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PubMedDate not supplied

Endolymphatic duct and sac in patients with Meniere's disease. A temporal bone histopathological study.

The endolymphatic ducts and sacs of 25 temporal bones with idiopathic endolymphatic hydrops from individuals with Meniere's disease were studied and compared with the same number of control bones without endolymphatic hydrops from individuals with no premortem history of otologic disease. The control bones were selected so that the sizes of their vestibular aqueducts matched those temporal bones from individuals with Meniere's disease. The endolymphatic ducts and sacs of all bones were studied by the medial view graphic reconstruction method and/or histological observation under a light microscope. In the endolymphatic duct and sac of many of the temporal bones from patients with Meniere's disease were noted a diminution of the width of the endolymphatic duct in its isthmus portion, an increase in the area of the collapsed lumen of the endolymphatic sac, fibrotic changes in the perisaccular loose connective tissue, and an increase in the quantity of intraluminal eosinophilic material. The frequencies with which these pathological findings were noted in bones from individuals with Meniere's disease and in control bones were statistically significantly different. No significant differences were observed under light microscopic study between these two groups with regard to the condition of the epithelial cells, the degree of rugosity of the endolymphatic sac, or the appearance of melanin-like pigmentation of hyalinization in the perisaccular connective tissue.

Adult↗
PubMedDate not supplied

Meniere's disease: clinical course, auditory findings, and hearing aid fitting.

Results of a five-year longitudinal study of Meniere's disease in 95 patients is presented. Tests utilized in diagnosis and in determining specific etiology are described. Clinical treatment for patients with Meniere's disease symptoms is discussed. Auditory test results for 101 ears are analyzed. The fluctuating nature of the hearing loss, the poor discrimination for speech, and the limited tolerance for amplification because of the narrow dynamic range present significant problems in utilization of hearing aids for patients with Meniere's disease. A practical approach is suggested for the fitting of hearing aids for these patients.

Hearing Aids↗
PubMed1986

Electrocochleography and low-frequency harmonic acceleration in Meniere's disease.

We evaluated a series of 31 consecutive cases of Meniere's disease using electrocochleography (ECochG) and low-frequency harmonic acceleration (HA). The ECochG was positive for endolymphatic hydrops in 74% of the cases. A positive ECochG was strongly related to the degree of hearing loss. The results of harmonic acceleration were consistent with peripheral vestibular disorder in 80% of the cases. Five illustrative cases are also presented.

Adult↗
PubMed2000

[Assessment of perilymphatic pressure using the MMS-10 tympanic membrane displacement analyzer (Marchbanks' test) in patients with Meniere's disease: preliminary report].

OBJECTIVES: The aim of this study was to investigate non-invasive measurement of perilymphatic pressure using the MMS-10 tympanic displacement analyzer (Marchbanks' test) in patients with Meniere's disease. METHODS: We performed measurements in 20 patients with Meniere's disease and in 9 normal subjects with normal hearing. Data were collected in three groups: healthy ears of normal-hearing patients, healthy and affected ears in patients with Meniere's disease. RESULTS: We found no significant differences between the 3 groups for the types of the graph. Measurements of the tympanic membrane displacement test variables (Vi and Vm) showed large inter-subject variations. No significant difference was found between the 3 groups for cochlear aqueduct patency. CONCLUSION: Preliminary results of this short series show that assessment of perilymphatic pressure using the MMS-10 procedure does not seem to be useful in Meniere's disease.

Adolescent↗
PubMed2000

Electrocochleography in the diagnosis of Meniere's disease.

