両側メニエール病に対する内リンパ嚢手術の適応とその成績

Results and Indication of the Endolymphatic Surgery for Bilateral Meniere's Disease

I．はじめに

　メニエール病は一側性の疾患であると考えられていたが，最近は両側罹患が問題とされ，筆者らの経験では約3割が両側性であることがわかった。このような両側メニエール病は，経過年数が長く，その予後も両側とも高度難聴もしくは全襲となる恐れがある深刻な疾患であるが，このような両側メニエール病に対していかなる手術適応を考えるかは議論の分かれるところである。そこで筆者らは東京大学耳鼻咽喉科前庭外来にて両側メニエール病と診断され一側の内リンパ嚢手術を行った23例について，その臨床像と手術成績を報告し，両側メニエール病に対する手術適応について考察を加えた。

　Bilateral Meniere's disease is a serious disease of long duration and its prognosis is poor. It may result in severe hearing loss or profund hearing loss. There are controversies concerning indications of operations for Meniere's disease. In this paper the author described clinical picture, results of dehydration tests and operative results obtained in 23 cases (27%) of bilateral Meniere's disease out of a total of 86 surgical cases for endolymphatic sac operation. Nine of these 23 cases were operated for ears with good hearing acuity and 14 cases for those with poor hearing acuity. In all of these cases furosemide test was positive, and the incidence of positive results was higher for ears with good hearing acuity than those with poor hearing. In many of the ears with good hearing acuity, hearing improvement was occurred postoperatively, while in most cases with poor hearing acuity no change of hearing acuity was seen after the operation. The incidence of improvement in vertigo was also higher for ears with good having acuity. No difference was seen in terms of the percentage of improvement in tinnitus between ears with good and poor hearing. From these results, it is recommended that the surgery should be performed actively even in ears with good hearing acuity.