A patient with definite Meniere's disease has failed dietary sodium restriction, betahistine, and diuretics. The next treatment step that reduces vertigo attacks without sacrificing hearing is:
- A Endolymphatic sac surgery (decompression or shunt) ✓
- B Intratympanic gentamicin (chemical labyrinthectomy)
- C Intratympanic dexamethasone injections
- D Labyrinthectomy via transmastoid route
Correct answer: A. Endolymphatic sac surgery (decompression or shunt)
Explanation
Endolymphatic sac decompression or shunt surgery aims to relieve endolymphatic hydrops and control vertiginous attacks while preserving cochlear function (hearing-preserving procedure). It is indicated when medical therapy fails and serviceable hearing remains. Intratympanic dexamethasone controls attacks but has lower long-term efficacy than surgery. Intratympanic gentamicin reduces vestibular function (partially ablative) with some risk of hearing loss. Labyrinthectomy permanently destroys 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.