This study prospectively analyses electrocochleography (ECoG) recordings obtained from ears demonstrating symptoms highly suggestive of Meniere's disease. Comparison is made with ECoG recording from ears in which the diagnosis of Meniere's is considered unlikely (control ears). Electrocochleograph recordings were made through a transtympanic recording needle, situated in the round window niche. Analysis was made of the 1 kHz tone burst summation potential (SP) and the summation potential:action potential (SP/AP) ratio response to a 90 dB click. All patients were prospectively awarded a Meniere's score based on a 10-point scale, and comparison was made between ears awarded a score of 7 or greater (Meniere's ears; n > 500), and ears awarded a score 3 or less (control ears; n > 900). Results demonstrate a significant difference in the 1 kHz SP response, and the SP/AP ratio, between "control" and "Meniere's" ears. Furthermore, we show that SP negativity is proportional to the amplitude of the AP click response, and in patients producing an AP click amplitude exceeding 10 V, sensitivity of the tone burst test approaches 85%. This study provides further evidence suggesting the useful role of electrocochleography in determining a diagnosis of endolymphatic hydrops. and demonstrates improved sensitivity of the 1 kHz SP response, compared with SP/AP click ratio, in the diagnosis of Meniere's disease.

Action Potentials↗
PubMedDate not supplied

Pneumatization and thickness of the petrous bone in patients with Meniere's disease. A histopathological study.

Histological evaluations were made of the degree of pneumatization and thickness of the petrous bone surrounding the vestibular aqueduct, and of the relationships of these parameters to the condition of the vestibular aqueduct in 27 temporal bones with idiopathic endolymphatic hydrops from individuals with Meniere's disease. The results were compared with those from the same parameters in 79 control temporal bones without endolymphatic hydrops from individuals who had no premortem history of otologic disease. Pneumatization of the temporal bones of patients with Meniere's disease was in most cases less than that of control temporal bones; this difference was statistically significant. Poor pneumatization of the temporal bones of individuals with Meniere's disease appeared to be closely associated with hypoplasia of the vestibular aqueduct, an anatomical feature of many individuals with Meniere's disease. However, no statistically significant difference could be found between the thickness of the petrous bone in the periaqueductal region in bones of patients with Meniere's disease and this parameter in control bones.

Adult↗
PubMed1984

Labyrinthine cryosurgery for Meniere's disease--present status.

When surgery is required to control attacks of vertigo caused by Meniere's disease, total labyrinthectomy performed by the transcanal or transmastoid approach is the procedure of choice when the disease is unilateral and has permanently damaged hearing to the point that only a distorted remnant remains and amplification would not be effective. For patients with bilateral Meniere's disease or unilateral cases with sufficient hearing to warrant its preservation, a surgical procedure is required that eliminates the vertigo and either improves or at least does not adversely affect the hearing. Labyrinthine cryosurgery has been used clinically since 1965 in an attempt to achieve this goal. The results of 225 procedures followed for 1 year or longer indicated that vertigo is controlled in 73% but not in the remaining 27%. Hearing seemed unaffected by cryosurgery. If hearing fluctuated prior to surgery, it generally continued to fluctuate afterward. Improved or decreased hearing could therefore not be interpreted as a direct result of surgery but rather as a continuation of the fluctuation in hearing that commonly occurs in this disorder.

Animals↗
PubMed1979

Neurotological studies on Meniere's disease and sudden deafness.

During the period from January 1973 to June 1975, 60 cases with definite Meniere's disease and 30 cases with sudden deafness were listed according to such criteria for the diagnosis of both diseases as determined by the Research Committee of Japan. A neurootological assessment for both diseases were performed in our series. In patients with definite Meniere's disease, hearing impairment was characterized by deficiency in detecting low- and middle-pitched tones and fluctuation of auditory threshold in low frequency range. In sudden deafness, highly impaired hearing loss, i.e., total deafness, was frequently observed (45%). However, recruitment occurred at the same incidence (80%) in both diseases tested. The incidence of spontaneous nystagmus was almost the same regardless of associated vertigo and the course of both diseases. Moreover, it was also recognized that a reduction of caloric responses was a better indication for assessment of the affected ear in both diseases.

Audiometry↗
PubMed2002

Prevalence of heat shock protein in patients with Meniere's disease and allergy.

