الفهرس 
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Abstract
SUMMARY
Under Meniere’s disease we have mentioned the main aspects
of clinical picture and diagnosis, as well as a short account on
its medical treatment.
The major surgical procedures for Meniere’s disease were
reviewed in more detail and these are:
Endolymphatic sac surgery, with an account on the surgical
anatomy of the ELS, the indication of which seemed to vary
from one surgeon to another and so did the unpredictable
results.
The surgical technique of each of the three main methods
was discussed along with the postoperative complications,
while no variation in results were obtained.
Labyrinthectomy, which, unlike ELS surgery, is a destructive
procedure of the labyrinth was discussed along with its indications
and techniques.
Results here were more positive than those of the ELS surgery
in controlling vertigo.
Slightly better results were obtained by the transcanal labyrinthectomy
with cochleovestibular neurectomy, otherwise differences
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in technique and route of labyrinthectomy gave no variation
In results. Besides sacrifice of hearing, complication rate here
is higher and more serious than in ELS surgery.
Vestibular neurectomy was outlined with its indications and
contraindications. It gave better results in control of vertigo
than ELS surgery, while hearing conservation results were
the same in both. This procedure carries a higher risk of
complications due to its intracrnial route, thus its application
is better to be followed by a trial of ELS surgery.
Sacculotomy . is a drainage procedure of endolymph into perilymph,
same idea as ELS drainage, but it is complicated by
a higher risk of postoperative hearing loss, with the same
or even inferior control onvertigo.
It is thus conserved to elderly patients with unilateral incapacitating
Meriere’s disease as a trial prior to labyrinthectomy.
Ultrasonic destruction of the vestibular labyrinth is a technique
of limited use and uncontrol able outcome with a risk of complications
which overweigh its value.
The results with most surgeons are unsatisfactory with high
incidence of recurrence of vertigo, of loss of cochlear function,
or both.
Cervical sympathectomy, which is based on the vascular
aetiology theory of Meniere’s disease and is applied at a
remote site from the ear, is useful as a trial prior to other
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conservative procedures when hearing is to be preserved,
mainly in bilateral Meniere’s disease.
The risk of hearing loss is negligible, but results of control
of vertigo are less satisfactory (50 % control after 2 years).
It is still not decided as to which surgical procedure is best
for treatment of Meniere’s disease, as none is directed to the
elimination of the aetiological factors which are still uncertain.
So it is left to each surgeon to do the operation that gives the
best results in his own experience.
Under acoustic neuroma, we have reviewed the anatomy of
the ViII cranial nerve, pathology and physiopathology of the tumor,
along with the clinical picture of the condition. Emphasis was
made on the methods of investigation especially the radiological
ones, as it is very important, besides confirming the diagnosis
of the tumor, to estimate its size in order to select the correct
surgical approach and to safeguard against surgical risks, especially
with large tumors. Also prognosis of hearing preservation is directly
dependent on the tumor size.
The three main surgical approaches were discussed as for
their indications, advantages and disadvantages, technique, complications
and results.
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The translabyrinthine approach is the one mainly done by
otosurgeons, while the suboccipital approach, although mainly
done by neurosurgeons in the past, is being recently done in combination
with the otosurgeon. Advantages of each of the above
approaches over the other were discussed along with their indications,
techniques, complications and results.
The middle fossa approach for acoustic neuromas besides
having very few indications, has less advantages than the other
two mentioned above.
Under benign paroxysmal positional vertigo, a comment was
given on its aetiological theory, clinical picture and diagnosis.
Technique of neurectomy of the nerve to the posterior canal
ampulla (Singular neurectomy), which is the surgical treatment
of choice for cases resistant to conservative medical management,
was discussed along with its indications, complications and results.
Under labyrinthitis, we discussed its stages, etiological factors,
clinical picture and management. The later included surgical
drainage of the labyrinth for which we gave a short account and
referred to (Chapter one) under labyrinthectomy for the technique.
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Finally perilymph fistula with its various causes and types
was discussed. Emphasis was made on the spontaneous (barotraurnatic)
fistulas, the etiological theory of which is discussed along
with its clinical picture and investigations. The steps of . management
of spontaneous and traumatic perilymph fistulas (i.e. conservative,
surgical exploration and repair of the fistula if found)
are discussed in detail, along with their indications and results.