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PubMed1980

Use of polytomography in Meniere's disease.

In a long-term study of the treatment of Meniere's disease, 105 cases treated from 1965 through 1973 were divided into subgroups by virtue of the institution of routine polytomographic examination of the vestibular aqueduct (1968). A comparison of results of treatment in the two groups (empiric indication of endolymphatic shunt vs x-ray film evidence) yielded the following conclusions: (1) Success or failure of the endolymphatic shunt operation is significantly correlated with patency or obliteration of the vestibular aqueduct as seen on roentgenographic examination. (2) To be effective, medical therapy must be instituted early, when fluctuant hearing is the primary symptom. (3) More severe cases with roentgenographically obliterated vestibular aqueducts and unrelenting vertigo are best treated with vestibular nerve section via middle fossa craniotomy. (4) More precise definition of pathogenesis is needed to define the disease at onset, so that early definitive therapy may be designed.

Affective Symptoms↗
PubMed1981

Meniere's disease: terminology and data bank acquisition.

It is proposed that the term Meniere's disease be restricted to patients with the classic symptom and sign complex in whom the etiologic factor is unknown (idiopathic). The term Meniere's syndrome is restricted to patients whose etiologic factor is known, who have an incomplete form of the disease, or who are in the process of being evaluated. Vestibular neuronitis and cochlear hydrops are terms that should be retained until the concepts of vestibular and cochlear Meniere's disease are better understood and can be identified prospectively. The classic symptoms and signs, both positive and negative, are outlined and a standard evaluation format is suggested. This must submit to mathematical reduction for pre- and post-treatment comparisons. Until this basic problem has been solved to the satisfaction of the profession, the inferences that may be drawn from otherwise excellent studies will continue to be of very limited clinical value.

Electronic Data Processing↗
PubMedDate not supplied

Meniere's disease in infants.

We described 3 patients who, from early infancy, evidenced attacks of vomiting associated with fluctuating hearing loss, culminating in bilateral severe sensorineural hearing loss. The patients suffered from Meniere's disease, according to all clinical yardsticks. The patients described by us were at first diagnosed and treated for gastroenteritis or meningitis. Meniere's disease was not suspected. We want to point out that Meniere's disease, though usually presenting itself at middle age, may well start in childhood as well as in infancy, and should be suspected whenever vomiting, without diarrhea, is associated with some hearing loss at any age--no matter how young the patient is. It is also possible that some sensorineural hearing losses in late childhood or adulthood are in effect the end result of burnt-out Meniere's disease--as our second case presented himself.

Age Factors↗
PubMedDate not supplied

Paravestibular canaliculus in Meniere's disease. A histopathological study.

The paravestibular canaliculus (PVC) and its contents were studied in 27 temporal bones from individuals with Meniere's disease and in the same number of controls. The specimens were examined by the medial view graphic reconstruction method and/or histologically under a light microscope. In most of these bones (88.9% of controls and 85.2% of Meniere's bones) only one PVC was noted; in the remaining bones (11.1% of controls and 14.8% of Meniere's bones) two PVCs were recognized. Most of the PVCs (88.9%) in both control and Meniere's bones were located in the petrous bone anterolateral to the vestibular aqueduct (VA). In one third of both control and Meniere's bones the PVC extended below the inferior margin of the posterior semicircular canal. In 74.1% of the Meniere's bones the PVCs were noted to exit directly to the posterior cranial fossa, whereas such a course was present in only 40.7% of controls. The difference in this parameter between control and Meniere's disease bones is statically significant and appears to be related to the size of the VA. The length of the PVC, however, seems to be independent of both the size of the VA and the degree of development (thickness) of the petrous bones surrounding the PVC. In four Meniere's bones a part of the main vein in the PVC was absent; this was never observed in a control bone. We found no other evidence in this study to link the function or anatomy of the PVC to Meniere's disease.

Aged↗
PubMedDate not supplied

Meniere's disease. A neuropsychological study.

A neuro-psychological study is described comprising 19 patients with Meniere's Disease who were participating in an experimental lithium therapy programme. The patients evidenced an organic dysfunction which is not entirely periphearl. The interpretation of the results are not incompatible with an attempt to reconcile neuro-psychological and psycho-somatic viewpoints regarding etiological aspects of Meniere's Disease. An evaluation of the lithium effect was performed.

Adult↗
PubMed1982

Type II collagen autoimmunity in otosclerosis and Meniere's Disease.

Antibodies to collagen types I, II, and IV were measured in patients with otosclerosis and patients with Meniere's disease. Levels of antibodies to type II collagen were significantly higher in these patients than in control subjects, while no differences were found among levels of antibodies to collagen type I or type IV. These observations suggest a possible role for type II collagen autoimmunity in the etiology of otosclerosis and Meniere's disease.

Autoantibodies↗
PubMed1979

Vestibular sensory epithelium in Meniere's disease.

Utricle and horizontal semicircular canal ampulla removed during labyrinthectomy from 11 patients with advanced Meniere's disease were studied under light and electron microscope. In light microscopy the epithelium of both sensory areas appeared fairly normal. Many sensory cells revealed fluid-filled crescents at the nucleus and many cells were extensively vacuolated. Ultrastructurally, a part of the observations were apparently artifacts due to specimen handling; some were normal, age-related findings. Some changes were considered secondary to dilation of the endolymphatic space. True signs of degeneration, seldom seen in these specimens were intraepithelial cysts, necrotic cells, and dark homogeneous masses in the sensory epithelium and dilated nerve fibers in the subepithelial tissue. No general degeneration of the utricular macula or ampullar crista seems to occur in Meniere's disease.

