ABSTRACT
CONCLUSION: Tenotomy is a promising surgical alternative with a high reduction in dizziness handicap in the short and long term. OBJECTIVES: To investigate the immediate and the long-term effect of tenotomy of the stapedius and tensor tympani muscles on subjective dizziness as measured by the Dizziness Handicap Inventory (DHI). METHODS: A retrospective follow-up study of 42 patients with definite, unilateral Meniere's disease (19 males, 23 females, average age = 58.1 ± 14.1 years) had undergone tenotomy under general anesthesia through an endaural approach. Pre- and postoperative DHI values were compared for all patients, with postoperative follow-up ranging from 6 months to 9 years. Additionally, results were divided into three postoperative subgroups (A = 0-3 years, B = 3-6 years, C = 6-9 years). RESULTS: A statistically significant reduction of 48 DHI points, from a median preoperative DHI = 52 to DHI = 4 postoperatively, was noted (p < 0. 001). In all, 40/42 patients reported a reduction of dizziness handicap, while in 33/42 the difference was > 12 points. A statistically significant reduction of DHI scores was noted (A = 60, B = 34, C = 33) in all subgroups. It was also noted that the higher the preoperative DHI score, the greater the subjective success of the surgery.
Subject(s)
Meniere Disease/surgery , Stapedius/surgery , Tenotomy/methods , Tensor Tympani/surgery , Adult , Aged , Cohort Studies , Disability Evaluation , Dizziness/diagnosis , Dizziness/etiology , Dizziness/surgery , Female , Follow-Up Studies , Humans , Male , Meniere Disease/complications , Meniere Disease/diagnosis , Middle Aged , Patient Satisfaction/statistics & numerical data , Quality of Life , Retrospective Studies , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
CONCLUSIONS: Because the presented data reveal an immediate and persistent reduction of vertigo and a clear improvement in hearing function and functional scales, we conclude tenotomy to be effective in unilateral, definite Meniere's disease - laying the foundation for future prospective, randomized controlled trials. OBJECTIVES: This study compares the unique long-term results of tenotomy of the stapedius and tensor tympani muscles in definite Meniere's disease refractory to medical treatment and presents a hypothesis on why tenotomy seems effective. METHODS: This was an interventional cohort study. The study sample comprised 30 patients (15 males, 15 females; average age 57 ± 13.1 years) with definite Meniere's disease (AAO-HNS criteria, 1995). Patients were evaluated pre- and postoperatively using pure tone audiometry, AAO-HNS questionnaires regarding vertigo attacks, functional level scores, and tinnitus, and were followed up for 2-9 years. Postoperative values were calculated for the patient collective as a whole and consequently divided into three equal postoperative terms of 3 years each. RESULTS: A statistically significant improvement of inner ear hearing levels postoperatively (p = 0.041) and a major reduction in vertigo attacks in all groups (p < 0.001) with complete absence of attacks in 26/30 patients was noted. Results remained constant up to 9 years postoperatively. Although tinnitus persisted, the intensity was lower overall (p = 0.013).
