Surgical procedures for treating Meniere's disease are discussed. Based on the results of 250 operations, it is concluded that interventions are sufficiently effective not only with vestibular dysfunction, but also with hearing disorders. In surgical treatment of Meniere's disease, it is expedient to adhere to by-stage tactics: to start with the simplest and least traumatic interventions - operations on the nerves of the tympanic cavity, and if these are ineffective to use more complex methods, including drainage or shunting of the endolymphatic sac

Soldatov, I.

English

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NASA TECHNICAL MEMORANDUM 	 NASA TM-76398
MENIERE'S DISEASE: A SURGEON'S TACTICS
I. Soldatov
Translation of "Bulezn' Men'yera: taktika khirurga", Meditsinskaya Gazeta,
June 20, 1979, pp. 3
(NASA-TM-76398) IIENIERE v 5 DISEASE: A
SURGEON S S TACTICS (National Aeronautics and
Space Administration) 7 p HC A02/KF AU1CSCL 06E
981-20719
Unclas
G3/52 19774
CD
Ab
NATIONAL AERONAUTICS AND SPACE ADMINISTRATION
WASHINGTON D.C. 20546
	 SEPTEMBER 1980
F m a_1
1
STANDARD TITLE PAGE
1. Report He. !. 4oeer«eMt AaseeelM t/e. 7: ReelpiMt'e Cetetet Ne.
NASA TM-76398
4. T114o wW SwMNdo S. Report Dote
MINIERVS DISEASE: A SURGEON'S TACTICS	 SEPTEMBER 1980
•. pet "109 OttMisetiM cede
!. AwtAer(e) !. ►etdereritq 0►rMeNiM Rspw1 No.
1. Soldatov	 10, werh Unit Me.
t. Performing Omen setioa Nome and Adtkeee
	
11. Cetttteet of 4.401 Nee
SCITRAN NASW-3198
Type 0 Re"" 404 Period CoweredBox 5456	 IS.
Santa Barbara, CA 93108 Translation
13. Sponwivog Agency Nome ewe ANress
National Aeronautics and Space Administration 14. Sp.r►.erlwg Agwwy Co"
Washington, D.C.	 20546
Is. Swppleseetery Notes
Translation of "Bolezn' Men'yera:
	
