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At least 451 records · Page 25Linked to original sources
PubMed2005

Surgical treatment of Meniere's disease.

PURPOSE OF REVIEW: This review comprises new insights from and discusses the impact of recent medical publications on the surgical treatment of Meniere's disease. RECENT FINDINGS: Refining surgical indications through recognition of clinical conditions with similar symptoms and through a more precise estimation of the degree of disability will improve the process of decision making for surgery. Further high-level evidence-based medical data supporting the effectiveness of intratympanic gentamycin has become available. Physiopathological progress, based on animal experiments, towards surgically applied intracochlear drug delivery is addressed. SUMMARY: Studies using level 1 or 2 evidence-based medicine must be conducted to enable better decision making, such as in the application of intratympanic gentamycin or micropressure Meniett therapy at an earlier stage of Meniere's disease. If the results of such studies are conclusive for surgery, this will lead to a shorter duration of discomfort for patients before being offered the possibility of surgery.

Animals↗
PubMed1979

Revision of the endolymphatic subarachnoid shunt for Meniere's disease. Review of 59 cases.

Members of the Otologic Medical Group, Inc, Los Angeles, diagnose Meniere's disease in patients with fluctuating hearing loss, fluctuating tinnitus, episodic vertigo, and fluctuating pressure symptoms in the ear. Treatment is vasodilation. If medical treatment fails, an endolymphatic subarachnoid shunt operation is performed. If the shunt relieves symptoms for three or more months but symptoms then recur, revision of the shunt is recommended. If the revision surgery also fails, a destructive procedure is suggested.

Audiometry↗
PubMed1975

Shunt surgery in Meniere's disease.

This is a clinical study of the results of endolymphatic sac shunt surgery for Meniere's disease in 28 patients. Postoperative audiometric results and clinical evaluation of vertigo and tinnitus were analyzed to determine the effectiveness of this form of treatment. Although this is a small study and the time interval since operation is of only moderate duration (6 to 46 months), the results are encouraging: 79% of the patients showed improvement or stabilization of hearing as well as control of vertigo.

Cryosurgery↗
PubMed1979

Hearing improvement in attacks of Meniere's disease treated with pressure chamber.

A method to reduce endolymphatic pressure by exposing patients with Meniere's disease to underpressure has earlier been described. In this work the possible mechanisms are discussed. A material of 36 patients with acute attacks, treated in this way, is now presented. 15 out of these patients experienced a rapid hearing improvement. In 11 cases the remission has lasted for more than 1 year. The method seems to be of great value for those who improved, since at least an early permanent damage to the cochlea can be avoided.

Atmosphere Exposure Chambers↗
PubMed2000

[Computed tomographic findings of the development of the bone around the vestibular aqueduct in Meniere's disease].

OBJECTIVE: To study the development of the bone around the vestibular aqueduct (VA) in Meniere's disease (MD) by CT. METHOD: The experiment consisted of three groups; normal ear group, non-MD vertigo group and MD group. VA in each group was examined by CT, and the minimum distance between the posterior semicircular canal and the posterior petrous surface where contain the endolymphatic sac. RESULT: VA visualization rate in MD was low, P-P distance in MD group was shorter than that of normal ear group and non-MD vertigo group. CONCLUSION: It is the fundamental pathological anatomy in MD that VA and the bone around VA are maldeveloped.

Adolescent↗
PubMed2003

[Evaluation of glycerol test in Meniere's disease with pure tone audiometry and distortion product otoacoustic emission].

