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PubMed1983

The effect of stapedectomy on hearing of patients with otosclerosis and Meniere's disease.

To determine new guidelines for stapedectomy in patients with both Meniere's disease and otosclerosis, we studied the position of the saccular membrane and Reissner's membrane in relation to the stapes footplate in eight temporal bones from patients with Meniere's disease. We also reviewed charts of four patients with both otosclerosis and Meniere's disease who had stapedectomy. Histologic and clinical findings were compared with preoperative bone conduction levels at 500 Hz and at high frequencies. We found that the saccular and Reissner's membranes did not contact the stapes footplate ain bones of patients with preoperative bone conduction levels of 35 dB or better at 500 Hz and no high-frequency loss. We also found that stapedectomy was successful in patients with the same criteria. We therefore conclude that stapedectomy does not increase the risk of sensorineural hearing loss for patients with otosclerosis and Meniere's disease who have bone conduction levels of 35 dB o better at 500 Hz and no high-tone loss, but it is contraindicated for patients with 45 dB at 500 Hz or worse and with high-tone loss.

Hearing Loss, Sensorineural↗
PubMed2001

Use of the round window microcatheter in the treatment of Meniere's disease.

OBJECTIVES/HYPOTHESIS: Transtympanic gentamicin is an increasingly popular treatment for Meniere's disease. The present report examines the 2-year follow-up of our first 27 patients with Meniere's disease treated with the use of microdose gentamicin through the Round Window Microcatheter. We applied the 1995 American Academy of Otolaryngology-Head and Neck Surgery criteria to this patient group to analyze the results of treatment. STUDY DESIGN: This study is an evaluation of consecutive patients with predetermined data collection on each patient. METHODS: Patients with confirmed Meniere's disease underwent placement of the Round Window Microcatheter, which was filled with 10 mg/mL gentamicin, after placement into the round window niche was confirmed. Ten milligrams per milliliter of gentamicin was injected into the catheter by hand on two occasions after device placement in the first several patients. The remaining patients had continuous infusion of 10 mg/mL gentamicin at 1microL/h for the next 10 days. The catheter was removed 10 days after placement. All patients underwent an extensive set of hearing and vestibular tests on several occasions before, during, and after treatment. RESULTS: In the patients in the study, vertigo was eliminated in 92.6%, with 3.7% of patients (1/27) demonstrating a mild permanent threshold shift in hearing. Tinnitus and pressure were significantly reduced in more than 65% of patients. Only one patient demonstrated a reduction of vestibular function after treatment. CONCLUSIONS: Results of this study on this group of patients indicate that vertigo can be controlled in the long term using microdose gentamicin without a significant reduction in cochlear or vestibular function in most of the patients in our series. Our results are compared with the published literature examining transtympanic injection. In addition, the underlying science supporting this type of treatment is examined.

Adult↗
PubMed1997

Demonstration of autoantibodies to the endolymphatic sac in Meniere's disease.

Recent evidence suggests that immune mechanisms may underlie some cases of Meniere's disease. This study was conducted to determine whether an autoimmune mechanism is involved. Sera from 30 patients with Meniere's disease were reacted with human endolymphatic sacs and examined by indirect immunohistochemistry and fluorescence microscopy. Three of the samples (10%) showed positive staining, indicating immunoglobulin G (IgG) binding against the sac. No positive staining occurred when sera from healthy individuals or phosphate-buffered saline was used as a control. Clinical data showed an association between immunoreactivity and extent of disease (worse hearing over a shorter disease course and bilateral involvement). This study suggests that, in some cases of Meniere's disease, autoantibodies directed against human endolymphatic sac are present in the sera, supporting the theory that a specific autoimmune reaction takes place in a minority of patients with Meniere's disease.

Aged↗
PubMed2002

Revision surgery after saccotomy for Meniere's disease: does it make sense?

