Gerritsen F R, Schenck A A, Locher H, van de Berg R, van Benthem P P, Blom H M
Department of Otorhinolaryngology, Haga Hospital, The Hague, Netherlands.
Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, Netherlands.
Front Neurol. 2024 Oct 24;15:1469276. doi: 10.3389/fneur.2024.1469276. eCollection 2024.
Knowledge of the natural and temporal course of a disease is important when deciding if an intervention is appropriate. In the case of Ménière's disease (MD), there is some evidence that attacks diminish over time, but the topic remains controversial. A conservative approach to surgery is usually followed in northern Europe, and leads to strict patient selection before considering surgery. Here, we describe the evolution of vertigo attacks among a group of intractable MD patients in whom surgery was considered.
Retrospective cohort study in a Ménière's disease expert center. Patients with definite unilateral Ménière's disease and persisting vertigo attacks despite treatment with intratympanic steroid injections were included. All patients had been waitlisted for participation in a planned trial assessing non-ablative surgery. They were waitlisted between June 2016 and June 2021 without undergoing the surgical intervention. In September 2022, data were collected from patient's files and follow-up telephone interviews were conducted to assess the evolution of their vertigo attacks.
Thirty-five patients (54% male, mean age of onset 52 years, 51% right sided) were included in the analysis. Twenty-five patients (71%) eventually declined surgery. Of the 33 patients with complete information on vertigo attacks, 21 (64%) were free of vertigo attacks upon data collection, after a median disease duration of 5.3 years. Patients who did undergo surgery, had longer duration of disease than patients who did not.
Even in a population with intractable MD, most patients will experience relief of symptoms over time. On one hand, active treatment may accelerate relief of symptoms, but on the other hand, non-ablative therapies are of debatable effect and ablative intervention carries a risk of life long side effects. Therefore, any active intervention should be carefully considered.
在决定一种干预措施是否适当时，了解疾病的自然病程和时间进程很重要。对于梅尼埃病（MD），有证据表明发作会随着时间推移而减少，但这一话题仍存在争议。北欧通常采用保守的手术方法，这导致在考虑手术前会对患者进行严格筛选。在此，我们描述了一组考虑进行手术的顽固性MD患者眩晕发作的演变情况。
在一家梅尼埃病专家中心进行回顾性队列研究。纳入确诊为单侧梅尼埃病且尽管接受了鼓室内注射类固醇治疗但仍持续眩晕发作的患者。所有患者都被列入了一项评估非消融手术的计划试验的等待名单。他们在2016年6月至2021年6月期间被列入等待名单，未接受手术干预。2022年9月，从患者病历中收集数据，并进行随访电话访谈以评估其眩晕发作的演变情况。
35名患者（54%为男性，平均发病年龄52岁，51%为右侧）纳入分析。25名患者（71%）最终拒绝手术。在33名有完整眩晕发作信息的患者中，21名（64%）在数据收集时已无眩晕发作，疾病中位持续时间为5.3年。接受手术的患者病程比未接受手术的患者更长。
即使在顽固性MD患者群体中，大多数患者的症状最终也会缓解。一方面，积极治疗可能会加速症状缓解，但另一方面，非消融疗法的效果存在争议，而消融干预有终身副作用的风险。因此，任何积极干预都应谨慎考虑。
