Endolymphatic sac decompression is done in-
Ans. is 'a' i.e., Menieres disease Treatment of Meniere's diseaseo Most treatments are for symptoms believed to be caused by excess endolymphatic fluid. Treatment of Meniere's disease is of two typesA) Medical management B) Surgical managementMedical managemento Treatment of Meniere's disease begins first with medical managemento Medical treatment controls the condition in over two third of patientso Medical management includes1 Antihistamine labyrinthine sedatives (vestibular sedatives)Many cases can be controlled by vestibular sedatives like prochlorperazine, promethazine, dimenhydramine, and cinnarzine.2 Anxiolytic and tranquillizersMany patients are anxious, therefore they may be helped by anxiolytic and tranquillizers like diazepam.3. VasodilatorsBetahistine hydrochloride appears to be the most useful recent addition to the medical armamentarium and is routinely prescribed for most patients. It increases labyrinthine blood flow by releasing histamine.Other vasodilators employed include nicotinic acid, thymoxamine, inhaled carbogen (5% C02 with 95% 02), and histamine drip.Vasodilators increase vascularity of endolymphatic sac and its duct and thereby increases reabsorption of endolymphatic fluid.4. Diuretics (furosemide)Diuretics with fluid and salt restriction can help to control recurrent attacks if not controlled by vestibular sedatives or vasodilators.5. Other drugsPropantheline bromide, phenobarbitone and hyoscine are effective alternatives.Surgical managemento Surgical therapy for meneire's disease is reserved for medical treatment failures and is otherwise controversial. Surgical procedures can be divided into two main categoriesDestructive surgical proceduresNondestructive surgical procedureso Destructive surgical procedures : rationale is to control vertigo. Endolymphatic hydrops causes fluid pressure accumulation within the inner ear, which causes temporary malfunction and misfiring of the vestibular nerve. These abnormal signals cause vertigo. Destruction of the inner ear and / or the vestibular nerve prevents these abnormal signals. The procedures performed are :LabyrinthectomyIntermittent low pressure pulse therapy (Meniett device therapy)o Conservative surgical procedures : are used in cases where vertigo is disabling but hearing is still useful & needs to be preserved. They are :Decompression of endolymphatic sacEndolymphatic shunt operationSacculotomy (Fick's operation & Cody's tack procedure)Vestibular neuronectomyUltrasonic destruction of vestibular labyrinth to preserve cochlear function.Stellate ganglion block or cervical sympathectomyIntratympanic gentamycinVestibular nerve section
Menieres disease
Otosclerosis
Otitis media
Vestibularschwannoma
Ear