Saccotomy is an established surgical treatment for Meniere's disease that involves exposing and opening the endolymphatic sac and draining the endolymph. However, in patients experiencing recurrent vertigo after saccotomy, it is questionable whether revision saccotomy should be recommended as opposed to more invasive procedures, such as neurectomy of the vestibular nerve. To determine the utility of revision saccotomy, we conducted a retrospective study of 29 patients undergoing this procedure for recurrent vertigo. Patient charts were reviewed for the re-occurrence of any vertiginous symptoms and outcomes with regard to hearing results and post-operative complications. An attempt was made to correlate vertigo status post-revision with surgical findings at the time of revision. After an average follow-up of 20 months, 18 patients (62%) were free of vertigo, and four patients (14%) had a significant decrease in the frequency and intensity of vertiginous attacks. Two patients (7%) relapsed after a vertigo-free period of 18 months, and five patients (17%) experienced no clinical improvement after revision surgery. In patients with a successful sac revision, a common finding at the time of revision was new bone formation in the endolymphatic sac area (n=11), which may have caused blocking of the endolymphatic drainage. Our results demonstrate that revision saccotomy should be considered for recurrent Meniere disease before other, more invasive, surgical options.

Adult↗
PubMed1999

Electrocochleographic changes after intranasal allergen challenge: A possible diagnostic tool in patients with Meniere's disease.

Numerous observers have suggested a relationship between allergy and Meniere's disease, but objective proof has heretofore been limited. Using standard criteria, we studied a group of 7 patients with previously diagnosed Meniere's disease in whom significant allergy to 1 or more inhalants had also been diagnosed. Patients underwent a baseline electrocochleographic study followed by intranasal challenge with a carefully quantified amount of the allergen to which they were most sensitive. This was followed by a second electrocochleogram. Four of the 7 patients demonstrated at least a 15% increase in the summating potential/action potential ratio in 1 ear, associated with the production of subjective inner ear symptoms. We present this protocol as a potentially useful tool to further study whether inhalant allergy may be a causative factor in patients with Meniere's disease.

Administration, Intranasal↗
PubMed1997

Vestibular rehabilitation strategies in Meniere's disease.

Once the episodic spells of vertigo associated with Meniere's disease have abated, vestibular rehabilitation exercises play an important role in promoting adaptation to the decreased vestibular input. Outlines of different treatment approaches for three types of patients with Meniere's disease are presented. The exercise approaches advocated here consist of exercises to foster adaptation of the vestibular system in cases of unilateral loss or hypofunction and exercises to promote the substitution of alternative strategies and to enhance remaining function in cases of bilateral vestibular hypofunction. The selection of the appropriate exercises is based on the nature of the vestibular loss, the patient's symptoms, and the functional capabilities of the patient. Based on an understanding of the vestibular system, the balance system, and normal functional capabilities, appropriate rehabilitative exercises can be designed for this group of patients.

Acute Disease↗
PubMed2000

[Long-term results of Meniere's disease treatment].

The authors present long-term results of Meniere's disease treatment: 2, 5, 10, 15, 20 and more years after drainage and exposure of the endolymphatic sac, chordoplexustomy (50 patients), conservative treatment (20 patients). Acoustic and vestibular functions in these patients are compared. Choice of Meniere's disease effective treatment depends on accurate diagnosis of the disease for which it is important to stage the disease exactly, to assess functional condition of the internal ear (cochlear secretion, lesion of the vestibular analyser, in particular). The most effective and safe treatment for Meniere's disease is now decompressing surgery on the endolymphatic sac. These not only preserve but also improve hearing at early stages of the disease.

Adult↗
PubMed2002

[The role of immunological factors in Meniere's disease].

Involvement of the immunological mechanisms in the pathogenesis of Meniere's disease has been discussed over the past two decades. Nevertheless, we lack well-defined laboratory tests that might confirm the autoimmune background of the disorder. Therefore the diagnosis is often based solely on the patient's clinical profile and the positive response to the immunosuppressive therapy. In this article we present a case of 44 year-old woman with Meniere's disease successfully treated with systemic glucocorticoids. The pathogenesis, diagnosis and management of immune-mediated cases of Meniere's disease are reviewed.

Adult↗
PubMed1979

Low-frequency harmonic acceleration in the evaluation of surgical treatment of Meniere's disease.

23 patients with classical findings of Meniere's disease and so diagnosed by a neurotologist were tested with harmonic acceleration. 7 of these patients were selected to receive endolymphatic-mastoid shunts for intractable vertigo and/or highly progressive fluctuant hearing loss. All 7 patients showed an increase in the impairment in their phase relationships at the lowest frequency (0.01Hz) following surgery which was considered to be secondary to the procedure. Later this phase lag returned to a level approaching normal. They also showed a definite decrease in the asymmetry (labyrinthine preponderance) of their nystagmic responses to acceleration.

