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PubMed1977

Therapeutic options in Meniere's disease.

Emphasis on treatment in Meniere's disease has recently shifted from a concentration on the vertiginous component alone to include conservation or improvement of hearing as well. This presentation tabulates the current otological literature's reports of both the medical and surgical options available in the treatment of Meniere's disease. The authors conclude that these more recent reports deemphasize the importance of the vertiginous component, while emphasizing the importance of the hearing component in evaluation of the efficacy of any therapeutic modality. Furthermore, these reports indicate that endolymphatic sac decompression and drainage surgery alone offers a considerable chance for conservation or improvement in hearing, as well as relief of vertigo in early cases of reversible, fluctuating hearing deficits. In nonreversible or nonfluctuating hearing deficits with hearing worth conserving, vestibular neurectomy with excision of Scarpa's ganglion yields the best results.

Ear, Inner↗
PubMed1985

Vestibular Meniere's disease.

The clinical entity of vestibular Meniere's disease (VMD) is assessed and described. Twenty percent of cases eventuating in typical Meniere's disease presented with VMD first. In other patients VMD alone persisted for many years (30 or more). VMD, usually unilateral, is characterized by recurrent episodes of vertigo typical of classical Meniere's disease. Positional vertigo can occur between or during episodes. Aural pressure is second to vertigo in importance, and electronystagmographic findings are third. Although hearing is normal, tinnitus or loudness intolerance may be present. Concepts of pathogenesis are discussed.

Adolescent↗
PubMed2002

History of Meniere's disease and its clinical presentation.

The term Meniere's disease is used to define either the classic triad of vestibular and cochlear symptoms and aural pressure from known or unknown causes or its clinical variants, vestibular and cochlear Meniere's disease. Some variants evolve after years into typical forms, whereas others do not. Some symptoms (positional vertigo) have been long underestimated in previous reports. The more we study our patients and correlate clinical findings and the natural history with pathologic studies on temporal bones and laboratory research, the more we will understand Meniere's disease and its causes. Some causes have already been identified as most probable. Extrinsic factors (inflammation, trauma, otosclerosis, autoimmunity, endocrine disorders, and such) interact with congenital (genetic) and developmental intrinsic factors (primary or secondary, acquired) into a multifactorial inheritance that is, to date, the best explanation for the basis of Meniere's disease. Endolymphatic hydrops is widely accepted as the pathologic substrate, but not all hydrops seems to be progressive or becomes clinically manifest. Endolymphatic hydrops is the result of a dysfunction in the mechanism of production/absorption of endolymph, which is mainly due to defective absorptive activity of the endolymphatic duct and sac. Hyperproduction of endolymph cannot be excluded in some cases. Ruptures of the labyrinthine membranes do not satisfactorily substantiate the multiform duration, recurrence, and repetitiveness of attacks of Meniere's disease, nor do they explain the entire complex of symptoms. It seems reasonable to explain symptoms of Meniere's disease on the basis of mechanical factors (as observed in temporal bone studies) associated with biologic and biochemical factors.

Adult↗
PubMedDate not supplied

Pathology of Meniere's disease.

From review of recent findings, the pathology of Meniere's disease is described and correlated with clinical signs. Since Meniere's disease can be seen only in humans, assessing its natural history is important. A recent survey of 500 patients demonstrated the three major symptoms to be vestibular, auditory, and aural pressure. Meniere's disease (idiopathic) is distinguished from Meniere's syndrome (symptoms with likely cause), which accounted for approximately one fourth of the patients. Atypical forms include vestibular and cochlear Meniere's disease. A recent review of our temporal bone collection and detailed study of the pathological conditions of 134 temporal bones described in the literature revealed characteristic pathological findings. Patients with clear-cut histories of Meniere's disease may demonstrate little or no endolymphatic hydrops at death. Nevertheless, hydrops of the pars inferior remains the most significant pathological correlate of Meniere's disease. On the basis of these findings, the pathogenesis of the disease (malabsorption of endolymph) and the pathophysiology of the symptoms (physical and chemical) are discussed.

Edema↗
PubMed2004

Meniere's disease: identifying classic symptoms and current treatments.

Meniere's disease affects 615,000 individuals in the United States. Therefore, occupational health nurses may encounter employees who express symptoms of Meniere's disease or have been diagnosed with this problem. When nurses have an understanding of the symptoms of Meniere's disease, they can validate clients' concerns by directing them to an otolaryngologist or audiologist for further evaluation. Awareness of Meniere's disease may aid in counseling individuals during their annual education and training that is required to maintain an effective hearing conservation program.

Female↗
PubMedDate not supplied

Vestibular investigations in Meniere's disease.

151 patients with unilateral Meniere's disease were investigated with a vestibular test battery in the interval between vertigo attacks, and the results were compared with those obtained in a control group. In 73.5% of the patients a caloric response reduction of the afflicted ear was observed. The mean caloric response reduction was 34.3%; a major response reduction or a total absence of the caloric response of the afflicted ear was rare. A correlation was found between the amount of caloric response reduction and the duration of the disease. Spontaneous nystagmus was found in 47% of the cases (mean value 3 degrees/sec) and a mainly direction fixed positional nystagmus in 78% (mean value 4.0 degrees/sec). No correlation was found between the mean hearing loss and the magnitude of caloric response reduction on the day of investigation.

