Chronic cerebrospinal venous insufficiency and Menière's disease: interventional versus medical therapy

Objectives/Hypothesis: To evaluate the incidence of chronic cerebrospinal venous insufficiency in Menière's disease patients and the effect of bilateral percutaneous transluminal angioplasty of the jugular/azygos veins compared to medical therapy. Study Design: Prospective case–control study. Methods: Five hundred fourteen subjects were included in the study, 412 affected by definite Menière's disease, and 102 healthy controls. All patients underwent audiovestibular and vascular examination. Patients with Menière's disease and concomitant cerebrospinal venous insufficiency were divided in two subgroups: patients who underwent vascular intervention with bilateral percutaneous transluminal angioplasty (PTA) of the jugular/azygos veins and patients treated with medical therapy. Results: Chronic cerebrospinal venous insufficiency was diagnosed in 330/412 (80.1%) Menière's disease patients and in 12/102 healthy individuals (11.8%) (P <.001). In the two chronic cerebrospinal venous insufficiency subgroups, a significant difference in Dizziness Handicap Inventory scores was found between patients in the PTA group compared to patients treated with medical therapy (31 ± 8.6 vs. 48.1 ± 14.4; P <.001); no significant differences were found for the Tinnitus Handicap Inventory scores (50.8 ± 16.58 vs. 49.6 ± 17.5; P =.23). Subjective evaluation of aural fullness was significantly better in patients in the PTA group (P =.003) as well as pure-tone average, which was significantly different between groups (49.8 ± 16.5 dB in the PTA group vs. 55.8 ± 13 in the medical therapy group; P =.035). Conclusions: The results of the present study confirm the close relationship between vascular disorders and Menière's disease. The encouraging responses to vascular interventional therapy on Meniére's disease symptoms suggest that this may be a promising path for interpretation and treatment of this complex disease. Level of Evidence: 2b Laryngoscope, 2019.