Treatments for Meniere’s disease: Fact, Fiction or Biological Plausibility? Part VII

    Ventilating tubes (Myringotomy and tubes)

This is a practice that I have never been personally exposed to in my training and experience. Some physicians believe that the pressure associated with Meniere’s disease can be alleviated by creating an opening between the ear canal and the middle ear. This is accomplished by lancing the eardrum and placing a small tube through the eardrum to keep the hole open. This creates a situation where there cannot be a pressure differential between the ear canal and the middle ear space behind the eardrum.

Previous studies have shown no relationship between middle ear pressure and Meniere’s episodes {{1}}[[1]]Maier W, Ross U, Fradis M, Richter B Ann Otol Rhinol Laryngol. 1997 Jun;106(6):478-82. Middle ear pressure and dysfunction of the labyrinth: is there a relationship?[[1]]. A recent study out of Germany reports that 68% of patient reported some improvement in symptoms of vertigo following insertion of a ventilating tube in the suspected ear, however, there was no improvement in  objective rotational chair tests of the Vestibular-Ocular Reflex. {{2}}[[2]]Park JJ, Chen YS, Westhofen M., Acta Otolaryngol. 2009 Dec;129(12):1408-13. Meniere’s disease and middle ear pressure: vestibular function after transtympanic tube placement. [[2]] Keep in mind that 60% to 80% of Meniere’s patients will report improvement regardless of treatment. I think one can conclude that there is no strong evidence (and frankly very little biological plausibility) that would incline one to have a ventilating tube inserted into their eardrum in the hopes that it would improve the symptoms of Meniere’s disease. This is summed up nicely on the Meniere’s disease information center website:

 The symptom of fullness that is experienced with Meniere’s Disease feels just like air pressure in the middle ear — but it is not air pressure in the middle ear. Meniere’s Disease does not affect the middle ear. Meniere’s Disease has nothing to do with the Eustachian tube, and the typical Meniere’s Disease patient has a fully functioning Eustachian tube. If so, adding a PE tube wouldn’t seem to accomplish anything. Nonetheless, doctors sometimes insert PE tubes into patients who have fully functional Eustachian tubes, and the patients sometimes report improvement with their symptoms, possibly (or probably) due to a placebo effect.

 

 

 

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.