Vestibular surgery for Ménière's disease in the elderly: A review of techniques and indications

Abstract

There are several safe and effective surgical options for the treatment of vertigo associated with Ménière's disease in the elderly patient. The choice of procedure depends on the patient's hearing status and overall health. Since 1987, combined retrolabyrinthine-retrosigmoid posterior fossa vestibular neurectomy was performed on 29 older patients who were in good physiologic health and whose hearing was better than 80 dB pure-tone average and 20% speech discrimination. Patients whose hearing is worse are offered transmastoid labyrinthectomy or transmeatal cochleovestibular neurectomy, barring contraindications. When extensive surgery is medically contraindicated and hearing is not a significant concern, cochleosacculotomy is preferred; this procedure has been performed with minimal morbidity on patients as old as 85. Finally, over the past several years, patients have been treated with transtympanic placement of gentamicin. Early results with this office-based local procedure demonstrate a high cure rate, but also a high incidence of sensorineural hearing loss.