The treatment of Meniere's disease

Abstract

Meniereova bolest je bolest unutrašnjeg uha koja se manifestira karakterističnim trijasom simptoma: vrtoglavicom, fluktuacijom sluha i šumom u uhu. Etiologija bolesti je nejasna. Okidač za nastanak Meniereove bolesti može biti stres, imunološki poremećaj, poremećaj metabolizma vode i elektrolita, vaskularni poremećaji te razna druga stanja. Bolest počinje iznenada, slabljenjem sluha, šumom u uhu i vrtoglavicama koje su često praćene vegetativnim simptomima mučnine i povraćanja. Nakon prestanka napadaja stanje bolesnika se normalizira. U početku bolesti sluh fluktuira, ali ponavljanjem napadaja dolazi do postupnog trajnog oštećenja sluha. Dijagnoza se postavlja na temelju anamneze i kliničke slike. Liječenje Meniereove bolesti može biti konzervativno i kirurško. Konzervativno liječenje se provodi u početnoj fazi bolesti i sastoji se od sedativa, antivertiginoznih lijekova, vazodilatatora, antihistaminika te kortikosteroida. Također, preporuča se smanjen unos soli u organizam. Kad je bolest rezistentna na konzervativnu terapiju, preporuča se kirurško liječenje. Postoje četiri skupine zahvata: lokalna primjena antibiotika u srednje uho, destruktivni i drenažni zahvati te vestibularna neurektomija. Destruktivni zahvat se najčešće izvodi intratimpanalnom aplikacijom ototoksičnog antibiotika. Drenažni zahvati omogućuju otjecanje endolimfe preko endolimfatičkog sakusa u subarahnoidalni prostor. Vestibularna neurektomija se izvodi selektivnom resekcijom vestibularnog živca, najčešće retrosigmoidnim pristupom.Meniere’s disease is a condition of the inner ear manifested by the triad of symptoms: vertigo, fluctuating hearing and tinnitus. The etiology of the disease remains unclear. Stress, immune system disorders, disorders of water and electrolyte metabolism, vascular disorders as well as various other conditions can all trigger Meniere’s disease. The disease starts suddenly with tinnitus and vertigo, often accompanied by symptoms of nausea and vomiting. After such attacks, the patient’s condition tends to stabilize. The disease starts with fluctuating hearing loss, but repeated attacks of Meniere’s result in gradual permanent damage to patient’s hearing. The diagnosis is based on the anamnesis and clinical features. The treatment of Meniere’s disease can be conservative and surgical. Conservative treatment is applied at an early stage of the disease and includes sedation, antivertigo medications, vasodilatators, antihistaminics and corticosteroids. Reducing salt intake is also recommended. When the disease is resistant to conservative therapy, there is a proposed surgical treatment. There are four surgical procedures: local application of antibiotics in the middle ear, destructive and drainage procedure and vestibular neurectomy. A destructive procedure is mostly carried out by intratympanal application of ototoxic antibiotics. Drainage procedure releases endolymph through endolymphatic sac into subarachnoid space. Vestibular neurectomy is carried out by selective resection of the vestibular nerve, usually by the retrosigmoid approach