BlueCross BlueShield of Tennessee Medical Policy Manual

Transtympanic Micropressure Applications as a Treatment of Ménière's Disease

DESCRIPTION

Transtympanic micropressure treatment has been proposed as an alternative treatment for Meniere disease. This treatment involves use of a handheld device (e.g. Meniett®) that delivers air pressure pulses to the ear. Symptoms of Ménière's disease include episodes of vertigo, tinnitus, varying levels of hearing loss, and a feeling of fullness/pressure in the ear. Conservative therapy includes a low sodium diet and diuretics to reduce fluid accumulation (i.e., hydrops) and pharmacologic therapy to reduce vestibular symptoms.

Use of the transtympanic micropressiure device consists of two phases. During the first phase, a conventional ventilation tube is surgically placed in the eardrum of the ear to be treated. During the second phase, the individual is instructed to place an ear-cuff in the external ear canal to minimize leakage to the external environment. The device is then used for 5-minute sessions that are self-administered three times a day in the home setting. Treatment is continued for as long as the individual is having symptoms.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Evidence for transtympanic micropressure therapy as a treatment for Ménière's disease includes randomized controlled trials and systematic reviews. The systematic reviews of the trials revealed that micropressure therapy does not result in better improvement of vertigo than placebo. The evidence is satisfactory to determine qualitatively that the technology is not likely to improve the net health outcome.

SOURCES

Ahsan, S., Standring, R. and Wang, Y. (2015). Systematic review and meta-analysis of Meniett therapy for Meniere’s disease. The Laryngoscope, 125, January 2015. (Level 4 evidence)

American Academy of Otolaryngology - Head and Neck Surgery. (2016, March). Position statement: Micropressure therapy. Retrieved September 8, 2016 from http://www.entnet.org.

BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2017). Transtympanic micropressure applications as a treatment of Ménière's disease (1.01.23). Retrieved July 25, 2017, from BlueWeb. (17 articles and/or guidelines reviewed)

Greenberg, S. L., & Nedzelski, J. M. (2010). Medical and noninvasive therapy for Meniere’s disease. Otolaryngology Clinics of North America, 43 (2010), 1081-1090. (Level 5 evidence)

Mattox, D. E., & Reichert, M. (2008). Meniett device for Ménière's disease: Use and compliance at 3 to 5 years. Otology & Neurotology, 29 (1), 29-32. (Level 4 evidence - Industry sponsored)

National Institute for Clinical Excellence (NICE). (2012, April). Micropressure therapy for refractory Ménière's disease. NICE interventional procedure guidance 426. Retrieved March 7, 2014 from http://www.nice.org.uk.

Russo, F., Nguyen, Y., De Seta, D., Bouccara, D., Sterkers, O., Ferrary, E., et al. (2016). Meniett device in Meniere disease: Randomized, double-blind, placebo-controlled multicenter trial. Laryngoscope, 2016 Aug 12, [Epub ahead of print]. Abstract retrieved September 8, 2016 from PubMed database.

Syed, M. I., Rutka, J. A., Hendry, J. & Browning, G. G. (2015). Positive pressure therapy for Meniere’s syndrome/disease with a Meniett device: a systematic review of randomised controlled trials. Clinical Otolaryngology, 40 (3), 197-207. Abstract retrieved September 8, 2016 from PubMed database.

U. S. Food and Drug Administration. (1999, December). Center for Devices and Radiological Health. Premarket notification database. K991562. Retrieved August 12, 2011 from http://www.accessdata.fda.gov.

Van Sonsbeek, S., Pullens, B., & van Benthem, P. (2015, March). Positive pressure therapy for Meniere’s disease or syndrome. Cochrane Database Systems Review. Abstract retrieved November 2, 2015 from PubMed database.

Zhang, S. L., Leng, Y., Liu, B., Shi, H., Lu, M., & Kong, W. J. (2016). Meniett therapy for Ménière's disease: An updated meta-analysis. Otology & Neurotology, 37 (3), 290-298. Abstract retrieved September 8, 2016 from PubMed database.

ORIGINAL EFFECTIVE DATE:  1/1/2004

MOST RECENT REVIEW DATE:  9/14/2017

ID_BA

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.