OBJECTIVE: The study purpose was to investigate the prevalence of elevated heat shock protein 70 (HSP-70) in patients with Meniere's disease who have milk allergy compared with those who are not allergic to milk. METHODS: Fifty-five patients with Meniere's disease and allergy in whom milk allergy had been confirmed by intradermal progressive dilutional food testing or skin testing to milk antigen were included. Blood serum was tested for HSP-70 elevation with a Western blot assay using bovine renal extract. The 29 women and 26 men ranged in age from 29 to 76 years (mean age 52.8 years). Forty percent of the patients had bilateral Meniere's disease. RESULTS: Overall prevalence of HSP-70 elevation was 29.1%. This was higher in bilateral patients (50%) than unilateral patients (15%) (P <or= 0.007). The effect was based primarily on elevated HSP-70 in bilateral (62.5%) and unilateral (7.7%) patients in those with no milk allergy (P <or= 0.006). The prevalence of HSP-70 elevation was actually lower in those with milk allergy (19.2%) than in those with no milk allergy (37.9%). This difference was statistically significant only in the subset of patients who were <50 years old (0% vs 33.3%, respectively; P <or= 0.04). CONCLUSIONS: We found no relationship between the presence of antibodies to HSP-70 and allergy to milk. The significance of elevated HSP-70 in patients with Meniere's disease has yet to be defined.

Adult↗
PubMed2003

Endolymphatic sac-vein decompression for intractable Meniere's disease: long term treatment results.

OBJECTIVES: We sought to determine the long-term efficacy of endolymphatic sac-vein decompression surgery on patients with classic Meniere's disease. STUDY DESIGN AND SETTING: Using the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium criteria, starting stage, functional level, vertigo class, and hearing results were addressed. We studied 68 patients with classic Meniere's disease from a tertiary, private otology-neurotology practice. Patient data were gathered by retrospective chart review, questionnaire, and patient interview. All patients underwent endolymphatic sac-vein decompression with an average follow-up period of 55 months. RESULTS: Median functional level before surgery was level 4, improving to level 2 after surgery. Eighty-one percent of patients showed improvement in functional level, 12% remained stable, and 7% declined. Long-term vertigo control was 47% in class A, 25% in class B, 9% in class C, 3% in class D, and 16% in class F. Twenty percent of patients were in hearing stage I Meniere's disease; 31%, stage II; 44%, stage III; and 5%, stage IV. Eighteen percent of patients showed improvement in hearing class, 64% were stable, and 18% declined. CONCLUSION: Endolymphatic sac-vein decompression surgery is a safe, nondestructive surgical option for Meniere's disease that offers durable control of vertigo and stabilization of hearing for the majority of symptomatic patients. SIGNIFICANCE: The beneficial long-term outcome of the endolymphatic sac-vein decompression supports its continued use as a first-line treatment option in intractable Meniere's disease.

Adult↗
PubMedDate not supplied

Meniere's disease at the University of Iowa: 1973 to 1980.

The goals of treatment in Meniere's disease are hearing preservation and control of vertigo. Controversy abounds with regard to the most expeditious and efficacious means of attaining these goals. Low-salt diet, diuretic therapy, endolymphatic-mastoid shunt, and middle cranial fossa vestibular neurectomy are all modes of treatment employed for Meniere's disease at the University of Iowa. This review of our experience from 1973 to 1980 summarizes the efficacy of each therapeutic option.

Endolymphatic Sac↗
PubMed1998

Tone burst auditory brain stem response latency estimates of cochlear travel time in Meniere's disease, cochlear hearing loss, and normal ears.

OBJECTIVE: The current study sought to determine whether tone burst auditory brain stem response (ABR) latencies could be used to detect an increase in the cochlear traveling wave velocity in patients with Meniere's disease. BACKGROUND: It has been proposed that the derived band ABR technique can be used to show an increase in cochlear traveling wave velocity in patients with Meniere's disease. The current study sought to replicate these findings using tone burst ABR at frequencies of 0.5, 1, 2, 4, and 8 kHz and intensities from 40-100 dB hearing loss (HL) in 10-dB steps. METHODS: Wave V latency differences between adjacent frequencies were taken to represent the time it takes the traveling wave to travel between the "place" on the basilar membrane where these two frequencies are represented. Thirty-two subjects participated in the project consisting of 10 with normal hearing, 10 with cochlear HL (not caused by Meniere's disease), and 12 with Meniere's disease. RESULTS: There were no significant differences in absolute wave V latencies or in wave V latency differences (travel time estimates) between the groups (repeated measures analysis of variance, p > 0.05). CONCLUSION: These results suggest that wave V latencies and estimates of cochlear travel time cannot be used to distinguish Meniere's disease from other forms of cochlear HL or from normal-hearing ears. The results of this study differ from those using the derived band ABR technique. This difference may be because of the disease state of the authors' subjects or differences in stimulus paradigm.

