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PubMedDate not supplied

[Recovery from Meniere's disease].

When vertigo attacks and balance disorders stop, menieric patients are generally considered recovered although they complain of more or less severe sensorineural hearing loss. As far as a true clinical recovery is concerned, the Authors think that it should correspond not only to absence of vertiginous spells but even to a long lasting normal and stable hearing level. On the basics of this presumption, they select the files of 7/207 patients showing complete recovery since not less than 8 years. Age at the onset of the disease, associated disease, isolated symptoms before the appearance of the classic triade, age at the first attack, total number of crises, length of active period of the disease, maximum hearing loss, shape of audiometric tracing are all analyzed. Healed patients are characterized by a smooth evolution, which reverses in the very first phases of the disease, as well as by the following: 1) absence of head injury and viral labyrinthitis in clinical history; 2) onset of disease with complete symptomatology; 3) slight hearing loss and up-sloping audiometric configuration; 4) few attacks of vertigo (less than 30) lasting no longer than 12 hours; 5) active period of disease not exceeding 18 months. Recovery from Ménière's disease seems possible as long as labyrinth lesions are not stabilized.

Adult↗
PubMed1984

Placebo effect in surgery for Meniere's disease: a three-year follow-up study of patients in a double blind placebo controlled study on endolymphatic sac shunt surgery.

In a previously published double blind, placebo controlled study, the efficacy of an endolymphatic sac-mastoid shunt was compared with a purely placebo operation (mastoidectomy) in controlling the symptoms in 30 patients with typical Meniere's disease. Minor differences could be demonstrated after one year between patients with the shunt versus the sham operation, but the greatest difference was between the pre- and postoperative scores, and both groups improved significantly. It was concluded that the impact of the various endolymphatic sac shunts upon the symptoms in patients with Meniere's disease is highly unspecific, and that the 70% improvement in both our groups was most likely caused by a placebo effect. The patients have now been regularly followed for a minimum of 3 years and the symptoms registered whenever present. The results of hearing tests, the patients' own evaluation, and the investigator's evaluation (while still unaware of the type of operation in each patient) show that the 3-year results are the same as our results from the first year: no significant difference could be found between the two groups.

Adult↗
PubMed2003

[Dissection of endolymphatic duct in Meniere's disease].

The authors believe that endolymphatic sac (ES) surgery produces the highest and most persistent effect in comparison with all other surgical interventions in Meniere's disease (MD). Conventional views on the mechanisms underlying a beneficial effect of the ES surgery are revised and a new surgical technique is proposed. A positive effect of the operation, according to the authors, depends not on ES decompression but on the ES break taking place in separation of the dura mater from the bone skull in the outlet area of the aqueduct of the vestibule (AV). When the AV is separated from the sac, a rise in endolymphatic pressure is relieved by the endolymph pushing through the AV as it is not connected with the ES. 10 year follow-up has shown that this technique excludes subsequent endolymphatic hydrops.

Endolymphatic Duct↗
PubMed2001

Intratympanic dexamethasone, intratympanic gentamicin, and endolymphatic sac surgery for intractable vertigo in Meniere's disease.

OBJECTIVE: To compare the efficacy of intratympanic dexamethasone (ID), intratympanic gentamicin (IG), and decompression of the endolymphatic sac (ESD) for intractable vertigo in Meniere's disease. STUDY DESIGN AND SETTING: This prospective study was conducted at Hacettepe University Medical Faculty, a tertiary care center. Dexamethasone was applied through a ventilation tube in 24 patients, intratympanic gentamicin (also through a ventilation tube) to 16 patients, and 25 patients underwent ESD. RESULTS: Satisfactory control of vertigo was 72%, 75%, and 52%, respectively for the ID, IG, and ESD. Two patients in the gentamicine group had total hearing loss. In the dexamethasone group, hearing level remained the same in 46% of the patients with 16% increase and 38% decrease (30% 10dB and 8% 20 dB). CONCLUSION: If the vertiginous symptoms still persist after 6 months of medical treatment, ID can be started. If there is no further improvement after 3 months with ID, patients with profound sensorineural hearing loss undergo treatment with IG, ESD is reserved for patients with good hearing. If ESD also fails, patients with good hearing may undergo vestibular nerve section; patients with nonservicable hearing become candidates for labyrinthectomy.

