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PubMed1983

Meniere's disease 1978-1982.

Over 250 reports concerning or related to Meniere's disease, published in English from 1978 through 1982, are summarized. Reports have been classified into the categories of incidence of occurrence, analysis and reporting results, pathophysiology, etiologic theories, diagnostic methods, medical management, and surgical procedures. Major emphases in reporting from 1978 though 1982 have been in the areas of pathophysiologic studies, expansion of diagnostic procedures, and the use of sac decompression and neurectomy procedures. This literature review reveals the continuing disagreement regarding the pathophysiology of Meniere's disease and the resultant continued controversies in its management.

Animals↗
PubMed1978

Unidirectional inner ear valve implant for endolymphatic sac surgery in Meniere's disease.

In five patients with long-standing Meniere's disease, a unidirectional inner ear valve was implanted into the endolymphatic sac (ELS) to facilitate removal of excess endolymph in the hydropic state. These patients were all candidates for ablative surgery. They all had intractable vertigo and severe hearing losses. Four out of five patients had positive preoperative glycerol tests. In the patients with positive glycerol tests, the group averages before surgery were as follows: pure-tone average (PTA), 63 dB; speech reception threshold (SRT), 79 dB; and discrimination score, 27%. All of the patients, except a patient with a negative glycerol test, benefited from the surgery, including exceptional hearing improvements, averages of 21 dB in PTA, 30.5 dB in SRT, and 48% in discrimination, which remained so for at least a one-year minimum follow-up. All patients with preoperative positive glycerol tests had a class A result according to the criteria set forth by the American Academy of Ophthalmology and Otolaryngology. The cumulative follow-up exceeded the minimal requirements by a factor of 39 times. The only failure was in a patient with a negative glycerol test, which was predictable. Results of tomography confirmed the correct position of the valve without evidence of migration or extrusion even in the failure. This new valve appears to be a safe and more effective implant than Silastic sheeting alone or any other ELS implant in patients with a positive glycerol test.

Adult↗
PubMed2000

[Value of condensation and rarefaction click evoked action potential latency difference in the diagnosis of Meniere's disease].

OBJECTIVE: To study the value of condensation and rarefaction clicks evoked action potential (AP) latency difference (LD) in diagnosis of Meniere's disease. METHODS: AP was recorded with ECochG in controls (50 ears) and patients with Meniere's disease(90 ears) and sensorineural hearing loss(SNHL) of other origins(60 ears). LD was calculated and analyzed. RESULTS: LD in patients with Meniere's disease was (0.30 +/- 0.15) ms, which was significantly larger than that of controls(0.18 +/- 0.07) ms and of patients with SNHL of other origins(0.20 +/- 0.10) ms (P < 0.01). In the group of Meniere's disease, LD in patients with the mild and moderate hearing impairment was larger than those with severe hearing loss(P < 0.01) and LD in patients with low tone or high tone auditory sensation curve was larger than those with flat auditory sensation curve(P < 0.01). Positive rate was 4/60(6.7%) in other SNHL patients and 58/90(64.0%) in Meniere's disease group respectively. CONCLUSION: The increase in condensation and rarefaction click evoked AP latency difference can be an objective parameter in diagnosis of Meniere's disease.

Action Potentials↗
PubMed1997

Meniere's disease of syphilitic etiology.

Congenital or acquired syphilis is the cause of Meniere's disease in six percent of all cases. The pathogenesis is endolymphatic hydrops and osteitis of the otic capsule which produces the characteristic fluctuating hearing loss, tinnitus and ear pressure associated with episodic spells of vertigo. The ear symptoms are, at first, typical of Meniere's disease of other etiologies. Failure to establish the specific etiologic diagnosis can result in unnecessary surgical treatment or inappropriate medical therapy. In some cases, if a steroid, the specific treatment, is not given promptly, hearing can be quickly and permanently lost. The etiology is confirmed by obtaining a reactive fluorescent treponema antibody absorption (FTA-abs) test. The clinical features and natural history of Meniere's disease of syphilitic etiology are unique. Ear symptoms often begin in the fifth decade of life, first in one ear and, after a few years, involving the second ear. Reduced or absent caloric responses are characteristic. When hearing loss is severe and sudden, this condition represents a true medical emergency and should be treated with prompt administration of steroids. An endolymphatic subarachnoid shunt operation is occasionally necessary as adjunctive management. An analysis of 34 cases shows that long-term use of steroids can maintain effective hearing for more than 20 years.

