Pressure Therapy in Bilateral Ménière's Disease: A Prospective Study.

BACKGROUND: Ménière's disease (MD) is an inner ear disorder characterized by unpredictable vertigo attacks, tinnitus, and aural fullness, ultimately leading to a decline in audiovestibular function. Linked to endolymphatic hydrops (EH), MD often progresses to bilateral involvement (BMD). When conservative therapies fail, MD requires destructive treatments. However, this is a high-risk choice in bilateral cases for hearing preservation. Pressure therapy (PT), a non-invasive treatment using low-pressure pulses to the middle ear, has shown potential in reducing EH and alleviating MD symptoms. This study aims to evaluate the efficacy of PT in treating BMD. METHODS: This prospective study enrolled patients with BMD refractory to standard therapy. Electrocochleography (ECochG) using click stimuli was used to identify the active MD ear. Patients underwent PT for 24 months on the affected side. Outcomes were re-assessed using the ECochG Summating Potential-to-Action Potential (SP/AP) ratio and the Dizziness Handicap Inventory (DHI) after 1, 3, 6, and 24 months. The contralateral ear was used as a control. RESULTS: Pressure therapy significantly reduced the EH (ECochG SP/AP ratio) in active MD ears (P < .001) and improved DHI scores (P < .001). The contralateral non-treated ear showed no significant changes (P=.9687). CONCLUSION: Pressure therapy alleviates symptoms and improves quality of life in refractory BMD, offering a non-destructive alternative before invasive procedures in case of standard conservative therapy failure.