Administration, Topical↗
PubMed1984

Meniere's disease. Role of otospongiosis and metabolic disorders.

In summary, the available published information on otospongiosis and metabolic factors in the production of endolymphatic hydrops viz. Meniere's disease was reviewed. By addressing these factors in a therapeutic approach, the effective management of this disorder reveals results as good as the reported surgical results. In addition, it was possible to salvage patients who had previously undergone successful surgery only to deteriorate several years later. At this time, the role of surgery on the endolymphatic sac is reserved for those patients who are failures in this form of management.

Adult↗
PubMed1980

The characteristics and natural history of tinnitus in Meniere's disease.

Four tests for the identification of tinnitus have been presented: pitch, loudness, maskability, and residual inhibition. The typical features of the tinnitus associated with Meniere's disease are as follows: 1. Usually the tinnitus is a low pitched noise. However, in the burned out condition it is often higher in pitch and tonal in quality. 2. The loudness match occurs at very low sensation levels. 3. Masking as a relief procedure is usually easily achieved, requiring only low levels of noise. 4. The masking recommended for relief of tinnitus is found to be acceptable as a substitute for tinnitus. 5. Masking of the tinnitus produces residual inhibition, which frequently is of longer than average duration.

Female↗
PubMedDate not supplied

The clinical picture of Meniere's disease in the light of glycerin and urea tests.

A mathematical-statistical analysis of the role of glycerin and urea tests in patients with Meniere's disease is presented. Using the quantification method for multidimensional qualitative data, 13 variables were analysed. The younger the patient the stronger was the correlation between age and positive glycerin and urea tests. At ages over 50 years, no correlation to positive test results was found. The longer the duration of disease, the stronger was the correlation between this duration and a positive urea test. The glycerin test showed no correlation to the duration of the disease. Hearing losses of 40-69 dB were correlated both to a positive glycerin test and to a positive urea test. Greater hearing losses were correlated only to a positive glycerin test. Hearing losses of less than 39 dB were not correlated to positive results of either the glycerin or the urea test. Directional preponderance in the caloric test showed a correlation to a positive urea test. On the basis of these results a hypothesis has been formulated to explain how glycerin and urea might affect the internal ear.

Adult↗
PubMed2002

Perilymphatic pressure measurement in Meniere's disease.

The aim of this study was to evaluate the perilymphatic pressure, by means of the MMS-10 Tympanic Displacement Analyzer (TDA), in patients with Meniere's disease (MD). Measurements were performed in 37 patients with MD and in 14 normal-hearing subjects. Data were collected from 3 groups: healthy ears of normal-hearing subjects, unaffected ears of patients with MD, and affected ears of patients with MD. Analysis of the results obtained with the TDA showed no significant differences between the 3 groups. Several hypotheses could explain this lack of difference: 1) perhaps indirect measurement of perilymphatic pressure with the TDA is not relevant; 2) perhaps hyperpressure of the inner ear is not the physiological basis for the clinical triad of MD; or 3) perhaps endolymphatic hydrops does not produce changes in perilymphatic pressure. The results of this series indicate that the TDA is not useful in the evaluation of patients with MD.

Adolescent↗
PubMed1981

Hyperlipoproteinemia, hyperinsulinism, and Meniere's disease.

