A patient with definite Meniere's disease has failed medical management (betahistine, diuretics, low-salt diet). She has good serviceable hearing (PTA 35 dB, speech discrimination 70%). Which surgical intervention has the best hearing-preservation outcome for vertigo control?
- A Labyrinthectomy — complete ablation of labyrinth for maximum vertigo control
- B Intratympanic gentamicin (chemical labyrinthectomy) — total ablation of vestibular function
- C Cochlear nerve section — cuts cochlear nerve while preserving vestibular nerve
- D Endolymphatic sac decompression/shunt — hearing-preserving procedure for vertigo control ✓
Explanation
In Meniere's disease with good residual hearing, hearing-preservation procedures are preferred. Endolymphatic sac decompression (ELS decompression/shunt) aims to reduce endolymphatic hydrops by surgically decompressing or shunting the endolymphatic sac. It controls vertigo in ~60–80% of cases and preserves hearing. Vestibular nerve section (retrolabyrinthine or translabyrinthine approach) also preserves hearing while definitively cutting vestibular input, but is more invasive. Intratympanic gentamicin causes partial or complete chemical ablation of vestibular hair cells — hearing risk is dose-dependent and present. Labyrinthectomy sacrifices all hearing and is reserved for non-serviceable hearing.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.