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首页> 外文期刊>JAMA otolaryngology-- head & neck surgery >Comparison of second-echelon treatments for Ménière's disease
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Comparison of second-echelon treatments for Ménière's disease

机译：梅尼尔病二级治疗的比较

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IMPORTANCE: To compare the efficacy of treatments commonly offered to patients with Ménière's disease who fail conservative medical therapy including diuretics and a sodium-restricted diet. OBJECTIVES: This study compared three second-echelon treatments: the Meniett device, endolymphatic sac decompression, and intratympanic gentamicin injections to determine their comparative effectiveness and capacity to mitigate against the necessity of a surgical labyrinthectomy. DESIGN, SETTING, AND PARTICIPANTS: Retrospective observational study at an academic tertiary care center. Patients with Ménière's disease who failed primary medical management were evaluated after treatment with a Meniett device (n=20), endolymphatic sac decompression (n=23) or intratympanic gentamicin injections (n=17). Cases were included if auditory and vertigo control data were available before and a minimum of two years after treatment, in patients without previous otologic surgery or intratympanic injections. Average age ranged from 54 to 75 years. INTERVENTIONS: Use of the Meniett device, endolymphatic sac shunt decompression surgery or intratympanic gentamicin injections using variable doses and injection schedules. MAIN OUTCOMES AND MEASURES: Proportion of patients with vertigo control and hearing preservation by a modified version of the AAO-HNS criteria after second-echelon treatment, thus not requiring definitive labyrinthectomy. RESULTS: Despite endolymphatic sac surgery demonstrating a longer duration (61 months) prior to labyrinthectomy, no differences were found between the 3 treatment options in terms of patients going on to definitive labyrinthectomy or in the number of months of symptom relief following treatment. There was also no difference in residual auditory perception across the 3 groups. CONCLUSIONS AND RELEVANCE: No significant therapeutic differenceswere found between the studied second-echelon treatments for symptom relief of Ménière's disease.
机译：重要信息：为了比较通常针对未接受药物治疗（包括利尿剂和限钠饮食）的梅尼埃病患者的治疗效果。目的：本研究比较了三种第二梯队治疗方法：Meniett装置，内淋巴囊减压和鼓膜内庆大霉素注射液，以确定它们的相对有效性和缓解手术迷路切除术必要性的能力。设计，地点和参与者：在学术三级护理中心进行的回顾性观察研究。经梅尼埃特装置（n = 20），内淋巴囊减压（n = 23）或鼓膜内注射庆大霉素（n = 17）治疗后，评估未通过基本药物治疗的梅尼埃病患者。如果没有耳科手术或鼓膜内注射，则在治疗前和治疗后至少两年可获得听觉和眩晕控制数据的病例。平均年龄为54至75岁。干预措施：使用Meniett装置，内淋巴囊分流减压手术或鼓室内庆大霉素注射，使用的剂量和注射时间表可变。主要结果和措施：在第二梯队治疗后，通过修订版的AAO-HNS标准进行控制和听力保持性眩晕的患者比例，因此不需要进行彻底的迷路切除术。结果：尽管进行迷路切除术之前进行了内囊囊手术显示了更长的时间（61个月），但在进行确定性迷路切除术的患者或治疗后症状缓解的月数方面，三种治疗方案之间没有发现差异。其余3组听觉知觉也没有差异。结论和相关性：研究的梅尼埃病症状缓解的二级治疗之间未发现明显的治疗差异。

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