Since first reporting the association of hyperlipoproteinemia with inner ear disease in a study of 300 patients in 1973, I have continued to focus attention on the presence of lipid abnormalities in patients with inner ear dysfunction. With over 1,400 patients now identified with both abnormal lipids and inner ear symptoms, it has become increasingly apparent that most patients seen by otolaryngologists because of Meniere's disease come from that same large population group who are prone to obesity, maturity-onset diabetes, coronary artery disease, and atherosclerosis. These patients share the common problem of being unable to handle refined carbohydrates well. Based on the reports and studies of many authorities, a hyperinsulinism exists in these conditions. These patients are helped by replacing refined carbohydrates with complex carbohydrates having increased fiber. When these conditions can be identified in patients with Meniere's disease, dietary management has been found to be the most effective therapy.

Humans↗
PubMed2001

Control of symptoms in patients with Meniere's disease using middle ear pressure applications: two years follow-up.

The effects of middle ear pressure pulses were studied in 37 patients with a diagnosis of definite Meniere's disease and active vestibular symptoms, 31 of whom had failed to respond to medical treatment including diuretics prior to pressure treatment. The number of vertigo spells during the 6 months prior to treatment and for 6, 18 and 24 months after the start of treatment were evaluated. The functionality level scores were three or worse according to the American Academy of Otolaryngology--Head and Neck Surgery (AAO-HNS) criteria. The results of the study were as follows: 19 patients experienced freedom from vertigo spells; 15 patients reported a significant decrease in the frequency of vertigo spells; and 3 patients did not respond to pressure treatment and were subjected to gentamicin injections, I of whom consequently became deaf in the affected ear. No patient became worse in connection with pressure treatment. With the exception of the three patients who did not respond to pressure treatment, all patients reported an improvement in functionality of at least two levels according to the AAO-HNS functionality scale. No side effects or adverse events were observed during the 2 years of pressure treatment. Overall, the results indicate that pressure treatment provides efficient control of symptoms in patients with intractable forms of Ménière's disease without producing any adverse effects on the inner ear.

Adult↗
PubMed2002

Hearing loss following intratympanic instillation of gentamicin for the treatment of unilateral Meniere's disease.

OBJECTIVE: To determine the incidence, extent, and time course of hearing loss following instillation of intratympanic gentamicin using a predetermined fixed protocol for incapacitating unilateral Meniere's disease and to determine whether such loss is associated with any identifiable risk factors. STUDY DESIGN: A retrospective analysis of all patients treated with intratympanic gentamicin between 1988 and 1998 using American Academy of Otolaryngology-Head and Neck Surgery reporting guidelines (1985 and 1995). A predetermined regimen using a fixed dose (gentamicin 26.7 mg/mL administered three times daily for 4 consecutive days) was used. METHODS: The records of patients treated with this particular protocol were reviewed. The relationship between pretreatment hearing acuity, pretreatment bithermal caloric response, duration of symptoms, and previous treatment to post-treatment hearing were analyzed with respect to hearing. RESULTS: Complete vestibular and audiologic data over a minimum 2-year follow-up were available for 85 individuals. Sixty-three patients (74.1%) had unchanged or improved hearing, and 22 patients (25.9%) realized hearing loss. In 80% of the latter, it occurred during the first month post-treatment. When hearing acuity at the 1-month post-treatment interval remained unchanged (91.1%), it was likely to remain so over the next 23 months. A significantly higher incidence of profound hearing loss was noted in patients who developed hearing loss in the first month, as compared with those who developed hearing loss at a later period (p = .0207, relative risk = 1.5). Re-treatment was not associated with hearing loss. The only identifiable risk factor for developing hearing loss was pretreatment hearing acuity stages 3 and 4 (pure-tone average > 40 dB) (p = .022, relative risk = 1.5). CONCLUSION: Hearing loss is a recognized complication of treatment with intratympanic gentamicin, occurring in approximately 26% of individuals. In those individuals in whom hearing acuity has remained unchanged after the first month interval, significant worsening of hearing is unlikely, and patients can be reassured accordingly.

Adult↗