Surgical treatment of Méniére's disease

Meniereova bolest je bolest unutrašnjeg uha nejasne etiologije. Karakterizira je trijas simptoma: jednostrani fluktuirajući gubitak sluha, šum u zahvaćenom uhu i napadaji vrtoglavice u trajanju od nekoliko minuta do nekoliko sati. Dojam punoće u uhu i vegetativni simptomi poput povraćanja česti su, ali ne i uvijek prisutni. Pretpostavlja se da su uzroci bolesti upalne etiologije, imunološki poremećaji, poremećaji metabolizma vode i elektrolita, stres te brojni drugi. Bolest se iznenadno pojavljuje neovisno o životnoj dobi. Nakon prestanka napadaja koji traju do nekoliko sati, stanje pacijenta se normalizira, međutim, ponavljajući napadaji dovode do trajnog oštećenja sluha. Dijagnoza se postavlja na temelju anamneze i kliničke slike. Postavljanje dijagnoze u većini slučajeva je otežano zbog odsutnosti simptoma. Liječenje Meniereove bolesti može biti konzervativno i kirurško. U ranim stadijima bolesti provodi se konzervativno liječenje kortikosteroidima, antihistaminicima, vazodilatatorima, antiemeticima te sedativima. U kasnijim stadijima bolesti, kao i u slučaju neadekvatnog odgovora na konzervativnu terapiju, provodi se kirurško liječenje. Lokalna primjena lijekova u srednje uho, drenažni i destruktivni zahvati te vestibularna neurektomija, četiri su skupine zahvata koje se redovito provode u liječenju Meniereove bolesti. Aplikacijom ototoksičnog antibiotika izvodi se destruktivni zahvat. Drenažnim zahvatom omogućuje se otjecanje endolimfe preko endolimfatičkog sakusa u subarahnoidalni prostor. U najtežim slučajevima, vestibularnom neurektomijom izvodi se selektivna resekcija vestibularnog živca.Meniere's disease is a disease of the inner ear of unclear etiology. It is characterized by a triad of symptoms: unilateral fluctuating hearing loss, tinnitus in the affected ear, and attacks of dizziness lasting from a few minutes to several hours. The impression of fullness in the ear and vegetative symptoms such as vomiting are common but not always present. It is assumed that the causes of the disease are those of inflammatory etiology, immune disorders, disorders of water and electrolyte metabolism, stress and many others. The disease occurs suddenly regardless of age. After cessation of seizures lasting up to several hours, the patient's condition normalizes, however, recurrent seizures lead to permanent hearing damage. The diagnosis is made on the basis of anamnesis and clinical picture. Diagnosis in most cases is difficult due to the absence of symptoms. Treatment of Meniere’s disease can be conservative and surgical. In the early stages of the disease, conservative treatment with corticosteroids, antihistamines, vasodilators, antiemetics and sedatives is performed. In the later stages of the disease, as well as in the case of inadequate response to conservative therapy, surgical treatment is performed. Topical administration to the middle ear, drainage and destructive procedures, and vestibular neurectomy are four groups of procedures that are regularly performed in the treatment of Meniere's disease. With the application of an ototoxic antibiotic, a destructive procedure is performed. The drainage procedure allows the endolymph to drain through the endolymphatic sac to the subarachnoid space. In the most severe cases, vestibular neurectomy is performed by selective resection of the vestibular nerve