Tenotomy of the middle ear muscles : An unknown surgical approach in Meniere's disease

Abstract

Tenotomy of the tendon of the stapedius and tensor tympani muscles is a relatively unknown therapeutic procedure in Menière's disease. Widespread approaches include medicinal treatment with betahistine or diuretics as well as interventional procedures, such as intratympanic gentamicin or glucocorticoid injection, vestibular neurectomy, labyrinthectomy or endolymphatic sac surgery. The exact pathomechanism of this approach is not fully known. It is assumed that by cutting the tendons of both middle ear muscles in cases of endolymphatic hydrops the stapes is not additionally actively pushed against the oval window but can deviate laterally and thereby does not augment the inner ear pressure even further. Studies have shown that this method does not only improve vestibular symptoms but also, in contrast to most other strategies, increases the hearing level. The formation of scar tissue and the resulting reduction of ossicular chain mobility, especially due to postoperative infections, may limit the success of tenotomy and should be considered as a possible factor in cases of limited postoperative vertigo control.

Keywords: Aural fullness; Dizziness; Meniere’s disease; Stapedius; Tenotomy; Tinnitus; Tympanotomy; Vertigo.