taktika khirurga", Meditsinskaya
Gazeta, June 20, 1979 ; pp. 3
lI.	 A► sr.esr
T41s article discusat• s	 surgical procedures for
treating Meniere's	 disease.'
The author, based on observing the results-of 250 operations,
states that• interventions.are sufficiently effective not only with
vestibular dysfunction, but also with hearing disorders.
He concludes with a caution.	 In surgical treatment of Meniere's
disease it is expedient ,to adhere to by-stage tactics: 	 to start with
the simplest and least traumatic interventions-- operations on the nerves
of the tympanic cavity, and if these are ineffective to use more complex
methods, including drainage or shunting of the endolymphatie sac.
11. Key wertis (Seloetel by Arther(s) 18. Diskibo%m SNteerew
Unclassified - Unlimited
It.	 Seewrity elossii. (of Wit topers) 70. Seewity Closed. (el this ppo) 	 a 71. Ne. of ►qoe 3L
Unclassified Unclassified
i
•	 11
NASA-110	 1
i	 ZE' S DIS r.A6L t It SURG)r0"-' S MCI. Ca
I. Soldatov *
heniere's disease is ;iaiuifested by hypoacusis, noise in the e p rs,	 /2**
dizzy spells acconparied by disruption of equilibrium, nausea, changes .s
in the work of the cardio-vascul&r, dic;estive, and urinary systems, and
perspiration. The possibility of developing totuul deafness and periodic
wo=k disability conditioned by vestibula a ,. ti.function gives this disease
a defl., ite social significalice and dictates the necessity of constantly
wcrkind to improve its treatment. he fccl that the character of treat-
dent, jarticularly -tua: ,ical tactics, : :ust with I.eniere's disease be
detet.Aned on the ba:-Is of riodern, katho-morpholo;,lcal and patho-physiolok;icr.1
'rufonaation concorning this illness.
In the opinion of most researchers, the basic norphological substratum
for the disease is endolyz:phatic hydrops (edema) of the otic labyrinth, while the
4asin patho6enetic factor is the dysfunction of the ve^,otative innervation
of the iriner eat• vessele. :.e n;ay z.snu»e that while the endoly.ipnatic
systw is able to periodically expand at the expense of the perilynphatic
rued to return to Ito initial state, thu dise."o proceeds in the ford of
, cal attacks faith lucid intervals and is acconpanied by fluctuntin`
(vanc111at1. ,._' h; poncunic. Vowevor, if the attacks becone very frequent,
even thou;;h less severe, lucid intervals disappear alnost entirely, hemrint-
ceases to fluotuatc, iknd hypoacusirs develops rapidly, we ;aay eonnider
* ncader:ician l
 A.. S ^^: , city of Kuybyshev.
** Numbers in iaarbins indicate foreiau pa.1nation.
spaces of the labyrinth during ISeniere's disease. Such a method
the glycerol test used for additionta diaenosties is clinical, studies.
We evaluate this test net only according to a.cumetric data, as do other
authors, but also accordin to vestibulonetry, We consider its results
in selectin a type and : ethod of trea,tnent.
Until recently, sur ical treatment of Feniere's disease was conducted
only in eases wheat* conservative treatment was ineffective, and had for its
Nrpose the arrestir of vestibular dysfunction. In recent years the
situation has changed, and with fluctuating hypoacusis, certain operations
have been viewed as a means of preventing pro-essive hearin- loss • Arlo,-V,-
such oferatio nS axe, for example, draina a of the endolr phatic sac, vestitvlar
neurotoni ,, and otherz.
Our clinic or otorhinol yn,;olow, z t the Kuybyshev ' edical Institute
reco ,.Uie ti s f t xly siir,^ical intervention, Vat ri^ari ly those which, lnclucti z
elenents of Ott"ode} eV c effect, would be technically simple and safe for
theatie.it, Cijir experterice in sur,,.cal treatment convinces tie of the
fact that with elinict 1 ;y -pions presupposin3 a reversible stage of endo-
lyuphatic hydrop s and with their confirmation by thel eerol test, early
operations on nerves iii the tyiip anic cavity axe ex pedient. o =,,e otosur eons
2
Observations at our clialo based on the results of 23D such operations
testify to the fact that these intervan iAons &-.a sufficiently effective
not only with vestibular djsfunctionj but also with hearili
	 CZA.
Thu: # a tvsitive result with vestibultur dysfunction was noted in 84 per-c-01A
of t -nz;e onerated, heaxin,,; was improw.4 in 12pore-ant, while in 55 percent
It re-m-4ned at the pro-operative level and did not deteriorate in later
years.&
in the absence of the affect of resectlonin^ the tyr.pmmio cord and
t^T--Panic plevus t at this st .e of the dl3ease drU-1 n1n,, and shuntinC the
endolx- ,  phatic sac or sacculotomy is exZedlont, as well as two types of
operatio'ns on the cccl-aea which we have developed l fenemtratior,
with ftmina_e anj	 of the tyTi:1-".ic scala and the-, cochlear duct,,
3huntI31 the.-A throu j;h the cochlear window. Tf the nicbe of the cochlear
window is -1,%xrow acid the secondary tympanic ne.-mbrane is not visible-,
tho first vil-riant of the operation Is Inpl ammented # and with a wid-- Ache
the second varia=nt. Polyethylene ot metallic tubes with non-slip perforations
ivid a move axe used as shunts. The distal end of the shunt Is sealed
so that there would be no diraet connection of the cochlea with the
tympanic cavity in order to avoid infection of tbo Irmw ow',
Operations
.
 on the membranal tomations of the vwtitulm and tho:
cochlea often have a negative, effect on the hearing fuactl.on, Considering
this fact, is It necessary to resort to then? V144mtly they should
not be rejected ,prinarily because operations on the oochlw. and the
vestibular am, differing by their lose, traumatic mess, are theoretically
the meet founded frith Mordere ts diawme. In actuality, results of
morphological studies ahou the+, edema develops first of all in the cochlear
duct j in the vestiUaar amp and later in other sections of the endo-
lymphatic syste n.o '.orsover, andolymph is produced primarily in the
area of the wazeular strip of the outside wall of the cochlOR. 'Ile r 
assune that fa-r the r Lmwovenent in the technolo_4 of surf 	 inter-
vention, the use of ultra.-soulid, cry o- and laser affects will reduce to
a r4niram the noZative off ect of these oPerations on the hearinZ function.
1411t1i unilateral affliction, fr&quent severe dizzy spells l shax—,%-
exporen,ced- lly^ cusiso and absence of fluctuation in hearing, operations on
tile l.-bx­­.inth, which ra.,,
 be called a partial labyvynthectony l have been
shown to be destructive. After the t'—,apanotony and xrmnoval of the bony
cove:rin-, we perforate the bozo of the stir_^ un, scrape out the MAnbraxal
1Cn111'rint,h fron the vectibtilum and the 3m-1circulnx 0awnIss and introduce
2',0.000 units of" straptw--:ycin in 0.5 -a Lifp1hy-siolo,,;icarl Solution Into the
labyrinth c,n_-%dty. if tho operation In perfor--ed properly, them are no
relar*es of the dirty spalls. Consequently, there Is no neee to resort
to vestibular newroto.-4 a-ad scarpector4.
TNUs t I.- nurdical treatment of ­ -- niere's disease it Is expedient to
adhere to by-stzat r tactim to -'art with the airplost and least traumatic
interventions -- opemtIons on the nerves of the tyripanic cavity, and if
4
these are ineffective to use pore conplex :^cthods, including drainage
or shunting of the endoly'uphatic sac. The latter op3rations ve pmfom,
as do other otoour vors, in the reversible stage of erAolymphatio
{ hydrops, i•ei, with fluctuating hypoacusis and a positive ycerol test.
t	 however, aureal intervention on the nerves of the tympanic cavity and
{ the options which we have proposed on 	 endo-perilynphatic shunting;
of the cbohleu are possible in the reversible - .ell as in the trreve ible
sta6e. Cansejuently, zur6loal intervention in the case of disease
should be selected pith a consideration for its clinical Yrress and
the ninction; l Condlitio of the inner car, ri "iI t  de ee of l,d -
cilsis an.d fl,  ctu t' o:- i_; by=ink .
5


Meniere's disease: A surgeon's tactics

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