Tenotomy of the tensor tympani and stapedius tendons in Ménière's disease

Tenotomy of the tensor tympani and stapedius tendons in Ménière's disease.

In Ménière's disease (MD), when patients have incapacitating vertigo that is resistant to drug treatment, an intratympanic gentamicin application (ITG) is often proposed. Recently, some authors suggested that tenotomy, sectioning of the tensor tympani and stapedius tendons, could be a promising treatment. We examined whether tenotomy (ST) has additional benefit, compared to ITG alone, with respect to tinnitus, vertigo, and quality of life.

We conducted a retrospective survey of the charts of 24 patients with MD who underwent ITG, or ITG plus ST. Baseline data and follow-up assessments were obtained, using the Ménière's Disease Outcomes Questionnaire (MDOQ), the Dizziness Handicap Inventory (DHI), vertigo frequency per month, tinnitus visual analogue scale, and functional level. Failure was determined by the need for an additional procedure.

ITG was performed on 15 patients, and 9 patients underwent ITG plus ST. The procedure was sufficient in 53% of the ITG group and in 22% of the ITG plus ST group. No significant difference was found between the two groups concerning MDOQ scores, DHI, functional level, vertigo frequency, and tinnitus. In the ITG group, we found a significant improvement in number of vertigo attacks and the tinnitus visual analogue scale. In the ITG plus ST group, there was a significant reduction in vertigo attacks, but not in tinnitus.

This preliminary study suggests no additional benefit of stapedius and tensor tympani tenotomy in the treatment of Ménière's disease patients.