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PubMed2002

Etiology, pathophysiology of symptoms, and pathogenesis of Meniere's disease.

Endolymphatic hydrops is the pathologic feature associated with Meniere's disease. The development of endolymphatic hydrops appears to arise from multifactorial inheritance with alteration of endolymphatic homeostasis. Various factors associated with the phenomenon of hydrops include functional or anatomic obstruction of endolymphatic flow, malabsorption of endolymph, genetic anomalies, vasodilation, allergy, viral infection, and autoimmunity.

Animals↗
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↗
PubMed1998

Sac-vein decompression for intractable Meniere's disease: two-year treatment results.

Surgical intervention has been offered to patients with Meniere's disease who have failed medical treatment and have disabling symptoms. Surgical options have included labyrinthectomy (mechanical and chemical), vestibular neurectomy, and endolymphatic sac surgery with or without shunting. We present a modification of endolymphatic sac decompression surgery that includes wide decompression of the sigmoid sinus, posterior cranial fossa dura, and endolymphatic sac (sac-vein decompression). Thirty-five patients underwent 37 primary procedures with 2 years of follow-up. Patients were evaluated according to the 1985 American Academy of Otolaryngology-Head and Neck Surgery criteria for assessing Meniere's disease. Vestibular symptom severity was resolved or mild in 92% and disability severity was none or mild in 95% of patients at 2 years after surgery. Vertigo control was complete or substantial in 85% and 100% of patients at 1 and 2 years after surgery. Audiologic data showed stable or improved hearing in 86% and 85% of patients at 1 and 2 years after surgery. In summary, wide decompression of the sigmoid sinus, posterior cranial fossa dura, and endolymphatic sac offers improved control of vertigo and hearing stabilization for intractable Meniere's disease compared with simple endolymphatic sac decompression or shunt surgery.

Adult↗
PubMed2001

[Surgical treatment of Meniere's disease and its pathophysiological validation].

The authors analyse their own and literature data on surgical treatment of Meniere's disease (MD) as intervention on the endolymphatic sac with assessment of various modifications by long-term results, on sympathetic intraaural and extraaural lesions. Surgical interventions on the endolymphatic sac are pathophysiologically validated. Insufficient knowledge on hydrodynamics in the internal ear labyrinth and the role of endolymphatic hydrops in MD pathogenesis hampers assessment and further development of surgical treatment of the disease. Future lines of the research in Meniere's disease and its treatment are outlined.

Humans↗
PubMed1979

Measurement of eye deviation under the nonfixative condition in patients with peripheral labyrinthine disorders, especially Meniere's disease.

Among 232 Japanese patients with peripheral disorders, 98 had a unilateral Meniere's disease. In these patients and 20 healthy adults, recordings of eye deviation were made utilizing DC-ENG under two conditions, i.e. eyes closed (EC) and eyes open in the absolute darkness (AD). (1) 90 % tolerance interval of AD. was significantly smaller than that of EC in controls. (2) Appearance of nystagmus in 5 groups with labyrinthine lesions was compared with the direction of deviation toward and against the affected side in both conditions. (3) Concerning unilateral Meniere's, the relationship among deviation, nystagmus and caloric response was analyzed statistically and the clinical application discussed.

Electronystagmography↗
PubMed2005

Comparative study of the daily lifestyle of patients with Meniere's disease and controls.

OBJECTIVES: This study was performed to investigate the possibility that daily lifestyle may have a causal relationship with Meniere's disease. METHODS: We conducted a questionnaire study of daily lifestyles among groups of patients with Meniere's disease and those with low-frequency hearing loss, and compared the results with those of control groups of local residents matched individually by gender and age. RESULTS: The Meniere's disease group diverged most widely from the control groups in their behavior patterns. Significant divergence was especially indicated in their engrossed, self-inhibiting, and time-constrained behaviors. Although the low-frequency hearing loss group also exhibited similar tendencies toward engrossment and in their feeling pressed for time, their self-inhibiting behavior was less pronounced. There was no major difference between the endolymphatic hydrops patient groups and the control groups on other items in the study such as daily lifestyle, environmental stress, and means of relaxation. CONCLUSIONS: The results of the present study strongly suggest that there may be a link between an individual's specific behavior patterns and the onset of Meniere's disease.

Adult↗
PubMed1998

Summating potential and action potential ratio in Meniere's disease before and after treatment.

