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Biomedical subjects

M J Derebery

Publications and source records attributed to M J Derebery.

13 recordsLinked to original sources
PubMed2000

Allergic management of Meniere's disease: an outcome study.

The effect of allergy immunotherapy and elimination of suspected food allergens was evaluated in patients with Meniere's disease. A total of 137 patients with Meniere's disease for whom allergy treatment had been recommended were identified and were mailed and returned a symptoms questionnaire. One hundred thirteen had received allergy treatment; 24 did not have treatment and served as a control group. Information regarding history, signs and symptoms, allergy test results, and audiologic data were obtained by chart review. The 113 patients treated with desensitization and diet showed a significant improvement from pretreatment to posttreatment in both allergy and Meniere's symptoms. Ratings of frequency, severity, and interference with everyday activities of their Meniere's symptoms also appeared better after allergy treatment than ratings from the control group of untreated patients. Vertigo control results, by use of the American Academy of Otolaryngology-Head and Neck Surgery classification, categorized 47.9% as class A or B. Hearing was stable or improved in 61.4%. Patients with Meniere's disease can show improvement in their symptoms of tinnitus and vertigo when receiving specific allergy therapy. The inner ear may be the target, directly or indirectly, of an allergic reaction.

Desensitization, Immunologic↗
PubMed2000

Prevalence of allergy in Meniere's disease.

OBJECTIVES: The goal of this study was to determine the prevalence of allergy in a population of patients with Meniere's disease. METHODS: A survey was mailed to all patients with Meniere's disease seen at our institution from 1994 to July 1998 (n = 1490). As a control group, 172 patients with otologic problems other than Meniere's disease completed the same survey. RESULTS: Of 734 respondents with Meniere's disease, 59.2% reported possible airborne allergy, 40.3% had or suspected food allergies, and 37% had had confirmatory skin or in vitro tests for allergy. These prevalence rates were significantly higher than those found in the control group, of which 42.7% reported having or suspecting airborne allergies and 25% had or suspected food allergies (differences all significant at P< or =0.005). CONCLUSION: The prevalence of allergy appears to be much higher in patients with Meniere's disease than in the general population or the population of patients visiting an otologic clinic for other symptoms.

Adolescent↗
PubMed2000

Allergy and health-related quality of life.

OBJECTIVE: We asked patients with allergies to complete the SF-36 Health Survey, a health-related quality-of-life (QOL) measure, to determine the impact of allergy on QOL. STUDY DESIGN AND SETTING: In total, 377 adults-140 men (37%) and 237 women (63%)-seen in a tertiary care private neurotologic practice allergy clinic completed the questionnaire before beginning immunotherapy and dietary management. One hundred patients completed both initial and 1-year follow-up questionnaires. The SF-36 measures 8 health concepts ranging from physical to mental health, and scale scores range from 0 to 100. RESULTS: Initial mean scores ranged from a high of 79.1 for the physical functioning scale to a low of 47.2 for the vitality scale, lower (poorer) on all scales than norms for the general US population. Significant improvement occurred from initial to follow-up on all scales. The largest improvements were in role functioning-physical, role functioning-emotional, and social functioning. CONCLUSION: Findings suggest that allergy symptoms can affect QOL and that treatment with specific immunotherapy and/or dietary management may lead to measurable improvements. SIGNIFICANCE: The significant impact of allergy must be recognized, and treatment should be offered. The SF-36 can be used to evaluate treatment outcome.

Adaptation, Physiological↗
PubMed1999

The diagnosis and treatment of dizziness.

Dizziness is a complex and frustrating symptom of potentially numerous causes. The history and physical examination can elicit the category that best characterizes the dizziness: vertigo, presyncope, dysequilibrium, or lightheadedness. If the cause of dizziness cannot be found or treated directly, medications may suppress symptoms. Surgery for vertigo includes conservative and destructive procedures. Rehabilitation is often a useful adjunct in the treatment of many types of dizziness.

Brain Diseases↗
PubMed1998

Allergy for the otologist. External canal to inner ear.