Adult↗
PubMed2000

Update on intratympanic gentamicin for Meniere's disease.

OBJECTIVE: To review the literature relating to intratympanic gentamicin injection therapy for Meniere's disease to detect consistencies and differences that might suggest optimal technique. DESIGN: Retrospective literature review. METHODS: Eighteen papers from the literature regarding clinical experience with intratympanic gentamicin injections for treatment of Meniere's disease were reviewed and tabulated. RESULTS: All papers reported high success rates in treating episodic vertigo of Meniere's disease, but technique, dose, duration, and treatment philosophy varied considerably. Hearing loss was typically reported in about 30% of patients. CONCLUSION: No single technique of gentamicin injection has a significant medical advantage over the others. Until controlled studies indicate otherwise, nonmedical needs such as convenience and safety may be considered when choosing a technique.

Gentamicins↗
PubMed1997

Low-dose intratympanic gentamicin and the treatment of Meniere's disease: preliminary results.

The most disabling symptom for most patients with unilateral Meniere's disease is vertigo. Eradication of the diseased end organ is effective in eliminating the vertigo. Labyrinthectomy remains the "gold standard"; unfortunately, residual hearing is sacrificed to obtain this end. The purpose of this study is to evaluate low-dose intratympanic gentamicin for the control of vertigo and for the preservation of hearing. A single dose of gentamicin (10-80 mg) was injected into the middle ear space of 23 patients with unilateral Meniere's disease as an office procedure. Eighty-four percent of the patients had no episodes of vertigo during the last 6 months of follow-up. Pure tone average and word discrimination scores were unchanged as a group. Ninety-five percent of patients had a hearing loss at 6 and 8 kHz that averaged 7.5 dB. Caloric function was reduced in 93%. Low-dose intratympanic gentamicin is a safe, simple, office procedure that is effective in controlling the definitive vertiginous episodes in most patients with unilateral Meniere's disease. Control of vertigo can be obtained with preservation of hearing.

Absorption↗
PubMed1999

The peaked audiometric configuration in Meniere's disease: disease related?

A retrospective analysis of audiograms was completed for persons from 3 different patient groups. These 3 groups were (1) persons with unilateral Meniere's disease, (2) persons with unilateral acoustic tumor, and (3) persons from the general clinical population of an audiology clinic in a major medical center. As Paparella, McDermott, Luiz, and de Sousa (1982) also report, the most common audiometric configuration in the Meniere's disease group was peaked, a condition in which poorer hearing is reported in the low and high frequencies, and an island of better hearing sensitivity occurs at either 1.0 or 2.0 kHz. Some of the peaked audiograms from persons in our Meniere's disease group could be a result of a low-frequency hearing loss caused by Meniere's disease combined with a high-frequency hearing loss due to aging or other environmental factors. However, 27% (13/48) of the peaked audiograms in ears with Meniere's disease were found in persons with no hearing loss in the high frequencies of their nondiseased ear. Thus, the peaked audiometric configuration is associated with Meniere's disease, as suggested by research results from animals with experimentally induced endolymphatic hydrops. Peaked audiometric configurations were also observed in roughly 9% of the general clinical population and in 12.5% of ears of persons with acoustic tumors. A rule--based on the audiometric configurations that maximized identification of patients with Meniere's disease--using the general clinical population as a control did not fare as well when the tumor group was used as a control. This finding provides further evidence that peaked audiograms, although common to Meniere's disease, are not pathognomonic of this disease. Furthermore, these results indicate that the diagnosis of Meniere's disease from audiometric profiles is risky, at best.

Adult↗
PubMed1983

Significance of tomography in Meniere's disease: periaqueductal pneumatization.

The revival of endolymphatic sac surgery has led to many investigations in Meniere's disease, including lateral tomography of the periaqueductal pneumatization. We radiologically assessed a series of Meniere's patients and a control group, and found hypocellularity to be more common in Meniere's disease as the literature has stated. However, we found this finding bilaterally in patients with unilateral disease. Our assessment of this information in regard to the etiology and treatment of Meniere's disease is presented.

Humans↗
PubMed1999

Headache in Meniere's disease.

