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PubMed1983

Significance of tomography in Meniere's disease: visualization and morphology of the vestibular aqueduct.

The revival of endolymphatic sac surgery has led to many investigations in Meniere's disease, including lateral tomography of the vestibular aqueduct. Contrary to recent literature, we found no difference in the presence and morphology of the vestibular aqueduct when assessed radiologically in a group of Meniere's patients and a control group. Our assessment of this information in regard to etiology and treatment of Meniere's disease is presented.

Humans↗
PubMed2002

Aquaporin-2 expression in the mammalian cochlea and investigation of its role in Meniere's disease.

The expression pattern of aquaporin-2 (AQP2), a vasopressin regulated member of the aquaporin gene family, in the cochlea and its potential role in Meniere's disease was investigated. RT-PCR screen of multiple rat tissues identified AQP2 transcripts in the cochlea, testis and kidney and an absence of tissue-specific splice variants. The level of AQP2 transcript in the cochlea was 10-fold lower relative to its expression in the testis and kidney. Western blot analysis demonstrated a single, 29 kDa band in the membrane fractions from cochlea, testis and the kidney. In the rat and mouse cochlea, AQP2 was expressed in the structures bordering the endolymph, including Reissner's membrane, the organ of Corti, inner and outer sulcus cells and the spiral limbus. A mutation screen of AQP2 in 12 individuals with Meniere's disease did not identify any sequence alterations or mutations within the four coding exons of AQP2 and their intron-exon junctions. The physiological role of AQP2 in water transport and its expression pattern in the cochlea suggests an important role for AQP2 in fluid homeostasis of the inner ear; however, its role in the pathogenesis in Meniere's disease remains to be established.

Animals↗
PubMed2001

Inhalant allergy and Meniere's disease: Use of electrocochleography and intranasal allergen challenge as investigational tools.

INTRODUCTION: In an earlier study, we demonstrated the feasibility of using electrocochleography (ECoG) to document changes in inner ear function objectively after intranasal challenge of patients with inhalant allergy (with no prior immunotherapy) and Meniere's disease, using the antigen to which they were most sensitive. OBJECTIVE: We expand on this earlier study and continue to investigate the feasibility of this model in a subset of patients with inhalant allergy and Meniere's disease after immunotherapy. STUDY DESIGN: Prospective study of 11 patients identified with both Meniere's disease and inhalant allergy in the practices of 2 neurotologists at our institution. Patients underwent a baseline ECoG, followed by intranasal challenge with the allergen to which they were most sensitive. This was followed by a second ECoG. RESULTS: Six of 11 patients had at least 1 year of immunotherapy (group 1), and 5 of 11 had had 0 to 6 months of immunotherapy (group 2). Four of 6 group 1 patients had a >15% increase in SP/AP ratio after immunotherapy. In group 2, 2 patients increased the SP/AP in at least 1 ear. No patient with a normal ECoG experienced vestibular symptoms after allergen challenge, whereas 2 of group 1 and 2 of group 2 had vestibular symptoms with abnormal ECoGs. CONCLUSION: This protocol is a useful tool for investigating the relationship of inhalant allergy and Meniere's disease, but needs a larger group of patients and further study to draw valid statistical conclusions.

Allergens↗
PubMed1999

Intratympanic gentamicin for control of vertigo in Meniere's disease: vestibular signs that specify completion of therapy.

OBJECTIVE: To determine if a protocol of weekly intratympanic gentamicin injections administered until development of signs of unilateral vestibular hypofunction can alleviate vertigo while preserving hearing in patients with intractable vertigo caused by unilateral Meniere's disease. STUDY DESIGN: The study design was a prospective investigational protocol. SETTING: The study was performed in outpatients at a tertiary referral center. PATIENTS: Entry criteria included a diagnosis of "definite" Meniere's disease according to the 1995 report of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), 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 outcomes of the first 34 patients who entered the protocol are reported. INTERVENTION: A buffered gentamicin solution was injected into the middle ear at weekly intervals until development of spontaneous nystagmus, head-shaking-induced nystagmus, or head-thrust sign indicative of vestibular hypofunction in the treated ear. MAIN OUTCOME MEASURE: The 1995 AAO-HNS criteria for reporting treatment outcome in Meniere's disease were used. The effects of treatment were assessed in terms of control of vertigo, disability status, hearing level, and quantitative measurement of vestibular function with caloric and rotatory chair tests. RESULTS: Vertigo was controlled in 91% of the patients. Profound hearing loss occurred as a result of gentamicin injection in one patient (3%). Intratympanic gentamicin was significantly less effective in controlling vertigo in patients who had previous otologic surgery on the affected ear. Recurrence of vertigo > or = 6 months after initially complete control was noted in seven patients (22%). Vertigo in six of these patients was eliminated by additional intratympanic gentamicin injections. CONCLUSIONS: Ending weekly intratympanic gentamicin injections when clinical signs of unilateral vestibular hypofunction appear can control vertigo in most patients. Hearing loss directly attributable to gentamicin is uncommon. Treatment outcome is best in patients who have not had previous otologic surgery.

Adult↗