Functional Level and Dynamic Posturography Results Two Years after Vestibular Neurectomy in Patients with Severe Meniere's Disease

Abstract

Objectives: The aim of this study was to evaluate the functional outcomes and balance compensation in patients with severe Meniere's disease after vestibular neurectomy. Methods: Pre- and postoperative results were analyzed in twenty patients with unilateral Meniere's disease before and two years after vestibular neurectomy. Clinical evaluation was performed using a subjective grading scale proposed by the American Academy of Otolaryngology-Head and Neck Surgery and the Dizziness Handicap Inventory. Sensory organization test results were analyzed to assess the balance system before and after the surgery. Results: All patients reported a complete resolution of vertigo attacks after the vestibular neurectomy; 95% of patients reported functional level improvement according to a scale proposed by the American Academy of Otolaryngology-Head and Neck Surgery, and the average score decreased from 4.5 to 1.6. Clinical improvement, evaluated with the Dizziness Handicap Inventory, was present in all patients, with the average result decreasing from 81.7 to 16.4. Analyzing both grading systems, differences between pre- and postoperative results were statistically significant. No statistically significant differences were found between the sensory organization test results before and after vestibular neurectomy. Significant correlations were found between a patient's age and postoperative results of the Dizziness Handicap Inventory and posturography. Conclusions: Vestibular neurectomy is an effective vertigo treatment in patients with severe Meniere's disease with no clinical improvement despite conservative treatment. It results in subjective physical, functional, and emotional improvement, enabling patients to return to daily activities and work. An appropriate qualification of patients and comprehensive preoperative evaluation are essential to obtaining satisfactory clinical outcomes.

Keywords: Meniere’s disease; computerized dynamic posturography; vertigo; vestibular compensation; vestibular neurectomy.

Figure 1

Functional level self-evaluated by patients with severe Meniere’s disease before and two years after middle fossa vestibular neurectomy. A grading scale ranging from 1 to 6, proposed by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), was used. The p-value represents statistical significance.

Figure 2

The results of the Dizziness Handicap Inventory (DHI) in patients with severe Meniere’s disease before and two years after middle fossa vestibular neurectomy. The p-value represents statistical significance. The p-value represents statistical significance.

Figure 3

The results of the sensory organization test (SOT) in patients with severe Meniere’s disease before and two years after middle fossa vestibular neurectomy. Panel (A) general composite score (a weighted average of all the SOT results) and vestibular tests, condition 5 (eyes closed, sway-referenced support) and 6 (eyes open with sway-referenced visual surround, sway-referenced support) results. The p-value represents statistical significance. Panel (B) vestibular (VEST), visual (VIS), somatosensory (SOM), and visual preference (PREF) ratio results. The p-value represents statistical significance.