Allergy may affect the outer, the middle, or the inner ear. Although the otologic manifestations of allergy are not by themselves diagnostic, the history, including family history and associated symptoms in other target organs, will often help lead to the correct diagnosis and institution of therapy. Patients with significant and chronic symptoms, including those with labyrinthine symptoms of allergy, will respond well to specific immunotherapy and/or dietary elimination.

Anti-Allergic Agents↗
PubMed1998

Transient deafness due to temperature-sensitive auditory neuropathy.

OBJECTIVE: To define mechanisms accounting for transient deafness in three children (two siblings, ages 3 and 6, and an unrelated child, age 15) when they become febrile. DESIGN: Audiometric tests (pure-tone audiometry, speech and sentence comprehension), tympanometry, middle ear muscle reflex thresholds, otoacoustic emissions (OAEs), and electrophysiological methods (auditory brain stem responses [ABRs], sensory evoked potentials, peripheral nerve conduction velocities) were used to test the children when they were afebrile and febrile. RESULTS: ABRs, when afebrile, were abnormal with a profound delay of the IV-V and absence of waves I-III. The ABR in one of the children, tested when febrile, showed no ABR components. Measures of cochlear receptor function using OAEs were normal in both febrile and afebrile states. Cochlear microphonic potentials were present in the three children, and a summating potential was likely present in two. When afebrile, there was a mild threshold elevation for all frequencies in the 15-yr-old and a mild elevation of thresholds for just low frequencies in the two siblings. Speech comprehension in quiet was normal but impaired in noise. One of the siblings tested when febrile had a profound elevation (>80 dB) of pure-tone thresholds and speech comprehension was absent. Acoustic reflexes subserving middle ear muscles and olivocochlear bundle were absent when febrile and when afebrile. No other peripheral or cranial nerve abnormalities were found in any of the children. Sensory nerve action potentials from median nerve in one of the children showed no abnormalities on warming of the hand to 39 degrees C. CONCLUSION: These children have an auditory neuropathy manifested by a disorder of auditory nerve function in the presence of normal cochlear outer hair cell functions. They develop a conduction block of the auditory nerves when their core body temperature rises due, most likely, to a demyelinating disorder of the auditory nerve. The auditory neuropathy in the two affected siblings is likely to be inherited as a recessive disorder.

Acoustic Impedance Tests↗
PubMed1997

Allergic eustachian tube dysfunction: diagnosis and treatment.

OBJECTIVE: The objective of this study was to describe the characteristics and response to specific allergy therapy of patients with clinically significant eustachian tube dysfunction secondary to allergy. STUDY DESIGN: This was a retrospective case review conducted in the setting of a private otologic practice (tertiary referral). PATIENTS: The study population was composed of 151 patients presenting with eustachian tube dysfunction who had evidence of allergy and had undergone allergy testing and treatment. The 105 females and 50 males ranged in age from 2.8 to 84 years (mean 41.8 +/- 17.3). INTERVENTIONS: Interventions used included diagnostic allergy testing (inhalants and food) and treatment with immunotherapy and diet. MAIN OUTCOME MEASURES: The main outcome measures were descriptive characteristics and ratings of fullness, allergy symptoms, and well-being rated as "improved," "no change," or "worse." RESULTS: All patients had reactivity to inhalants, and 92.3% were positive to one or more foods. Nearly half of the patients (49.4%) had undergone at least one advanced test beyond an audiogram as part of their diagnostic evaluation before referral to a tertiary center for treatment. Forty percent had undergone radiological assessment. Nearly all had used one or more other treatments without success before allergy therapy. The majority were rated as improved on all three symptoms (fullness 70.9%; allergy symptoms 82.8%; and well-being 80.2%). Adherence to the recommended elimination diet was significantly related to outcome. CONCLUSIONS: Eustachian tube dysfunction may be due to underlying inhalant and/or food allergies. Even patients with refractory cases of patulous eustachian tube and eustachian tube obstruction who have not responded to traditional medical and surgical management may do well on specific allergy therapy.

Adult↗
PubMed1997

The role of allergy in Meniere's disease.