The purpose of the work was to follow up changes in the pure tone audiometry and distortion products otoacoustic emissions (DPOAE) after glycerol administration in Meniere's patients. Twenty patients with Meniere's disease and 16 with cochlear hearing loss without vestibular symptoms were subjected to the glycerol test following the complete audiological evaluation. Glycerol was administered orally 1.5 ml/kg of body weight dissolved in the equal amount of the physiological saline. The results of the glycerol test were analyzed with reference to changes in the pure tone threshold and DPOAE testing. Both investigations were performed in four series: as an initial testing before the glycerol intake and next--one, two and three hours after the glycerol administration. DPOAE included DP-gram registration (L1 = L2 = 70 dB; f2/f1 = 1.22; 1/2 octave) and input/output (I/O) function at 2, 4 and 6 kHz. The glycerol test was regarded as positive in the audiometry if the pure tone threshold improved at least 15 dB at minimum 3 frequencies. Positive result of the glycerol test in DPOAE was judged if DP amplitude increased more than 5dB at 2 or more frequencies in DP-gram and/or DP-threshold lowered at least 10dB in minimum two I/O registrations. In the subjects with Meniere's disease, 11 positive and 9 negative glycerol tests in audiometry and 10 positive and 10 negative DPOAE glycerol tests were obtained. In the reference group, one audiometric glycerol test and two DPOAE glycerol tests were regarded as positive. Much conformity, making 85%, between audiometric and DPOAE tests results is observed. The dynamics of the parameter changing in the consecutive test hours was also similar in both pure tone audiometry and DPOAE. These studies suggest that distortion product otoacoustic emission could be useful in diagnostics of Meniere's disease and would be a valuable diagnostic tool as an objective examination.

Acoustic Stimulation↗
PubMed2005

[Towards a cellular pathophysiology of Meniere's disease].

BACKGROUND: A modest increase in the hydrostatic pressure within the endolymphatic space may induce an endolymphatic hydrops which in turn is typically associated with Meniere's disease. However, there is no convincing pathophysiological model that might explain, on a cellular level, how a pressure increases may cause disturbed functions of vestibular hair cells and vertigo attacks. METHODS: So far, models involve osmotic mechanisms leading to electrolyte imbalances in the endolymphatic space. Alternatively, impaired longitudinal flow in the endolymphatic space is considered important. RESULTS: Recently, a pressure-sensitive potassium current was identified and characterized in vestibular hair cells. CONCLUSIONS: This current may modify the frequency behavior of a cell and may be the "missing link" in a cellular pathophysiology of the hydrops. Ion currents in hair cells offer attractive targets for pharmacological interventions in Meniere's disease.

Calcium↗
PubMed1999

Three new surgeries for treatment of intractable Meniere's disease.

OBJECTIVE: This study aimed to describe the rationales for and preliminary results of three new types of surgery for the treatment of intractable Meniere's disease, all involving insertion of a capillary tube into the endolymphatic duct. This study also aimed to compare the contrasting surgical strategies of endolymphatic sac enhancement versus sac supplantation. STUDY DESIGN AND SETTING: The study design was a retrospective review of 129 surgeries conducted by the author at Chang Gung Memorial Hospital since 1993: 51 cases of Huang/Gibson inner ear shunt implantation, 52 cases of intraductal capillary tube implantation (ICTI), and 26 cases of ICTIin combination with endolymphatic sac ballooning surgery (ESBS). PATIENTS: This study is limited to patients with classic Meniere's disease whose vertiginous symptoms were disabling and refractory to dietetic and medical treatment. MAIN OUTCOME MEASURES: Comparison of preoperative and postoperative conditions (e.g., vertigo control, hearing, disability) using American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1985 criteria and chi-square statistical method was measured. RESULTS: After 1 year of follow-up, use of the Huang/Gibson shunt resulted in a 94.1% vertigo control rate (complete or substantial) and fairly good hearing results, ICTI by itself resulted in an 88.5% rate of vertigo control and relatively unremarkable hearing results, and the ICTI in combination with ESBS (ICTI/ESBS) achieved a vertigo control rate of 96.1% in addition to good hearing results. CONCLUSIONS: The 1-year follow-up results for Huang/Gibson shunt implantation and sac-preserving ICTI/ESBS have approximately duplicated the excellent performance of the Arenberg implant after the same follow-up period, perhaps attributable in part to enhancement of endolymph flow through the endolymphatic duct.

Adult↗
PubMed2002

Early vestibular rehabilitation in patients with Meniere's disease.

This article proposes a broadened definition of vestibular rehabilitation to include patients with active, fluctuating Meniere's disease. Pedagogy in the program shifts from amelioration of symptoms by vestibular adaptation or habituation to education, prevention, and self-empowerment. Recommendations are given for patient education, prevention, and examination.