Adult↗
PubMed1984

Meniere's disease: peripheral or central origin. A neuroanatomical study.

Previous clinical and histological studies have suggested that the aetiology of Meniere's disease should be sought not only in the endolymphatic hydrops, but also in pathological changes of the brain and brain stem. Moreover, neuropsychological studies have indicated some centralization of the disease, whether it be primary or secondary. In order to elucidate this problem further we have examined the temporal bones and brains of 4 patients with Meniere's disease, who died of diseases unrelated to the inner ear or the central auditory and vestibular pathways. Endolymphatic hydrops was found in 6 temporal bones to a varying degree, as well as degeneration of the ganglion cells. The brain stem was divided by many horizontal sections from the rostral border of the superior colliculi above, to 15 mm caudal to the border between pons and medulla below. The principal nuclei and fascicles, the intra- and extraparenchymatous vessels and the leptomeninges were examined. The morphology of ganglion and glial cells was studied. Myelin sheaths were investigated for focal or diffuse demyelination, and the axons were observed. In addition, vessels and leptomeninges were studied for atherosclerosis and fibrosis. The brain autopsies did not reveal any changes, either locally or diffusely, which could support central pathoanatomical lesions as being responsible for the symptoms in Meniere's disease.

Aged↗
PubMed2003

Intratympanic gentamicin for intractable Meniere's disease.

OBJECTIVE: The study aimed to analyze the results of the intratympanic injection of gentamicin as a treatment option for patients with unilateral Meniere's disease who were refractory to medical treatment. STUDY DESIGN: Prospective study in the setting of a tertiary care medical center. METHODS: Seventy-one patients with unilateral Meniere's disease according to 1995 American Academy of Otolaryngology-Head and Neck Surgery 1995 guidelines who had been unresponsive to medical therapy for at least 1 year were studied. Intratympanic injections of a prepared concentration of 27 mg/mL gentamicin were performed at weekly intervals until the development of symptoms and signs indicative of vestibular hypofunction in the treated ear. As the main outcome measure, the 1995 American Academy of Otolaryngology-Head and Neck Surgery criteria for reporting treatment outcome in Meniere's disease were used. The results of treatment were expressed in terms of control of vertigo, disability status (functional level and degree of overall impairment evaluated by the Dizziness Handicap Inventory and the University of California Los Angeles Dizziness Questionnaire), hearing level, and quantitative measurement of vestibular function. RESULTS: Vertigo was controlled in 83.1% of the 71 patients. Recurrence of vertigo spells after initially complete control was noted in 17 patients. In 13 of these patients, this was cured by another course of intratympanic injections of gentamicin. Functional level and measures of self-reported handicap were significantly and promptly lowered after treatment in the patients who attained control of vertigo. Hearing level as pure-tone average was unchanged 2 years after treatment, but hearing loss as a result of gentamicin injections occurred in 23 patients at the end of treatment and in 9 and 11 patients at 3 months and 2 years after the treatment, respectively. Vestibular function was kept normal or reduced in 49.3% of the patients, whereas in the rest of the patients vestibular areflexia was observed. Control of vertigo did not depend on the amount of vestibular damage. CONCLUSIONS: Ending weekly intratympanic injections when clinical signs of vestibular deafferentation appear can control vertigo in the majority of patients, and it is a useful alternative, together with other surgical options, for the treatment of patients with Meniere's disease who do not respond to medical treatment.

Adult↗