Endoscopic tenotomy of the middle ear muscles as a Meniere’s disease treatment: case report and review of the literature

By June 7, 2019

Tenotomy of middle ear muscles is a recent and widely misunderstood new method to treat Meniere attacks. It has been demonstrated to be effective in decreasing or eliminating aural fullness and dizziness symptoms as well as improving hearing levels. However, mechanism of development of Meniere’s disease and the reason why this treatment works remains unknown.

A 57-year-old woman complaining about stablished clinic of dizziness, aural fullness, tinnitus and right ear low frequencies neurosensorial hearing loss. She had up to four weekly episodes of many hours long each. She was treated with Betahistine, diuretics and intratympanic injection of Dexamethasone with no benefit.  We proposed her rather intratympanic injection of Gentamicin or endoscopic tenotomy of the TTM and SM and she leant for the latter option.

After the surgery the attacks decreased to a few episodes monthly of less than 5 minutes each of unspecific mild instability. The aural fullness completely gone. Tinnitus and hearing level remained the same.

The mechanism of action of middle ear ossicles and muscles and their influence in the inner ear dynamic pressure has been studied for many years.

Endolymphatic hydrops is an accepted cause of Meniere disease and their triggering symptoms (6)

It has been suggested that the ossicular chain actively pressed against the oval window would increase the inner ear pressure in cochlear hydrops of Meniere’s disease.

We propose that the outward movement of the stapes in stapes muscle contraction could be responsible for the development of the disease.