Forecasting↗
PubMed1999

Meniere's disease: the incidence of hydrops in the contralateral asymptomatic ear.

OBJECTIVE: This study analyzes the incidence of endolymphatic hydrops in the asymptomatic contralateral ear of patients with classic Meniere's disease. STUDY DESIGN: A retrospective study of 3000 subjects who underwent electrocochleography (ECOG) from 1988 to 1998. METHODS: The presence of endolymphatic hydrops was determined by use of ECOG recordings, which were made through a transtympanic recording needle situated in the round window niche. Analysis was made of the 1-kHz toneburst summation potential (SP), and comparison was made between asymptomatic contralateral "Meniere's ears" (n = 144) and asymptomatic normal "control ears" (n = 114). RESULTS: Results demonstrated that more than 10% of the contralateral asymptomatic Meniere's ears have an ECOG recording that is highly suggestive of the presence of endolymphatic hydrops. In contrast, less than 2% of the control population demonstrate abnormal ECOG recordings. Furthermore, 15% of the population of contralateral Meniere's ears lie above the 95th percentile of the control population for 1-kHz tone-burst (100 dB) SP negativity. CONCLUSIONS: This study suggests that a high percentage of patients who have what appears to be unilateral Meniere's disease have evidence of endolymphatic hydrops in the contralateral asymptomatic ear. This finding has important clinical relevance for the management of patients in whom destructive surgery is planned and further highlights the importance of electrocochleography in the diagnosis and management of this disease process.

Audiometry, Evoked Response↗
PubMed1997

Comparison of anti-heat shock protein 70 (anti-hsp70) and anti-68-kDa inner ear protein in the sera of patients with Meniere's disease.

The 68-kDa antigen detected in the sera of patients with autoimmune inner ear disease is known to represent the highly inducible heat shock protein 70 (hsp70). To evaluate the existence of anti-hsp70 in the sera of patients with Meniere's disease and to develop a more reliable method to detect this antibody, the sera of patients and controls were examined. Bovine kidney (MDBK) cells were cultured and some of them were heat shocked. Proteins in the cells were separated using sodium dodecyl sulfate polyacrylamide gel electrophoresis. Sera were reacted simultaneously with the blots of non-heat-shocked cells and heat-shocked cells. The serum was considered positive if the band in the 70-kDa location was denser in the lane with heat-shocked cells relative to non-heat-shocked cells. Presence of the antibody against the 68-kDa protein was compared with the result of immunoblotting with MDBK cells. In immunoblotting with MDBK cells, 33.3% of patients with Meniere's disease had anti-hsp70, while in the control group, only 5% had this antibody. Of the 60 cases, 13 were positive against both hsp70 and the 68-kDa protein, whereas 7 were positive only against hsp70 and 6 only against the 68-kDa protein. These differences appeared to result from the greater sensitivity of the differential anti-hsp assay and from difficulties in interpreting the results in blots with bovine inner ear extracts because of faint, broad, or overlapping multiple bands. Quite a number of patients with Meniere's disease have anti-hsp70, and it may be indicative of an immune etiology of the disease. The Western blot using heat-shocked and non-heat-shocked cells could be a reliable method to detect this antibody.

Adult↗
PubMed1998

Risk of progressive sensorineural hearing loss and Meniere's disease after breast implantation.

