[Preoperative vestibular diagnosis in therapy of Menière's disease]

Surgical treatment of Meniere's disease is indicated in patients with severe attacks who have failed drug therapy. A decision between a conservative or destructive procedure demands firstly exclusion of patients with non-otogenic diseases, bilateral disease or complete unilateral loss of function, and secondly assessment of the laterality of the disease, of residual labyrinthic function and of vestibular compensation. A total of 185 patients with Meniere's disease were investigated. All of them had a history and clinical signs that indicated surgery. Canal function, otolith responses and vestibular compensation were examined, in addition to routine preoperative tests as recommended by the Committee on Hearing and Equilibrium of the American Academy of Ophthalmology and Otolaryngology. Of the 185 patients 22% had findings that contraindicated surgery, 4% suffered from Meniere's disease in the opposite ear, 6% showed no signs of vestibular compensation and 12% had dead labyrinths on the side of the cochlear disease. No caloric response was elicited from the labyrinth by thermal bilateral testing in 25% of the 185 patients. In patients who were thought to have dead labyrinths based on routine caloric tests, residual canal function was detected by means of 20 degrees C stimulation in the prone and supine position. Without extensive vestibular testing the indications for surgical treatment of Meniere's disease will be incorrect in 47% of patients.