PEARLS 263, May 2010, written by Brian R McAvoy

Clinical question
How effective is surgery for the treatment of Meniere's disease?  

Bottom line
The only surgical intervention which has been evaluated in randomised controlled trials (RCTs) is endolymphatic sac surgery. Two trials, involving a total of 59 patients, were included in the review, 1 comparing endolymphatic sac surgery with ventilation tubes and 1 with simple mastoidectomy. One study lasted 9 years, the other 12 months. Neither study reported any beneficial effect of surgery.  

Caveat
Due to the different ways the outcome measures were obtained, and because not all the required data were reported, it was not possible to perform a meta-analysis. In total, 70% of participants in both the endolymphatic sac surgery groups and the comparator experienced some relief of complaints. There is no evidence to choose 1 surgical technique over another.  

Context
Meniere's disease is characterised by 3 major symptoms: vertigo, deafness, and tinnitus or aural fullness, all of which are discontinuous and variable in intensity. A number of surgical modalities, of varying levels of invasiveness, have been developed to reduce the symptoms of Meniere's disease, but it is not clear whether or not these are effective.  

Cochrane Systematic Review
Pullens B et al. Surgery for Meniere's Disease. Cochrane Reviews 2010, Issue 1. Article No. CD005395. DOI: 10.1002/14651858. CD005395.pub2. This review contains 2 studies involving 59 participants