OBJECTIVE: We examined headache in 86 patients with severe or moderately severe Meniere's disease (MD) or with Meniere's syndrome (MS) chosen for intratympanic gentamicin treatment. Forty-five patients with vestibular neuronitis (VN) served as a control group. METHODS: In addition to a clinical examination, the patients filled out a questionnaire concerning their headache. RESULTS: Altogether 60 MD patients (70%) and 26 VN patients (58%) reported headache. Headache was severe in 35 MD patients (58%), moderate in 16 patients (27%) and slight in nine MD patients (15%), and as a whole more severe than that of the VN patients (P < 0.01). The MD patients exhibited significantly more occipital (P < 0.005) and neck headache (P < 0.005) than the VN patients. Analgesics had been used by 82%, antidepressants by 35%, sumatriptan by 13% and carbamazepine and/or amitriptyline by 12% of the MD patients suffering from headache. Pain relief was reported as good by 27%, satisfactory by 60%, poor by 5% of the MD patients and 8% could not rate the pain relief. In this study migraine was diagnosed in 5 MD patients. CONCLUSION: It is concluded that MD is associated with headache that can be handicapping, and tricyclic antidepressants with pain alleviating medication is often needed to treat the headache in MD whereas sumatriptan did not alleviate the headache of the non-migraine patients.

Adult↗
PubMed1998

Titration streptomycin therapy in Meniere's disease: long-term results.

As soon as the use of streptomycin was started for the treatment of tuberculosis, its ototoxic effect was discovered. Initial reports demonstrated that streptomycin was successful in reducing vestibular responses while preserving cochlear activity. Streptomycin sulfate has been used for almost half a century for the treatment of vertigo in patients with Meniere's disease. At the Gruppo Otologico, Piacenza, Italy, between 1987 and 1995 we treated 16 patients with either bilateral Meniere's disease or with Meniere's disease in their only hearing ear, adopting the titration streptomycin therapy protocol of Graham et al. Three patients with follow-up periods of less than 2 years were not included in this study. The ages of the patients ranged from 36 to 64 years with a mean of 49.2 years. The patients were observed for 2 to 8.8 years. The dose of administered streptomycin varied from 14 to 49 gm. Episodic vertigo was totally relieved in all of the patients after initial treatment, whereas hearing remained the same or was improved when compared with the pretreatment levels. Five of the patients experienced recurring vertigo during a period of 4 to 24 months after initial treatment. Oscillopsia persisted in two patients and ataxia in darkness persisted in another two patients. Hearing was unchanged in 14 ears, improved in 2 ears, and worsened in 4 ears at the last follow-up evaluation. The overall outcome indicated that intramuscular titration streptomycin therapy seems to be one of the most important therapeutic options in the treatment of disabling vertigo in patients with either bilateral Meniere's disease or Meniere's disease in an only hearing ear.

Adult↗
PubMed2000

[Evaluation of the effect of streptomycin perfusion of the labyrinth in the treatment of Meniere's disease and endolymphatic hydrops].

OBJECTIVE: To investigate the clinical effect of streptomycin perfusion of the labyrinth (SPL) in the treatment of Meniere's disease. METHOD: 13 patients with Meniere's disease and 3 patients with delayed endolymphatic hydrops (DEH) underwent SPL. The follow-up time was between 5 and 7 years (average 6.3 years). RESULT: Vertigo was completely controlled in 9 patients, substantialy controlled in 4, limitedly controlled in 2 and not controlled in 1. Hearing was improved in 1 patients, stabilized in 5 and worse in 10. Tinnitus was improved in 3 patients, stabilized in 5 and worse in 8. CONCLUSION: SPL is a safe and effective method in the treatment of Meniere's disease and DEH, but the hearing may be insulted and tinnitus may be worse in some patients.

Adult↗
PubMedDate not supplied

Multidirectional and computerized tomography of the vestibular aqueduct in Meniere's disease.

Multidirectional and computerized tomography have been used for the radiographic assessment of the vestibular aqueduct in Meniere's disease. The results of studies performed by us and/or other authors indicate that there is a statistically significant difference in the size of the vestibular aqueduct between the Meniere's and control groups (in Meniere's disease the vestibular aqueduct is often narrowed or obliterated); and that periaqueductal pneumatization is often decreased or absent in ears affected by Meniere's disease. Recent histological studies performed on temporal bones of patients with Meniere's disease have confirmed these radiographic observations.

Humans↗