Current Management Practices in Ménière's Disease
To evaluate current trends in managing Ménière's disease (MD) by both general otolaryngologists and otologists/neurotologists and discuss treatment modalities.Study Design:
Survey of physicians.Subjects and Methods:
An electronic questionnaire was disseminated to all members of American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS).Results:
Eight hundred and sixty members replied for a response rate of 14.5% for generalists and 35% for neurotologists. Thirty-nine percent of respondents think that diet and lifestyle changes are effective in controlling symptoms in more than 50% of their MD patients. Overall, 72.8% of respondents used hydrochlorothiazide/triamterene (HCTZ/TAT) “often” or “always” with neurotologists using HCTZ/TAT more often than generalists (p < 0.001). Half of neurotologists used IT steroids “often” or “always,” compared with only 10% of generalists (p < 0.001). Endolymphatic sac procedures are the most common surgeries and are used more often by neurotologists than by generalists (p < 0.001). The Medtronic Meniett device is used more by neurotologists (p < 0.001) but it is not commonly used overall (69.2% “never” use).Conclusion:
Many options are available for the treatment of MD. Neurotologists tend to use a wider variety of medications in their treatment protocols than generalists. Neurotologists tend to perform surgical interventions more frequently than generalists. Our evidence shows significant heterogeneity for treatment of Ménière's disease among otolaryngologists. A guideline that outlines appropriate therapeutic options, dosing, and treatment escalation is warranted.