Meet the editor

Professor Fayez Bahmad Jr. is a doctor of medicine and specialist in otology and neurotology. He lives in Brasilia (the Brazilian capital). He did an ENT residency program at the University of Brasilia Hospital in otolaryngology between 2002 and 2005, and received his PhD from the University of Brasilia—Medical School under the orientation of Professor Carlos A. Oliveira, MD, PhD. Professor Oliveira established an otopathology laboratory in his

department, which is one of the most well-respected research groups in otology in Brazil and South America. Professor Bahmad received a Fellowship in Otology and Neurotology from the Massachusetts Eye and Ear Infirmary, Harvard Medical School, and a Fellowship in Human Genetics from the Seidman Laboratory, Department of Genetics, Harvard Medical School, where he was engaged in research projects under the mentorship of Professor Saumil N. Merchant MD, PhD, and Professor Jonathan Seidman MD, two of the foremost researchers in otology, otopathology, and hearing pathogenetics. In 2019 he became Professor Livre-docente of Ophthalmology and Otorhinolaryngology, Department of the University of Sao Paulo, Sao Paulo, Brazil. He has experience in medicine, focusing on otological surgery, acting in the following subjects: hearing loss and tinnitus. He is the Director of the Brasiliense Institute of Otolaryngology, editor in chief of *The International Tinnitus Journal*, and a professor at the Health Science Faculty at the University of Brasilia, Brazil.

Contents

**Section 1**

**Section 2**

**Section 3**

**Section 4**

**Section 5**

*by Fayez Bahmad Jr*

*by Carlos A. Oliveira*

**Preface III**

Introduction **1**

**Chapter 1 3**

Etiopathogenesis **11**

**Chapter 2 13**

Nonsurgical Treatment **35**

**Chapter 3 37**

Intratympanic Treatment for Meniere's Disease **65**

**Chapter 4 67**

**Chapter 5 77**

Surgical Treatment **93**

**Chapter 6 95**

The Treatment of Meniere's Disease by the Intratympanic Therapy *by Maria Stella A. Amaral, Henrique F. Pauna, Ana Claudia M.B. Reis* 

Intratympanic Gentamicin Treatment for Ménière's Disease

Introductory Chapter: Ménière's Disease (MD)

Menière's Disease: Etiopathogenesis

Meniere's Disease: Nonsurgical Treatment *by Yetkin Zeki Yilmaz, Begum Bahar Yilmaz* 

*and Aysegul Batioglu-Karaaltın*

*and Miguel A. Hyppolito*

*by Yongchuan Chai and Hongzhe Li*

Surgical Procedures for Ménière's Disease *by Ricardo Ferreira Bento and Paula Tardim Lopes*

## Contents


#### **Section 6**

Future of Surgical Treatment **107**

#### **Chapter 7 109**

Meniere's Disease: Surgical Treatment *by Yetkin Zeki Yilmaz, Begum Bahar Yilmaz and Mehmet Yilmaz* Preface

Ménière's disease is an alteration of the inner ear characterized by two groups of symptoms: vestibular symptoms and auditory symptoms. Classical symptoms such as fluctuating hearing loss, tinnitus, atrial fullness, and concomitant dizziness greatly aid the otorhinolaryngologist to diagnose carriers of the disease. But in

In this book we will adopt the term Ménière's disease to follow the prevailing trend among most research groups and discuss the main topics and current and past ideas about the etiopathogenesis, diagnosis, and treatment of Ménière's disease and

It is likely that there are genotypic—racial as well as phenotypic—environmental factors that influence the prevalence difference between countries. One of the major problems in this respect is that the initial presentation of the disease is often the cochlear form, which is not clinically recognized, and is again attributed to another specific cause or is presumed to be simply due to aging. Even after the vestibular component becomes obvious, long periods of remission may mask the complete final image of the syndrome with episodic vertigo, fluctuating autistic loss, tinnitus, and aural fullness. Therefore, generally, in clinical practice, only moderate to severe

Some of the epidemiologically published studies to date have tended to blend different epidemiological concepts. The direction of these studies is mainly retrospective (the themes are identified after a result or illness), and they actually measure only prevalence (existing events or the number of cases of a disease at a given moment divided by the population at risk). Only prospective studies (subjects are identified before a result or illness, and future events are counted) would have the power to adequately measure this incidence. Although more reflective of real life than an artificial experiment, retrospective observational studies are susceptible

The multiplicity of diagnostic criteria is another problem that makes it difficult to establish the true incidence of Ménière's disease in the general population. In 1972 the Committee on Hearing and Equilibrium of the American Academy of Otorhinolaryngology proposed a specific definition of the disease and guidelines for the evaluation of Ménière's disease in communicating treatment results. In 1985, it was considered that the definition of Ménière's disease needed to be restricted to cases with a complete set of classic signs and symptoms. The 1995 criteria were intended to simplify the definition of Ménière's disease and allow greater flexibility, making it usable in a wide range of studies and classifications. A minimum set of signs and symptoms must be noted in such a way that the degree of certainty of the

Currently, there is no universally accepted theory about the pathophysiology of this disease. Through histopathological studies, it is presumed that endolymphatic hydrops is the most descriptive pathological characteristic of Ménière's disease.

many patients, their presentation may be different.

Ménière's disease associated with migraine.

cases have been tabulated in the estimates so far.

to bias.

diagnosis can be established.
