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PubMed1985

Cochlear endolymphatic shunt for Meniere's disease.

We have now performed the cochlear endolymphatic shunt operation for Meniere's disease on 102 ears and have follow-up data on ninety cases. In this fourth report of results of the procedure, we show that after follow-up ranging from one month to six years (average 22.3 months), definitive vertigo was relieved in 72% of the cases and that hearing at the time of most recent audiogram (average 12.6 months postoperatively) was worse (AAO criteria) in 45% of the cases.

Adolescent↗
PubMedDate not supplied

The cause (multifactorial inheritance) and pathogenesis (endolymphatic malabsorption) of Meniere's disease and its symptoms (mechanical and chemical).

A clinical classification separates Meniere's disease (MD) of known cause (e.g. infection, trauma, otosclerosis, syphilis, genetic and others) from MD, idiopathic. Atypical forms of MD include vestibular MD and cochlear MD. Temporal bone studies from our laboratory and as reviewed in the literature reveal hydrops of the pars inferior, sometimes with ruptures, most often seen in Reissner's membrane, and sometimes without ruptures, to be the most important pathological correlate. Gross anatomical pathological findings include decreased mastoid and periaqueductal pneumatization and anterior displacement of the lateral sinus which reduces Trautmann's triangle. Such developmental changes most probably influence the endolymphatic absorptive system. Any explanation for the mechanisms of pathogenesis of clinical symptoms must encompass all aspects of the natural history, including vestibular symptoms, auditory symptoms, and aural pressure. Both mechanical and chemical factors best explain the clinical symptoms, and both may be traceable to multifactorial inheritance.

Ear, Inner↗
PubMed1977

Positive Hennebert's sign in Meniere's disease.

A positive Hennebert's sign was found in 24 of 81 (30%) of ears with Meniere's disease and in none of 22 cases of vestibular schwannoma or 100 normal controls. Negative pressure applied to the external auditory canal was the required stimulus in 14 of 24 (58%) ears. The character of induced eye motion was variable, although horizontal nystagmus was found in 22 of 24 (92%) ears. A positive Hennebert's sign is seen in a variety of labyrinthine lesions and gives corroborative evidence for a cochlear site of hearing impairment with hydrops and vestibulofibrosis are the underlying pathophysiologic condition.

Adult↗
PubMed2004

Postural instability in Meniere's disease.

In order to characterize the postural instability by duration of Meniere's disease (MD) we present the results of 180 MD patients tested on posturography. The duration of the disease varied from 4 weeks to 36 years. The patients were clinically examined and they had filled a questionnaire concerning their symptoms. Postural instability was examined by a force platform posturography and the results are expressed as sway velocities (SV). There was no statistically significant difference in the mean SV between groups of different duration of MD. The number of the patients with normal eyes open SV declined by duration of the illness from 73% to 38% but the decline was not statistically significant. The mean age in the different duration groups of MD varied from 47 to 61 years. In general 58% of the patients had their eyes open SV in normal range and 55% when measured eyes closed. When examining the SV between the 4 different hearing stages of MD we found that those belonging into the group III (pure tone average [PTA] 41-70 dB) had significantly higher eyes open and eyes closed SV's than the patients in the group I (PTA under 25 dB).

Adult↗
PubMed2006

Disorder of the saliva melatonin circadian rhythm in patients with Meniere's disease.

OBJECTIVES: Stress is involved in the development of symptoms of Meniere's disease (MD). Stress-related disease has been reported to be associated with disorders in the circadian rhythm of melatonin (MEL) which regulates that rhythm. We therefore investigated MEL circadian rhythm of patients with MD. PATIENTS AND METHODS: A comparison of 13 MD patients was made with age-matched controls. Saliva samples were collected every 3 h. A statistical analysis of the circadian rhythm of saliva MEL was performed for a circadian rhythm by the fit of a 24- and 12-h composite cosine model. In addition, we assessed the stress and depression status of the two groups. RESULTS: The rhythmic amplitude of MEL in the MD group was significantly lower than that in the control group (P < 0.05). The acrophase in the MD group was significantly earlier than that in the control group (P < 0.05). MD patients had significantly higher stress score and depression score than control subjects (P < 0.05). The amplitude in MD patients had no significant correlation with their otologic clinical data. CONCLUSIONS: These results suggest that MD patients have a MEL deficiency, which is related to their stress and depression status rather than the otologic pathological status of MD.

Adult↗
PubMed2003

Horizontal eye response to an abrupt lateral head drop in normal subjects and patients with Meniere's disease.