Acceleration↗
PubMed2004

Incidence of virus infection as a cause of Meniere's disease or endolymphatic hydrops assessed by electrocochleography.

Meniere's disease (MD) may follow viral infection such as by neurotropic viruses known to invade the endolymphatic sac (ES) and provoke endolymphatic hydrops (EH). The objective of this study was to investigate whether neurotropic viruses may cause infection of the inner ear and provoke EH. Antiviral immunoglobulin (IgG) assay against herpes simplex 1 (HSV1), herpes simplex 2 (HSV2), adenovirus (ADV), varicella zoster virus (VZV) and cytomegalovirus (CMV) were performed in 109 patients with an advanced stage of MD and compared with those obtained from 26 patients operated on because of vestibular schwannoma (VS), who served as a control group, to evaluate whether there is an association between the IgG levels and the ECoGs summating potential/action potential ratio (SP/AP ratio) in the MD group. In MD patients, the IgG titre against VZV and ADV were significantly higher than in the control (schwannoma) group. However, no correlation was found between the IgG levels against ADV and VZV with the SP/AP ratio. Neurotropic viruses such VZV and ADV may play a role in the pathogenesis of MD, despite the absence of association between the levels of IgG titres and the SP/AP ratio.

Action Potentials↗
PubMed2003

Can low frequency sound stimulation during posturography help diagnosing possible perilymphatic fistula in patients with sensorineural hearing loss and/or vertigo?

Perilymphatic fistula (PLF) is often difficult to diagnose because of the similar symptomatology, such as vertigo, tinnitus and hearing loss, which is found in several inner ear diseases. We attempted to correlate a positive result of low frequency sound (LFS) stimulation tests in posturography with the presence or absence of a PLF confirmed by transtympanic endoscopy in 209 patients with various inner ear diseases (Meniere's disease ( n=128), vestibulopathy ( n=41), cochleopathy ( n=28) and sudden deafness ( n=12). LFS provoked unsteadiness in posturography without PLF in 24 patients with Meniere's disease, in 5 patients with vestibulopathy, in 3 patients with cochleopathy and in 2 patients with sudden deafness. In one patient, tympanoscopy revealed fistula in the round window membrane that was covered with a fibrinous layer. In four cases there was abnormal light reflex in the round window but without PLF. In eight cases, Hennebert's sign was present with nystagmus, without PLF. We conclude that pathological responses to the LFS test in posturography can also be encountered in other inner ear diseases without PLF.

Acoustic Impedance Tests↗
PubMed2000

Clinimetrics of Meniere's disease.

Two clinically useful measures to quantify the morbidity of Meniere's disease are the daily vertigo diary card and the Meniere's Disease Patient-Oriented Severity Index (MD POSI). The development and application of these outcomes instruments for patients with vertigo are discussed.

Health Status Indicators↗
PubMed1998

Surgical observations on the endolymphatic sac in Meniere's disease.

OBJECTIVE: This study aimed to clarify the pathoanatomic characteristics of the endolymphatic sac in Meniere's disease by surgical observations. STUDY DESIGN: The study design was a retrospective case study conducted in the setting of University Hospital at Shiga University of Medical Science. PATIENTS: Studied were 101 patients with Meniere's disease who underwent endolymphatic sac drainage surgery at the university hospital by the same surgical team between 1984 and 1995. Control group consisted of 23 patients with non-Meniere's disease. MAIN OUTCOME MEASURES: Photographs were taken of the sac in 101 patients with Meniere's disease during endolymphatic sac drainage surgery, and the pathoanatomic findings of the sacs were classified into three grades regarding position (types I, II, III), size (large, intermediate, small), color (red, intermediate, white), and vascularity (fair, intermediate, poor). Statistical difference was studied between Meniere's group and non-Meniere's group by chi-square test. RESULTS: The patients with Meniere's disease were found to have endolymphatic sacs located inferiorly to the posterior semicircular canal, very close to the jugular bulb (type III) (p < 0.001). The sacs also were smaller in size (p = 0.068), whiter in surface color (p = 0.0036, 0.01), and of less vascularity (p = 0.051) than those of the patients with non-Meniere's disease. The comparisons showed significant differences only in position and color. CONCLUSION: The patients with Meniere's disease were found to have endolymphatic sacs located inferiorly to the posterior semicircular canal, very close to the jugular bulb. The sacs also were whiter in surface color.

Endolymphatic Sac↗