OBJECTIVE: This study aimed to compare the summating potential and action potential ratio (SP:AP) in patients with Meniere's disease before and after various surgical and medical treatments as an indication of change in endolymphatic hydrops to study the progression of Meniere's disease. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at an otology-neurotology referral center. PATIENTS: Eighty-eight ears of 84 patients with Meniere's disease received medical treatment in 18 ears and surgical treatments including endolymphatic shunt in 12 ears, streptomycin perfusion of the lateral semicircular canal in 9 ears, streptomycin perfusion of the middle ear in 33 ears, and dexamethasone perfusion of the middle ear in 16 ears. INTERVENTION: Transtympanic electrocochleography (ECoG) was performed in all patients before treatment and 1-57 months after treatment (mean, 13.5 months) with a 2-year interval in 28 patients. MAIN OUTCOME MEASURE: An enlarged SP:AP ratio (> or = 0.40) was used as the diagnostic criterion for endolymphatic hydrops. RESULTS: Overall, an enlarged SP:AP ratio was found in 75% of ears before treatment and 78% after treatment. The SP:AP ratio, when enlarged, remained enlarged in 91% of ears. A nonenlarged SP:AP ratio before treatment became enlarged after treatment in 41% of ears. In American Academy of Otolaryngology-Head and Neck Surgery stage 1 Meniere's disease (pure-tone threshold average < or = 25 dB), an enlarged SP:AP was found in 58% of ears before treatment and 79% after. Twenty-five (89%) of 28 patients followed for 2 years were free of vestibular symptoms after treatment, and in 22 patients (79%), the SP:AP remained enlarged. The distribution of an enlarged SP:AP ratio was associated with the duration of disease (chi-square = 33.5552, p < 0.01). CONCLUSIONS: The development of endolymphatic hydrops, as indicated by an enlarged SP:AP, is part of the progression of Meniere's disease. The longer the duration of the disease, the more likely the SP:AP ratio will be enlarged. These findings indicate that endolymphatic hydrops as detected by ECoG was not reversed in this study by the treatments used. Despite the absence of definitive spells of vertigo in most patients, endolymphatic hydrops as evidenced by an enlarged SP:AP ratio persisted.

Adolescent↗
PubMed2005

[Vestibular drop attacks or Tumarkin's otolithic crisis in patients with Meniere's disease].

INTRODUCTION: Drop attacks (DA) are a sudden fall that comes without warning and without loss of consciousness, with no associated neurological symptoms and normal neurological examination. A certain number of patients with Meniere's disease, develop Tumarkin's otolithic crisis or DA. The purpose of this study is to document the frequency and clinical features of DA in patients with Meniere's disease. METHODS: A cohort of 40 patients with "definitive" Meniere's Disease were followed up between six months and 12 years. The presence and characteristics of Tumarkin's otolithic crisis were recorded. RESULTS: Thirteen (32.5%) patients developed DA during the outcome of their Meniere's disease. The interval between the onset of typical symptoms of Meniere's disease and the DA ranged from less than one year to 18 years. The number of DA varied from 1 to 14. The attacks typically occurred in a flurry during a period of 1 year or less. Six patients had only one DA. No patient requiered treatment for the DA. CONCLUSIONS: Tumarkin's otolithic crisis in Meniere's disease are not uncommon. They can occur at any time during the course of the disease, generally in a flurry of less than one year. Most patients have a spontaneus remission of the DA.

Adolescent↗
PubMed2006

Meniere's disease may be caused by common intraosseous dental pathology--Diagnosis using the comparative compression sign.

Meniere's disease has been ascribed to a disturbance of the vestibular apparatus or its connections within the Central Nervous System. Several hypotheses have been advanced regarding its aetiopathogenesis, but treatments based on these hypotheses have often not produced the desired results. Two cases are described where common intraosseous pathology within the lower half of the functional face, i.e. within the mandible and maxillae, was shown to be the cause of Meniere's disease. Together, these cases contributed to the chance discovery of the comparative compression sign which, when able to be elicited, may be considered pathognomonic for a dental origin of the condition. It is suggested that, in addition to other hypothesized causes involving the vestibular apparatus and the CNS, Meniere's disease and vertigo may also be caused by common, readily-identifiable intraosseous dental pathology. These unexpected findings open up a new field for future research.

Adult↗
PubMed2005

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

OBJECTIVE: To determine the long-term hearing and vestibular outcomes in patients with intractable vertigo caused by unilateral Meniere's disease, who were treated with transtympanic injection of gentamicin. STUDY DESIGN: the study was a long-term analysis of hearing and control of vertigo in patients with unilateral Meniere's disease who received transtympanic gentamicin. METHODS: Pure-tone thresholds and ENG, along with the control of vertigo. Criteria described in 1995 by the American Academy of Otolaryngology - Head and Neck Surgery were used. Patients treated with transtympanic gentamicin had definite Meniere's disease and had intractable vertigo despite optimal medical therapy, no symptoms suggestive of Meniere's disease in the contralateral ear, and serviceable hearing in the contralateral ear. The study analyzed the outcomes of 9 patients for whom follow-up data were available for periods greater than 24 months after transtympanic gentamicin. RESULTS: Complete control of vertigo was obtained in all 9 patients. Profound sensorineural hearing loss occurred only in 1 patient. Hearing was improved in 6 patients, and in 2 was unchanged. CONCLUSIONS: Transtympanic gentamicin therapy is a good method of controlling vertigo and the risk of hearing loss is low.

Adult↗
PubMedDate not supplied

Etiopathogenesis of Meniere's disease: a hypothesis.

A new hypothesis of etiopathogenesis of Meniere's disease proposes that an autoimmune response to type II collagen could induce idiopathic endolymphatic hydrops. This hypothesis is extended to provide a rational explanation for Meniere's attacks.

Animals↗