Use of polytomography in Meniere's disease.

In a long-term study of the treatment of Meniere's disease, 105 cases treated from 1965 through 1973 were divided into subgroups by virtue of the institution of routine polytomographic examination of the vestibular aqueduct (1968). A comparison of results of treatment in the two groups (empiric indication of endolymphatic shunt vs x-ray film evidence) yielded the following conclusions: (1) Success or failure of the endolymphatic shunt operation is significantly correlated with patency or obliteration of the vestibular aqueduct as seen on roentgenographic examination. (2) To be effective, medical therapy must be instituted early, when fluctuant hearing is the primary symptom. (3) More severe cases with roentgenographically obliterated vestibular aqueducts and unrelenting vertigo are best treated with vestibular nerve section via middle fossa craniotomy. (4) More precise definition of pathogenesis is needed to define the disease at onset, so that early definitive therapy may be designed.