THE EFFECT OF DISCUSSING SURGERY FOR MENIERE'S DISEASE

Alan G Kerr, Joseph G Toner

Royal Victoria and Belfast City Hospitals

Belfast

Our indication for surgery in Meniere's disease is purely for vertigo, preferably with preservation of hearing. Over the years we have often been amazed at how many patients have been free from dizziness between the date of surgery being planned and the date of admission.

We therefore started a prospective study in December 1994 in those who had prolonged incapacity from their vertigo. We offered surgery but not without a waiting period of 6 to 8 weeks. We explained to the patients the surgical options and reassured them that they would not have to continue indefinitely with the problems of their vertigo. We then saw them 6-8 weeks later.

So far, this surgery has run for two and a half years, from Dec 94 until June 97. During that time we saw 23 patients with incapacitating vertigo whom we thought should be offered surgery. When we saw them 6-8 weeks later. 12 of them had had a dramatic improvement in vertigo, most not having had any further attacks whatsoever. Many had also had a dramatic improvement in hearing.

The 11 patients who were not dramatically better were, as in the protocol, offered some form of destructive surgery. Eight accepted and three refused, two because they were pleased with the improvement they had already experienced.

What is happening? Maybe the indications for surgery are too low, but we don't think so. These patients were from a weekly vertigo clinic with many tertiary referrals. A total of 23 cases in two and a half years does not suggest a high surgery rate.