OBJECTIVE: To detect the endolymphatic hydrops by using the otolithic nature in patients with Meniere's disease and delayed hydrops. METHODS: We developed a new technique for measuring horizontal eye movements, corresponding to lateral head drop in total darkness, approximately 1g environment. Normal subjects (n=16, mean age: 27.3 years old) and patients (seven for pre-operative state, four for furosemide test at pre-operative state; two for post-operative state) were employed in the test. The principle of the test is to drop the head in a lateral position separately from the body with a rapid release exposing the head. Bitemporal EOG, accelometric and trigger signals for the releaser were recorded for processing at 1 KHz sampling time. RESULTS: The drop was performed five times in succession. The latency of horizontal eye response was of 40 ms order in normal subjects on both sides and were never beyond 60 ms. Eye response of the patients was in different patterns from normal subjects and the latencies delayed either to normal side or to the affected side. Following furosemide intravenous injection, more certain information was obtained. Three of four patients were recovered to normal range as to the latency. CONCLUSIONS: We emphasize that this test may provide a new measure sensitive to the hydrops and can underline this test to detect the hydrops in Meniere's disease.

Adult↗
PubMed2005

Endolymphatic sac decompression as a treatment for Meniere's disease.

OBJECTIVES/HYPOTHESIS: Endolymphatic sac decompression is a surgical treatment option for patients with medically intractable Meniere's disease. However, effectiveness is debated because published data show great variability. Outcome-based research studies are useful in incorporating the patient's perspective on the success of treatment. To further assess effectiveness of endolymphatic sac decompression, we performed a prospective study to examine both symptom-specific and general health outcomes. STUDY DESIGN: Prospective, observational outcome study. METHODS: Nineteen patients with endolymphatic sac decompression responded to symptom-specific questionnaires and the Medical Outcomes Short-Form 36 Health Survey (SF-36) before and after surgery. Follow-up ranged from 6 to 58 months with a mean duration of 50 months. RESULTS: Overall measures of physical health were significantly improved following endolymphatic sac decompression (P = .04), whereas overall measures of mental health were unchanged (P = .74). Role Physical and Social Functioning scores were significantly improved following endolymphatic sac decompression (P = .04 and P = .03, respectively). Study patients scored significantly lower (P < .05) than SF-36 normative data in 6 of 10 categories before endolymphatic sac decompression but patient scores were not significantly different from normal scores in all but one category (General Health) following endolymphatic sac decompression. The mean number of vertigo episodes was significantly reduced from an average of 8.3 times per month to an average of 2.6 times per month following endolymphatic sac decompression (P = .006). Ninety-five percent of patients (18 of 19 patients) reported improvement in symptoms (frequency, duration, or intensity) of vertigo and 37% (7 of 19 patients) reported complete resolution of vertigo. CONCLUSION: Endolymphatic sac decompression significantly improved perception of physical health, as well as symptom-specific outcomes, in patients with medically intractable Meniere's disease.

Adult↗
PubMed1979

Round window ultrasonic irradiation: conservative surgery for Meniere's disease.

Ultrasonic irradiation of the labyrinth through the round window approach is a minimally destructive method of surgical management for Meniere's disease. Results of 48 procedures, followed from six months to eight years, are reported. Relief from vertiginous symptoms was obtained in 70 percent of the patients. Hearing was improved in 14 percent; hearing was also significantly worse in 14 percent. These findings resulted in an overall 56 percent of the patients falling into American Academy of Otolaryngology control classes A or B. No significant postoperative complications were observed. Results are difficult to classify on a cause-and-effect basis due to the remissions and exacerbations characteristic of Meniere's disease. Ultrasonic irradiation using the round window approach does not involve the potential risks of such surgical procedures as labyrinthectomy, vestibular neurectomy, and endolymphatic sac procedures. The primary disadvantage of this procedure is securing and servicing the instrumentation. Due to its conservative nature, ultrasonic irradiation through the round window is an attractive surgical consideration until such time when the pathologic processes in Meniere's disease are better understood.

Adult↗
PubMed2004

Meniere's disease and allergy: allergens and cytokines.

