Many patients with Meniere's disease are subject to anxiety and nervous
tension. The patient who has just had an attack of vertigo, possibly with
accompanying nausea and vomiting, is an anxious and worried person. Therefore
the pyhsician's approach to the case is important, and he must be prepared to spend
time and patience. This may prove difficult, since these cases, like neurotics,
are not easily reassured and often have many symptoms to describe.The doctor must be prepared to discuss and explain what is happening to
the patient, that several kinds of treatment are available and effective in many
cases, and that the disease is not due to any irreparable intracranial condition.
The first essential in re- establishing the patient's confidence is a complete
and careful physical examination.At the same time it is a mistake not to point out that there is no
quick cure, that the course of treatment is liable to be prolonged and that
relapses do occur in certain cases. Most patients are prepared to accept the
liklihood of a lengthy period of treatment and at least some restriction of their
activities.Most authorities agree that ¡0;g - 31015 of cases of tree Meniere's disease
are benefited by medical treatment. It is difficult to estimate the efficacy of
any treatment because of the characteristic natural remissions of the condition.About 20' - 30' of cases are severe enough to call for surgical intervention. In general, destructive surgery is reserved for severe cases with gross
incapacity due to unilateral disease. The factors which must be considered in the
decision to operate or not are: -1. The presence of bilateral disease.
2. The age and physical condition of the patient.
3. The amount of hearing retained in the affected ear, and the presence of
good or bad hearing in the other ear. not
4. The status of the patient, e.g. a labourer may not be prepared to bear the
financial burden of at least two months and possibly longer off work.In unilateral cases, destructive labyrinthectomy is probably the operation
of choice, and here Cawthorne's method would appear to be the safest.It would appear also that in such cases, with good hearing in the affected
ear, there is a place for hemisection of the VIIIth cranial nerve, or ultrasonic
therapy, preferably the latter in view of the mortality associated with hemisection.The difficulty in choice of procedure arises in bilateral cases.
Bilateral sympathectomy may be the answer here.
On the other hand ultrasonic
therapy to both ears may prove the only surgical alternative. Only time will
tell
