Glasscock M E, Miller G W
Laryngoscope. 1977 Apr;87(4 Pt 1):529-41. doi: 10.1288/00005537-197704000-00007.
The triad of fluctuating hearing loss, tinnitus, and episodic attacks of vertigo known as Ménière's disease can be a frustrating therapeutic problem. While most patients respond to a medical regime consisting of a low salt diet, diuretics, diazepam, and propantheline bromide, there is a significant group who remain refractory to conservative management. These individuals either continue to experience their distressing symptoms or undergo some type of surgical procedure in an attempt to seek relief. There are a multitude of such techniques available to the otologic surgeon and he must make the decision as to which procedure is best for any given individual. The authors' employ three surgical approaches for the management of Ménire's disease. These are the translabyrinthine labyrinthectomy, the endolymphatic subarachnoid shunt, and the middle fossa vestibular nerve section. In this paper the indications for surgery, technique, results and complications are covered in detail. Thirty-one patients are reviewed who have been followed from one to four years postoperatively. Seventeen had total and 14 had superior vestibular nerve sections. The results were much better in the total group, as 94 percent had complete relief of vertigo and 76 percent were able to maintain their preoperative hearing level. The authors feel the middle fossa vestibular nerve section is a valuable addition to the otologist's armamentarium in the treatment of the patient who is refractory to medical management.
波动性听力损失、耳鸣以及发作性眩晕三联征，即梅尼埃病，可能是一个令人沮丧的治疗难题。虽然大多数患者对包括低盐饮食、利尿剂、地西泮和溴丙胺太林在内的药物治疗方案有反应，但仍有相当一部分患者对保守治疗无效。这些患者要么继续经历痛苦的症状，要么接受某种手术以寻求缓解。耳科外科医生有多种此类技术可供选择，他必须决定哪种手术对任何特定个体最适用。作者采用三种手术方法治疗梅尼埃病。这些方法是经迷路迷路切除术、内淋巴蛛网膜下腔分流术和中颅窝前庭神经切断术。本文详细介绍了手术适应症、技术、结果和并发症。回顾了31例患者，术后随访1至4年。17例接受了完全迷路切除术，14例接受了上前庭神经切断术。完全迷路切除术组的结果要好得多，因为94%的患者眩晕完全缓解，76%的患者能够维持术前听力水平。作者认为，中颅窝前庭神经切断术是耳科医生治疗对药物治疗无效患者的武器库中的一项有价值的补充。