Adolescent↗
PubMedDate not supplied

Electrophysiological and biochemical findings in four cases of Meniere's disease.

In 4 cases of Meniere's disease, E.P., concentrations of Na, K, Cl, and protein, and osmolality were determined in endolymph from the basal coil of the cochlea. In 3 cases, endolymph was found normal in nature as compared with normal animals. In one long-standing (11 years) case, a strial dysfunction was evidenced. In 2 cases, the surgical treatment consisted in the mere withdrawal of endolymph. This resulted in the transitory aggravation of the hearing loss. This observation might suggest that, at the considered stages of the disease: 1) hearing loss is not related to the excess of fluid; 2) the rate of endolymph production averages 0.35 microliter per day; 3) the water displacement induced by the glycerol test concerns rather perilymph than endolymph; 4) any pharmacological or surgical therapy aiming at reducing the excess of endolymph is unlikely to succeed as far as hearing is concerned.

Adult↗
PubMedDate not supplied

Macula utriculi in four cases with Meniere's disease.

Four patients suffering from Meniere's disease were labyrinthectomized. Maculae utriculi were removed and studied by electron microscopy. The neuro-epithelia from all four patients appeared fairly normal, considering the age of the patients. However, two types of degenerative change, which could be related to the inner ear disorder, could be distinguished. One was vacuolation of the sensory cell cytoplasm, followed by pycnosis of the nucleus and cell death. The other was cystic degeneration. This started with localized separations between the sensory cell and the nerve chalice. These separations developed into a single cystic cavity. A few large intra-epithelial cysts were found, probably representing the final stage of the cystic degenerative process.

Adult↗
PubMed2000

Detection of antibody to sialyl-i, a possible antigen in patients with Meniere's disease.

An autoimmune hypothesis for the etiology of Meniere's disease has been proposed. In this study, we focused on gangliosides as potential antigens for autoantibodies in Meniere's disease patients. In an attempt to investigate ganglioside antigens which respond to the serum of patients with Meniere's disease, we analyzed gangliosides of human acoustic neurinomas, and used them as antigens to broadly explore gangliosides that react to serum. All the acoustic neurinoma samples used in the present study showed a similar ganglioside profile on TLC (thin-layer chromatography). For the microscale ganglioside analysis, a newly developed TLC blotting/secondary ion mass spectrometry (SIMS) system together with TLC immunostaining method was employed. Most of the ganglioside bands could be analyzed, and they were identified as GM3, GM2, SPG, GM1a, GD3, S-i (sialyl-i ganglioside) and GD1a. GD1a was the predominant ganglioside and many neolactoseries gangliosides were recognized by immunological analysis. Next, the immune reactivity of serum samples, from patients with Meniere's disease, with the acoustic neurinoma gangliosides was studied by TLC immunostaining. The result showed that five of 11 patients with Meniere's disease and one of eight normal subjects reacted with a specific band, which was identified as S-i by the TLC blotting/SIMS system. The findings of the present study indicate that S-i ganglioside is an autoantigen and possibly involved in the pathogenesis of Meniere's disease.

Autoantibodies↗
PubMed1983

The treatment of Meniere's disease by acupuncture.

34 patients suffering from Meniere's disease were treated by acupuncture. Prior to acupuncture most of them had been treated with various other medical means without satisfactory results. After acupuncture treatment their condition greatly improved. The classic symptoms of Meniere's disease are vertigo, tinnitus and deafness, but for all the treated patients vertigo was the most uncomfortable and distressing symptom. In all our cases vertigo stopped after a few acupuncture courses; but in our opinion it is more important to follow and control hearing threshold, since if it remains stable the other symptoms of Meniere's disease also do not persist. All our patients were regularly followed by careful audiometric studies several years after acupuncture treatment. In most cases hearing level had not greatly varied, so the other symptoms of Meniere's disease were not present in any large degree.

Acupuncture Therapy↗
PubMedDate not supplied

The vestibular aqueduct in patients with Meniere's disease. A temporal bone histopathological investigation.

Meniere's disease (idiopathic endolymphatic hydrops) was studied in human temporal bone histology sections. Measurements were made of the area, length, width, angle, position, and external aperture of the vestibular aqueduct in 27 temporal bones of individuals with this disease. These measurements were compared with measurements of the same parameters in 88 normal temporal bones. It was found that small vestibular aqueducts were more often observed in the temporal bones of patients with Meniere's disease than in temporal bones from individuals without this disorder. The difference in size of the vestibular aqueduct in bones with hydrops and normal bones was statistically significant.

Adult↗
PubMed1979

Meniere's disease: a neuropsychological study II.

23 Meniere patients were examined with an extensive battery of neuropsychological tests. In a previous investigation the authors had demonstrated that patients with a long duration of Meniere's disease had psychological disturbances, presumably localized in the nondominant hemisphere. In the present investigation the patients had a short duration of the disease, and we were unable to reproduce the psychological disturbances. It is concluded that the central changes in the nondominant hemisphere function develop over a long period of time. It is hoped for that further neuropsychological investigations of Meniere patients can give more information of what is primary in Meniere's disease: peripheral sensory or central neurological changes.

Adult↗