There is considerable clinical and immunologic evidence for a probable role of allergy in the production of the symptoms of Meniere's disease. The endolymphatic sac is the seat of immune reactivity in the inner ear. Inhalant and food allergies have been linked with symptoms of Meniere's disease, and many of the clinical characteristics of Meniere's disease suggest an underlying autoimmune etiology. A significant percentage of patients with Meniere's disease and allergy show improvement in their symptoms of tinnitus and vertigo when receiving specific allergy therapy.

Antigens↗
PubMed1996

Allergic and immunologic aspects of Meniere's disease.

Meniere's disease, although idiopathic by definition, has been ascribed to a variety of causes, which more recently include autoimmune factors. Interest in the role of allergy in Meniere's disease has also increased. Studies from this institution and elsewhere provide evidence that allergy and immunologic factors play a role in Meniere's disease in at least some patients. The symptoms of Meniere's disease are thought to be produced by a sudden influx of fluid into the endolymphatic sac, producing a rupture of Reissner's membrane in the cochlea. The endolymphatic sac is capable of trapping antigen and generating its own immune response. It has a highly vascular subepithelial space containing numerous fenestrated blood vessels that are peripheral and "leaky." At least three mechanisms by which allergy may play a role in the production of fluid in the endolymphatic sac are described: the endolymphatic sac itself might be a "target organ" of mediator released from systemic inhalant or food reactions; deposition of circulating immune complex may produce inflammation and interfere with the sac's filtering capability; and a predisposing viral infection in childhood that produces a mild impairment of endolymphatic sac function may interact with allergies in adulthood and cause the endolymphatic sac to decompensate, resulting in endolymphatic hydrops. The endolymphatic sac is the seat of immune reactivity in the inner ear. Repeated inflammatory reactions can produce sac dysfunction and eventual production of Meniere's disease.

Adult↗
PubMed1993

Otolaryngic allergy.

The treatment of chronic sinusitis and nasal polyposis requires an interface between allergy and otolaryngology. The tendency of allergy to produce chronic symptoms from repeated exposure to inhalant or food antigens plays a role in both the production and chronicity of sinus disease. Mild, seasonal, or easily avoidable allergens may be well treated by proper selection of antihistamines, cromolyn sodium, topical steroids, or the judicious use of systemic steroids, as well as environmental control. More severe or perennial symptoms require identification by in vivo or in vitro testing techniques, with desensitization for offending inhalant allergens and dietary restrictions or injection therapy for food antigens. The otolaryngologist dealing with sinus disease is in a unique position to offer optimal patient care by combining surgical skills with specific medical treatment of allergy.

Adrenal Cortex Hormones↗
PubMed1992

Ménière's syndrome and allergy.

The role of allergic and autoimmune factors in both the production and amplification of symptoms of Ménière's disease has yet to be clearly defined. Reasons to suspect an allergic factor influencing Ménière's disease include a relationship with symptoms to seasons or a suspect food, a known history of allergy in a Ménière's patient, bilaterality of symptoms, and refractoriness to the usual medical and surgical treatments. The majority of patients tested in this study were found to have rather low levels of sensitivity to inhalant allergens as measured by SET, and to have food reactions to very common "hidden" foods that are frequently ingested in the diet. By proper recognition and treatment of the underlying allergic factors affecting Ménière's disease, significant clinical improvement may be obtained even in longstanding or refractory cases.

Adult↗
PubMed1991

Menière's disease: an immune complex-mediated illness?

The cause of Menière's disease is unknown. Recent clinical research suggests that one etiology is immune-mediated damage to the inner ear. The diagnosis of autoimmune Menière's syndrome is largely based on history, response to steroids, or results of nonspecific laboratory tests such as serological studies. Polyethylene glycol (PEG) assay was used to determine levels of circulating immune complexes (CIC) in 30 patients with Menière's disease and 20 control subjects. Patients with Menière's disease had a statistically significant elevation of serum circulating immune complexes when compared to the control group. This suggests that CICs may be involved in the pathogenesis of Menière's disease, either as a direct cause of damage, or as a by-product of an underlying autoimmune abnormality. Therapeutic implications include use of plasmapheresis to remove the complexes or CIC monitoring to serve as a marker for treatment efficacy.

Adult↗