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The effects of middle ear pressure pulses were studied in 37 patients with a diagnosis of definite Ménière's disease and active vestibular symptoms, 31 of whom had failed to respond to medical treatment including diuretics prior to pressure treatment. The number of vertigo spells during the 6 months prior to treatment and for 6, 18 and 24 months after the start of treatment were evaluated. The functionality level scores were three or worse according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria. The results of the study were as follows: 19 patients experienced freedom from vertigo spells; 15 patients reported a significant decrease in the frequency of vertigo spells; and 3 patients did not respond to pressure treatment and were subjected to gentamicin injections, 1 of whom consequently became deaf in the affected ear. No patient became worse in connection with pressure treatment. With the exception of the three patients who did not respond to pressure treatment, all patients reported an improvement in functionality of at least two levels according to the AAO-HNS functionality scale. No side effects or adverse events were observed during the 2 years of pressure treatment. Overall, the results indicate that pressure treatment provides efficient control of symptoms in patients with intractable forms of Ménière's disease without producing any adverse effects on the inner ear. [ABSTRACT FROM AUTHOR]

Different medical and surgical methods have been tried in attempting to reduce endolymphatic pressure in Ménière's disease. Pressure treatment has a role on the treatment staircase, after pharmacological treatment and before destructive methods. Pressure chamber treatment has shown that some patients respond well to the treatment with diminishing inner ear symptoms and also some hearing improvement. Earlier studies have shown that electrocochlear measurements improve after local pressure treatment in the ear. The present study was a prospective randomized placebo controlled, multicentre clinical trial. 56 patients with active Ménière's disease, age 20-65 years, with a hearing loss of 20-65 dB PTA participated. A total of 31 patients completed 2 weeks use with an active apparatus (Meniett) and 25 patients completed the 2 weeks with the placebo gadget. Both machines were produced by Pascal Medical, Halmstad, Sweden. Two weeks before the start of treatment a grommet was placed in the tympanic membrane. A significant improvement concerning frequency and intensity of vertigo, dizziness, aural pressure and tinnitus was reported by the active group on the visual analogue scales (VAS) questionnaire. In the placebo group no change was the most common finding, followed by worsening of the symptoms and a few improvements. The function in professional and family life improved during active treatment and did not during placebo treatment. Pure-tone audiometry did not improve after placebo treatment, but improved at the frequencies 500 Hz and 1,000 Hz after active treatment. The study showed an improvement in the inner ear symptoms after Meniett treatment. The mechanism may be explained by the influence on the round window membrane pressure receptors or an endolymphatic flow out through the pressure release points, such as the endolymphatic duct and sac, thus activating the longitudinal flow. Other mechanisms are also possible. [ABSTRACT FROM AUTHOR]

Sir, The new, non-destructive technology to control inner ear symptoms in Meniere's disease is presented. A connection between the ambient pressure changes and inner ear symptoms in Meniere's disease has suggested that an inducement of intermittent overpressure in the middle ear can influence inner ear symptoms and relieve attacks of vertigo. The existing body of experimental and clinical evidence indicates that the method can safely be tried on patients who have failed to respond to available medical treatment methods and are candidates for destructive procedures because of intractable inner ear symptoms. [ABSTRACT FROM AUTHOR]