapy. As a conservative medical treatment of first line, the authors recommend to use diuretics and Betahistine or local pressure therapy. When medical treatment fails, the recommendation is to use a second line treatment, which consists in the intratympanic injection of steroids. Then as a third line treatment, depending on the hearing function, could be either the endolymphatic sac surgery (when hearing is worth being preserved) or the intratympanic injection of gentamicin (with higher risks of hearing loss). The very last option is the destructive surgical treatment labyrinthectomy, associated or not to cochlear implantation or vestibular nerve section (when hearing is worth being preserved), which is the most frequent option.
提出梅尼埃病（MD）治疗建议的国际共识。
基于文献综述以及来自四大洲的4位专家的报告，这些建议已于2017年6月在巴黎举行的第21届国际耳科学会（IFOS）大会上提出，并在本研究中呈现。
建议改变生活方式，在发作间期进行前庭康复训练并提供心理治疗。作为一线保守药物治疗，作者建议使用利尿剂和倍他司汀或局部加压疗法。当药物治疗失败时，建议采用二线治疗，即鼓室内注射类固醇。然后作为三线治疗，根据听力功能，要么进行内淋巴囊手术（当听力值得保留时），要么鼓室内注射庆大霉素（听力损失风险较高）。最后一个选择是破坏性手术治疗迷路切除术，可联合或不联合人工耳蜗植入或前庭神经切断术（当听力值得保留时），这是最常用的选择。