OBJECTIVE: The association of various immunologic abnormalities with the presence of silicone breast implants in women has been described. In addition, some studies report a correlation between autoimmune disorders and silicone breast implants, whereas other studies indicate no difference in the incidence of disease between women with silicone breast implants and control groups. Until recently, no reports had attempted to identify an association between silicone breast implants and hearing impairment. A recent study suggested a possible correlation between prior silicone breast implants and the development of various forms of hearing loss. This study tried to determine whether such a correlation could be duplicated. METHODS: To determine whether such a correlation could be established, we studied 119 female patients with either Meniere's disease or progressive sensorineural hearing loss and 100 age-matched healthy controls. Subjects completed questionnaires that provided various types of information, including the presence or absence of previous silicone breast implants. Serum from all 119 patients with Meniere's disease and progressive sensorineural hearing loss had been subjected to previous Western blot testing for reactivity to a 68 kD protein associated with certain forms of autoimmune hearing loss. RESULTS: Results indicated no significant difference in frequency of prior silicone breast implants among the patients with Meniere's disease, patients with sensorineural hearing loss, or controls. The presence or absence of the 68 kD protein also was not significantly relevant to the frequency of silicone breast implants. CONCLUSIONS: Our data did not show evidence of a significant relationship between the presence of silicone breast implants and later development of Meniere's disease, progressive sensorineural hearing loss, or positive 68 kD serum.

Adult↗
PubMed1979

Vestibular neurectomy and saccus decompression surgery in Meniere's disease.

Results of vestibular neurectomy, total eighth nerve section, and saccus decompression in 42 patients with Meniere's disease are reported. Vestibular nerve section was found in isolated cases to be a very effective method of abolishing the symptom of vertigo. Hearing is not affected but may be lost owing to opening of the vertical canal or disruption of blood supply. Saccus surgery might be the surgical treatment of choice in early cases with good hearing but in patients with fixed non-fluctuating hearing loss, rehabilitation can be effected only by vestibular neurectomy. In bilateral cases either sac surgery or the use of vestibulotoxic drugs is advised.

Adult↗
PubMed2001

Herpesvirus DNA in peripheral blood mononuclear cells of some patients with Meniere's disease.

Herpes simplex virus-1 (HSV) or varicella zoster virus (VZV) DNA was detected by nested polymerase chain reaction in peripheral blood mononuclear cells of patients with Meniere's disease (one of 28 patients for HSV-1, 2 of 28 patients for VZV) during acute illness (within 5 days after onset). On the other hand, neither HSV-1 DNA or VZV DNA was detected in PBMCs of 50 age- and sex-matched healthy individuals and 50 pregnant women. These findings may imply that reactivation of HSV- 1 or VZV may be associated with the development of some cases of Meniere's disease.

Acute Disease↗
PubMed1998

Intratympanic gentamicin injection for the treatment of Meniere's disease.

OBJECTIVE: This study aimed to examine the effectiveness of intratympanic injection of gentamicin as a nonsurgical treatment option in the treatment of patients with unilateral Meniere's disease who are refractory to medical treatment. STUDY DESIGN: The study design was a prospective case series. SETTING: The study was conducted at a physician's office setting in a tertiary care hospital. PATIENTS: The results of 37 patients who became eligible for reporting according to the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) guidelines for reporting treatment results of Meniere's disease were reviewed. INTERVENTION: Intratympanic injections of a prepared gentamicin concentration of approximately 30 mg/ml were given weekly until the patient reported cessation of vertigo attacks. Patients reclined for 45 minutes after each injection. MAIN OUTCOME MEASURES: The 1995 AAO-HNS guidelines were used in this report, and measures included pure-tone hearing results, word recognition scores, vertigo control scores, and ice-water calories after a minimum of 24 months of follow-up. RESULTS: Vertigo control was achieved in 32 patients (87%). Fifteen patients (41%) had complete recovery from vertigo spells, 17 patients (46%) had substantial recovery, and 5 patients (14%) had treatment failure requiring additional surgery to control vertigo. Hearing results showed that 21 patients (72%) had unchanged or better hearing, 10 patients (28%) had an average threshold shift of 10-25 dB, 4 patients (11%) had a threshold shift between 16 and 25 dB, 1 patient (3%) had a threshold shift between 26 and 40 dB, and 1 patient (3%) had a threshold shift of > 40 dB. CONCLUSIONS: The authors found intratympanic gentamicin to be a useful alternative to surgery. The flexible treatment protocol allowed for better hearing monitoring compared to the more frequent injection schedules of other studies and yielded a lower rate of severe hearing loss. It had a higher failure rate for vertigo control and a greater amount of hearing loss than the author's experience with vestibular nerve section.

Anti-Bacterial Agents↗