The figure represents a proposal of an algorithm for MD treatment as an ICON obtains for the IFOS meeting 2017. The first line of treatment includes medical conservative treatment. After this line of treatment, 80% of patients with MD are cured or in remission. Then the second line is the IT injections, mainly ITC as a conservative treatment and ITG in case of failure and preferentially in patients with hearing impairment. After this second line, 90% to 95% of the patients are cured or in remission. The third line is the surgical, conservative, or destructive treatment. If indicated, ELSS must be indicated before ITG.
ITC, intratympanic injection of corticosteroids; DXM, dexamethasone; ITG, intratympanic injection of gentamycin; ELSS, endolymphatic sac surgery; VN, vestibular neurectomy; labyrinthectomy +/- Cl (with and without gentamycin); ICON, international consensus; MD, Ménière's disease
Reproduced from Nevoux J, Barbara M, Dornhoffer J, Gibson W, Kitahara T, Darrouzet V: International consensus (ICON) on treatment of Ménière’s disease. Eur Ann Otorhinolaryngol Head Neck Dis. 2018, 135:S29–32. 10.1016/j.anorl.2017.12.006 Permission by permissionfranceelsevior.com