Functional results and quality of life after retrosigmoid vestibular neurectomy in patients with Ménière's disease

摘要

BACKGROUND: Severe Ménière's disease (MD) may be debilitating and compromising, despite intensive medical treatment. Vestibular neurectomy (VN) is considered an effective surgical treatment for disabling MD. Our aim was to analyse the medium- to long-term outcome after retrosigmoid VN with special regard to vertigo, quality of life (American Academy of Otolaryngology-Head and Neck Surgery criteria), and pure tone average (PTA). Methods: Retrospective evaluation of patients with disabling MD treated with retrosigmoid VN at the university hospital of Bern (1992-2009), after unsuccessful attempts at medical treatment. Demographics, clinical signs and symptoms, quality of life, thresholds of hearing, and adverse events were documented at baseline, 1 week, 12 months, and 24 months after surgery. Results: Medium to long-term follow-up data were available from 44 of 78 patients, who had undergone retrosigmoid VN (19 men; mean age, 50.3 ± 11.0 yr). Vertigo disappeared in 34 (77.3%) of 44 patients and improved in 6 (13.6%) of 44 patients. Quality of life significantly improved postoperatively (mean American Academy of Otolaryngology-Head and Neck Surgery, 0.68 ± 1.14 [1 yr] and 0.57 ± 1.19 [2 yr] versus 5.11 ± 0.66). Mean PTA decreased (52.3 ± 19.2 dB versus 56.2 ± 21.6 dB [1 wk] and 60.4 ± 20.5 dB [1 yr]; p < 0.001). Ten (22.7%) of 44 patients showed improved PTA after VN. These patients had significantly higher baseline PTA (69.4 dB versus 47.9 dB; p = 0.001). Conclusion: Retrosigmoid VN is a valuable and safe surgical option to treat disabling MD that has proved resistant to medical treatments. It may also be indicated for patients with preoperative severely impaired thresholds of hearing, in whom a certain hearing gain may be observed.