Indications for surgery in Mé Niére's disease.

Ménière's disease has been shown to have multiple causes, each of which requires a specific treatment. Patients who do not respond to medical treatment often are allowed to suffer prolonged disability from their symptoms or develop permanent hearing loss without the benefit of surgery. The physician's uncertainty regarding which patient will ultimately respond to medical treatment or have spontaneous remission of symptoms can cause a delay in what would otherwise have been definitive surgical treatment which would have allowed the patient to return to a happy and productive life. A careful analysis of 120 patients studied intensively for five years has shown that patients who exhibit specific characteristics and diagnostic findings will ultimately require surgery for control and relief of their symptoms, while others can be expected to recover with medical treatment. Fifty-six of the 120 patients ultimately required surgery to rid them of their symptoms. These patients were almost exclusively of the group considered to be idiopathic, viral, small internal auditory canal syndrome, or caused by physical or acoustic trauma. Those patients who had other causes for their Ménère's disease rarely required surgical treatment and were well controlled by specific medical therapy. These observations would seem to provide us with information which would allow patients who might be reasonably stages of their disease where conservative measures can more often be expected to give complete relief with preservation of hearing. The indications for surgery in patients with Ménière's disease based on this information will be reviewed. The use of this knowledge has significantly reduced the morbiditiy associated with Ménière's disease.