The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Micropressure therapy for refractory Ménière's disease.


Ménière's disease is a disorder of the inner ear that can affect hearing and balance, which gets worse over time. Symptoms vary in severity and usually start in one ear but can affect the other in time. The cause is not known but it is thought to result from a rise in pressure in the fluid that bathes the nerve endings in the inner ear. Medications and/or a low salt diet aim to treat symptoms (usually the loss of balance and dizziness) but if they fail, surgery can be used to reduce pressure in the inner ear and correct problems with balance. Micropressure therapy involves inserting a grommet (small tube) through the eardrum into the middle ear and blowing air at low pressure into the inner ear. This aims to reduce pressure in the ear, relieving symptoms and avoiding the need for more invasive surgery.

Coding recommendations

D23.8 Other specified operations on inner ear

In addition ICD-10 code H81.0 Ménière’s disease is assigned.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)