Middle fossa vestibular nerve section in the management of Ménière's disease.

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.