The aim of this article is to evaluate the role of allergy in the pathogenesis of Meniere's disease by means of cytokine profiles, allergic parameters and lymphocyte subgroups. A total of 46 patients aged between 26-68 years diagnosed with Meniere's disease between 1993-2002 were recruited to this study. The control group consisted of 46 healthy volunteers who were from the same age group, living in the same region and possessing similar socioeconomic indicators. Lymphocyte subgroups were measured from the peripheral blood by employing Becton Dickinson (BD) monoclonal CD4, CD8, CD23 antibodies. IFN-gamma, IL4, total IgE levels, and specific IgE levels pertaining to tree, fungus, fruit, egg-white, cow's milk, wheat flour, corn flour, beef, and rice allergens, in all seasons, were measured and compared in the patient and control groups. In patient serum samples there were positive correlations between CD23 and IgE, CD8 and IgE, CD4/CD8 and IgE, and CD23 and CD8 (p <0.01). There were negative correlations between IL-4 and IFN-gamma, IFN-gamma and IgE, and a positive correlation between IL-4 and IgE. Total IgE levels were above the normal values in 19/46 (41.3 per cent) of the patient group, but the ratio was nine out of 46 (19.5 per cent) in the control group. A history of allergy was found in 31/46 (67.3 per cent) when the patients were questioned. The ratio of a history of allergy was 16/46 (34.7 per cent) in the control group. When specific IgE levels were evaluated the ratio of patients with all the panels negative was eight out of 46 (17.9 per cent), but it was 31/46 (67.3 per cent) in the control group. This study found that the prevalence of allergy was higher in patients with Meniere's disease than in the control group. Thus the authors suggest that allergy should be taken into account when patients with this disease are treated.

Adult↗
PubMedDate not supplied

Experimental study on Meniere's disease.

Experimental hydrops caused by underabsorption of endolymphatic fluid is a model of remissional stage of Meniere's disease. In this study, another type of model, ie, hydrops caused by overproduction of endolymphatic fluid, was accomplished by applying various pressures into scala media through a micropipette via stria vascularis. This type of hydrops could be a model of attacks of Meniere's disease. By using two types of the model, effects of glycerol administration and of opening the endolymphatic sac were discussed.

Animals↗
PubMed2003

Insertion of tympanic ventilation tubes as a treating modality for patients with Meniere's disease: a short- and long-term follow-up study in seven cases.

OBJECTIVES: As a treatment for patients with Meniere's disease, insertion of a ventilating tube in tympanic membrane was carried out, and the effect of the therapeutic modality was analysed. METHODS: Seven patients (four males and three females, age ranged 35-62 years) with active Meniere's disease were placed with ventilating tubes in the affected ear and postoperative change in symptoms, i.e. incapacitating vertigo and hearing loss were investigated. Disease severity was scored and evaluated pre- and postoperatively under the guidelines proposed by the Committee on Hearing and Equilibrium in the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS, 1985). RESULTS: Of the seven cases, the number of patients and the degree in controlling vertigo after the treatment were: at 24 months (short-term) five cases with substantial, one with limited and one with insignificant control, then at 42 months (long- term) four cases with substantial, three with limited control, respectively. The degree of disability in patients at 24 and 42 months of the treatment was compatible with the level of vertigo controlling. On the other hand, patients' hearing level was not affected by the treatment. CONCLUSIONS: Exact explanation for the effect of ventilating tubes in tympanic membrane is vague and its therapeutic effect was limited. However, at least this treatment might represent a short-term effect for the reduction of persistent vertigo in some patients with Meniere's disease and so it might become a treatment option because of its simple and less-invasive procedure.

Adult↗
PubMed1998

Cervical signs and symptoms in patients with Meniere's disease: a controlled study.

This study compares the frequency of signs and symptoms from the cervical spine in 24 patients diagnosed with Meniere's disease and 24 control subjects from a population sample. From a previous controlled comparative study concerning signs and symptoms of craniomandibular disorders, 24 patients diagnosed with Meniere's disease (10 males and 14 females) and their 24 matched control subjects participated in this investigation on the state of the cervical spine. Symptoms of cervical spine disorders, such as head and neck/shoulder pain, were all significantly more frequent in the patient group than in the control group. Most of the patients (75%) reported a strong association between head neck movements in the atlanto-occipital and atlanto-axial joints and triggered attacks of vertigo. Also, 29% of the patients could influence their tinnitus by mandibular movements. Signs of cervical spine disorders, such as limitations in side-bending and rotation movements, were significantly more frequent in the patient group than in the control group. Tenderness to palpation of the transverse processes of the atlas and the axis, the upper and middle trapezius, and the levator scapulae muscle were also significantly more frequent in the patient group. The study shows a much higher prevalence of signs and symptoms of cervical spine disorders in patients diagnosed with Meniere's disease compared with control subjects from the general population.

Adult↗
PubMed2000

Preliminary results of a new delivery system for gentamicin to the inner ear in patients with Meniere's disease.

