Surgical treatment of Menière's disease since Thomsen.

The effects of Thomsen's 1981 report of a controlled double-blind study on the surgical treatment of Meniere's disease were studied by reviewing the current literature and Thomsen's subsequent reports. The current surgical literature was found to contain reasonable support for the continued use of endolymphatic shunt procedures despite the criticism of such procedures by Thomsen. Surgical therapy for Meniere's disease continues to be divided into auditory sparing or conservative procedures and auditory ablative or destructive procedures. Conservation procedures are important because approximately 30% of patients with Meniere's disease progress to bilateral involvement. Endolymphatic sac procedures continue to be classified as conservative. Important findings in the current literature are reports of long-term follow-up of patients after sac surgery. These question the long-term control of hearing loss but support the use of the procedure due to its low morbidity and consistent control of vertigo. Other authors have described the different types of endolymphatic procedures and confirm their equal effectiveness. The results of middle fossa and retrolabyrinthine vestibular neurectomy were also reviewed, and its continued control of vertigo were affirmed. The increased number of severity of complications (compared with endolymphatic shunt procedures) were noted. Finally, a strategy for surgical treatment of Meniere's disease, beginning with the patient with uncontrollable vertigo, is presented.