Adult↗
PubMed1998

Dexamethasone inner ear perfusion for the treatment of Meniere's disease: a prospective, randomized, double-blind, crossover trial.

OBJECTIVE: To investigate the benefits of intratympanic administration of dexamethasone in the treatment of unilateral Meniere's disease, with particular attention to the symptoms of hearing loss and tinnitus. STUDY DESIGN: A prospective, randomized, double-blind, crossover study comparing improvements in hearing loss, tinnitus, aural fullness, and caloric vestibular response secondary to intratympanic dexamethasone and sodium hyaluronate injection versus placebo consisting of saline and sodium hyaluronate. SETTING: A private otology/neurotology practice. PATIENTS: Twenty patients diagnosed with either definite or probable Meniere's disease as defined by the American Academy of Otolaryngology Head and Neck Surgery Committee on Hearing and Equilibrium. All patients were < or =21 years old and were not receiving any other form of treatment for their Meniere's disease. Each patient's primary symptoms of concern were hearing loss, aural fullness, and roaring tinnitus. INTERVENTIONS: Three consecutive daily administrations of intratympanic dexamethasone or placebo to the involved ear. MAIN OUTCOME MEASURES: Changes in audiometric pure-tone averages, speech reception thresholds, caloric vestibular responses, scores on the tinnitus handicap inventories, questionnaires, and telephone interview responses. RESULTS: No significant changes were observed in any measured parameter. Patients were unable to consistently identify which medication was dexamethasone and which was placebo. CONCLUSIONS: Intratympanic administration of dexamethasone in a group of patients with unilateral Meniere's disease (Shea's stage IV) showed no benefit over placebo for the treatment of hearing loss and tinnitus.

Adult↗
PubMedDate not supplied

The natural course of Meniere's disease.

The case history and disability of 111 patients suffering from Meniere's disease are reported. Observed for more than 5 years, the patients have had no, or only medical treatment, in most cases of short duration. The number of patients disabled and their degree of disability seems to justifiy surgical treatment in patients with frequent and incapacitating attacks of vertigo.

Adult↗
PubMed1997

[A long-term follow-up of patients with Meniere's disease--comparative study of unilateral and bilateral Mènière's disease].

A retrospective study was carried out on 46 patients with Meniere's disease (MD). Twenty of them were followed up for 20-40 years (long-term follow-up cases), and 26 of them for 5-12 years (middle-term follow-up cases). Thirteen of the patients suffered from fluctuating sensorineural hearing loss in one ear (unilateral MD), and 33 of them suffered from it in both ears (bilateral MD). Comparing the results of repeated audio-vestibular examinations of patients with unilateral MD with those of patients with bilateral MD revealed the following differences between them: 1) The range of fluctuation of the hearing level of the patients with unilateral MD was greater than that of the patients with bilateral MD. 2) Most patients with unilateral MD showed three audiometric configurations, but most patients with bilateral MD showed two audiometric configurations during the first 5 years of the follow-up period. 3) The patients with unilateral MD showed unilateral weakness on the caloric test more often than the patients with bilateral MD. But other clinical features in the patients with unilateral MD and those with bilateral MD were similar. We confirmed that there was an increase in bilaterality with time, but it is impossible to speculate whether the patients with unilateral MD will also suffer it in the contralateral ear or not. Therefore, it is possible that in all patients who have suffered from unilateral MD for a long time the disease may become bilateral in the future. Clinical observation of patients with MD as long as possible is the only way to clarify the relationship between unilateral and bilateral MD. It is stressed that to gain the patient's confidence is not only the basis of long-term follow-up of the patient, but also of effective treatment of MD.

Aged↗
PubMed2000

Proto-oncogene Raf-1 as an autoantigen in Meniere's disease.

The 28 kd protein extracted from the guinea pig inner ear membranous fraction, which reacted with sera from patients with Meniere's disease, has been subjected to microsequencing. Nineteen amino acids were obtained (IVQQFGFQRRASDDGKLTQ). A protein data bank search showed that this sequence corresponded to residues 41 to 60 of human Raf-1 protein. Sera from 16 of 27 patients with Meniere's disease showed reactivity to the recombinant purified glutathione-S-transferase-Raf-1 protein. These results support the hypothesis that a subgroup of patients who suffer from Meniere's disease, as well as some other kinds of autoimmune inner ear diseases, have an autoantibody against Raf-1 protein.

Amino Acid Sequence↗
PubMed1997

Pathophysiologic theories in the etiology of Meniere's disease.

The etiology of the attacks of vertigo that occur in Meniere's disease is discussed in this article. None of the current theories remain tenable in view of recent findings concerning the physiology and pathophysiology of the cochlea and endolymphatic sac. A new theory suggests that a narrowed duct becomes obstructed by debris that is cleared by a combination of the secretion of hydrophillic proteins within the sac and a hormone, saccin, that increases the volume of endolymph within the cochlea. It is proposed that the sudden restoration of longitudinal flow initiates the attacks of vertigo.

Endolymphatic Sac↗
PubMed1997

Bilateral Meniere's disease. Treatment with intramuscular titration streptomycin sulfate.

Most patients with bilateral Meniere's disease treated with streptomycin sulfate titration therapy and followed over the long term have either improvement or relief of their disabling vertigo. Although persistent post-treatment disequilibrium occurs not infrequently, it is mild in the most patients. Stabilization or improvement of hearing occurs in most patients, and the authors have not encountered hearing loss to date as a result of streptomycin sulfate titration therapy. There seems to be considerable separation between the vestibulotoxic and cochleotoxic doses of streptomycin sulfate intramuscularly when administered in humans.

Antibiotics, Antitubercular↗