メニエール病・遅発性内リンパ水腫に対する中耳加圧治療効果の検討

In September 2019, we introduced a tympanic membrane massage device for transtympanic positive-pressure therapy at our institution. This treatment is selected for patients definitively diagnosed as having Ménière’s disease (Stage 4) or delayed endolymphatic hydrops with recurrent vertigo attacks, who insist on omit conservative treatment. In the past, surgical treatments, such as endolymphatic sac surgery and selective vestibular neurectomy were considered for patients with the symptoms described above. At present, however, we proactively provide transtympanic positive-pressure therapy using the above-mentioned tympanic membrane massage device, because it is very minimally invasive and easy to perform. Until September 2020, we have provided transtympanic positive-pressure therapy using the tympanic membrane massage device to 24 patients (including 20 patients with definitively diagnosed Ménière’s disease and 4 with definitively diagnosed delayed endolymphatic hydrops). In these patients with a definitive diagnosis, the vertigo coefficient was calculated, and the therapeutic effect of this treatment modality was examined. The following six factors were used to calculate the vertigo coefficient: subjective distress level, daily life limitations, number of vertigo attacks per month, and scores on the DHI (Dizziness Handicap Inventory) and VAS (Visual Analog Scale). Our findings revealed the following two useful effects of trans-tympanic positive pressure therapy using the aforementioned device: 1) the scores for subjective distress level and daily life limitations decreased during the course of treatment (p<0.001), and 2) the number of vertigo attacks per month decreased significantly after one month of treatment could be omitted (p= 0.001). Thus, our present study demonstrated that “transtympanic positive-pressure therapy using the tympanic membrane massage device” is an effective treatment method for alleviating the symptoms of intractable Ménière’s disease and definite delayed endolymphatic hydrops. Long-term follow-up of the patients is warranted to establish the usefulness of this treatment.