Intratympanic gentamicin therapy has gained some clinical popularity in the treatment of vertigo associated with Meniere's disease. This therapeutic modality offers some advantages over traditional surgical treatment. The vestibulotoxic effect of gentamicin is well documented, but there is no general agreement about the dose needed to control vertigo attacks without affecting hearing. In the current preliminary study 27 patients with Meniere's disease refractory to medical management were treated by small doses of gentamicin delivered via microcatheter in the round window niche and administered by an electronic micropump. The patients received a total dose of 0.24-90 mg. The effect on vestibular symptoms resulted in the cessation of vertigo in the 22 patients, control of drop attacks in 4 of 6, and release of aural pressure and fullness in 2 of 4. Significant hearing loss (anacusis) occurred in six patients, slightly related to the flow rate in the pump setting. Different explanations for the loss of hearing are presented. The new delivery system for gentamicin appears to be effective in controlling vertigo, but with an unacceptable negative effect on hearing. The effectiveness and the safety of this new delivery system must be investigated further in controlled studies. However, it opens up the possibility of future novel ways of treating inner ear diseases, such as sudden deafness and tinnitus, as well as for the protection, repair, and regeneration of inner ear sensory cell function in damage due to aging, noise, toxic substances, immune reactions, etc.

Adult↗
PubMed2004

Cellular changes of Reissner's membrane in Meniere's disease: human temporal bone study.

OBJECTIVE: To study the cellular characteristics of Reissner's membrane (RM) in temporal bones (TBs) from patients with endolymphatic hydrops with symptoms of Meniere's disease (EH/+MD) and TBs with endolymphatic hydrops without symptoms of Meniere's disease (EH/-MD) in an effort to understand the role of endolymphatic hydrops in MD symptoms. STUDY DESIGN: Comparative study of human TB histopathology. METHODS AND MATERIALS: Epithelial and mesothelial cellularity of RM from control TBs, TBs from patients with EH/+MD, and TBs from patients with EH/-MD were compared. The cellularity of epithelial and mesothelial cell nuclei (defined as number of cells/100 microm width of RM) were counted along the width of RM. The width of RM was measured from the vestibular crest of the spiral ligament to the limbus spiralis. RESULTS: The cellular densities of epithelial cells in the basal and middle turns of RM were significantly higher in the EH/+MD and EH/-MD groups compared with "controls." There was no difference in epithelial cellularity between EH/+MD and EH/-MD. There was a decrease in the number of mesothelial cells of RM in the basal turn in EH/+MD and EH/-MD groups (statistically significant only in EH/+MD group) when compared with controls. The number of mesothelial cells of RM in the middle turn in EH/+MD and EH/-MD groups were significantly decreased compared with normals. DISCUSSION: Similar findings in cellularity of RM in temporal bones with EH/+MD and EH/-MD suggest that pathophysiologic mechanisms other than hydrops may be responsible for symptoms in Meniere's disease.

Adolescent↗
PubMed2005

Angular vestibulo-ocular reflex gains correlate with vertigo control after intratympanic gentamicin treatment for Meniere's disease.

OBJECTIVES: The objective of our study was to determine whether angular vestibulo-ocular reflex (aVOR) gains correlated with vertigo control after intratympanic gentamicin treatment for Meniere's disease. METHODS: We conducted a prospective study of 18 subjects with unilateral Meniere's disease treated with intratympanic gentamicin injection and followed all subjects for 1 year. We measured the gain of the aVOR elicited by rapid rotary head thrusts in each of the canal planes for each subject before and after treatment with intratympanic gentamicin by using magnetic search coils to record eye movements. RESULTS: During the follow-up period, 11 subjects ("single-treatment group"; 61%) had control of their vertigo with a single gentamicin injection. The remaining 7 subjects ("multiple-treatment group"; 39%) experienced recurrent vertigo that required a second injection of gentamicin at a mean of 6 months after the first treatment. The 11 subjects in the single-treatment group had significantly greater reduction of labyrinthine function after the first treatment, as measured by change in ipsilateral horizontal canal gain, than did the 7 subjects with vertigo recurrence. Changes in caloric asymmetry did not correlate with vertigo control. CONCLUSIONS: Our results suggest that successful treatment of Meniere's disease is closely related to attenuation of semicircular canal function as measured by horizontal canal aVOR gains.

Adult↗
PubMedDate not supplied

Intravenous xylocaine in the treatment of attacks on Meniere's disease.

The effect of xylocaine on epileptic attacks suggested a study of its effect in attacks on Meniere's disease, as the symptoms can be very much alike in the two conditions. The results were found to be excellent, especially as regards the vegetative dysfunctions. In attacks of Meniere's disease the tinnitus disappeared for 20 minutes, vomiting generally disappeared for good and nausea for an hour or two. Nystagmus was unaffected.

Drug Evaluation↗