Inadequate opening capacity of the eustachian tube in Meniere's disease

CONCLUSION

In this physiological study subjects with Meniere's disease (MD) had high resistance to opening of the eustachian tube (ET) in three of four provocation tests. These subjects can be exposed to pressure deviations in the middle ear (ME) above their equalizing capacity. Transmission of the pressure deviations to the inner ear fluids and influence of the symptoms of MD are feasible.

OBJECTIVE

The aim of the study was to reveal potential inadequacy in the ET equilibration capacity and deviations in ME pressure in patients with MD.

METHODS

Direct ME pressure measurements were made during provocation tests of the ET, and continuously during the daytime and night-time in 21 patients with unilateral, definite and active MD. Twenty subjects with healthy ears (HEs) were used for comparison.

RESULTS

In all, 15/21 subjects could not equilibrate an induced positive and/or negative pressure in the ME by deglutition; 9/21 subjects were not able to perform Valsalva's manoeuvre. All the controls could effectively perform these manoeuvres. However, the continuous measurements showed a similar pressure pattern in patients with MD and the controls, i.e. a slightly negative mean ME pressure during the daytime and positive pressure during sleep.

Correlation between caloric and ocular vestibular evoked myogenic potential test results

CONCLUSION

The ocular vestibular evoked myogenic potential (o-VEMP) test results correlate significantly with caloric test results for patients with acoustic neuroma (AN), but not for patients with Meniere's disease (MD), indicating that the o-VEMP test may replace the caloric test for evaluating the vestibular nerve from which the AN arises. Conversely, the caloric, o-VEMP, and cervical VEMP (c-VEMP) tests should be performed to map lesion sites in the vestibular labyrinth.

OBJECTIVE

This study performed caloric, o-VEMP, and c-VEMP tests on patients with central and peripheral vestibular disorders to investigate their relationships.

METHODS

In all, 66 patients comprising 16 with unilateral AN and 50 with unilateral definite MD were enrolled. All patients underwent caloric, o-VEMP, and c-VEMP tests.

RESULTS

In the AN group, the caloric test identified canal paresis and caloric areflexia in 10 ears, while the o-VEMP and c-VEMP tests identified abnormal (absent or delayed) responses in 12 and 11 ears, respectively. A significant correlation existed between caloric and o-VEMP test results, but not between caloric and c-VEMP test results, or between o-VEMP and c-VEMP test results. For the MD group, abnormal caloric, o-VEMP, and c-VEMP test results were obtained for 24%, 44%, and 38% of hydropic ears, respectively. No correlation existed between any two test results.

Longitudinal study of 29 patients with Meniere's disease with follow-up of 10 years or more (In commemoration of Professor Emeritus Isamu Watanabe)

CONCLUSIONS

A final incidence of bilateral involvement was 20.7%. Episodic spells of vertigo were completely controlled in 23 of 29 patients, while 11 of 29 patients demonstrated over 70 dB hearing loss.

OBJECTIVE

To analyze the clinical course of 29 patients with Meniere's disease during follow-up of 10 years or more.

METHODS

The subjects were 29 patients with a mean follow-up of 18.3 years. The hearing level was measured by the pure tone average (PTA) of four frequencies at the initial and the final examination, and it was classified into four categories according to the American Academy of Otolaryngology-Head and Neck Society (AAO-HNS) criteria. The control of vertigo was evaluated by the modified AAO-HNS criteria.

RESULTS

At enrolment two patients had bilateral involvement. In the period of follow-up, bilateral involvement emerged in four more patients. The hearing levels at the final examinations were as follows: 3 patients, <25 dB; 6 patients, 26-40 dB; 9 patients, 41-70 dB; and 11 patients, >70 dB. The control of vertigo according to the modified AAO-HNS guideline was class A in 23 patients, class B in 2 patients, and class C in 1 patient; the remaining 3 patients could not be evaluated.

Cluster analysis of auditory and vestibular test results in definite Menière's disease

OBJECTIVES/HYPOTHESIS

To determine whether patients with Menière's disease can be grouped into distinct subtypes based on a cluster analysis of distinct disease parameters.

STUDY DESIGN

Prospective study at a tertiary center associated with a university hospital.

METHODS

The study included 153 patients diagnosed with unilateral definite Menière's disease. The main variables employed were taken from auditory, vestibular, posturographic, and disability assessments.

RESULTS

A four-cluster solution best fitted the data. Each cluster represented a distinct patient profile. Cluster 1 patients (13.1%) were the eldest, with the worst hearing bilaterally and good vestibular function but with a significant postural impact and a low level of disability. Cluster 2 patients (41.2%) were the least affected in all the parameters that were close to normal. Cluster 3 patients (34.6%) were the most affected, experiencing frequent and intense vertigo attacks, and they were visually dependent. Cluster 4 patients (11.1%) had strong asymmetric hearing between both ears and the most uncompensated vestibular deficit; they were moderately disabled.

CONCLUSIONS

We have identified four distinct profiles of patients with definite Menière's disease that we consider as "mildly active elderly," "mildly active young," "active compensated," and "active uncompensated." We have demonstrated that only in a restricted population of patients can the American Academy of Otolaryngology-Head and Neck Surgery staging system provide analysis of subtypes of the disease.

Association of air-conducted sound oVEMP findings with cVEMP and caloric test findings in patients with unilateral peripheral vestibular disorders

CONCLUSION

This study showed that the ocular vestibular evoked myogenic potential (oVEMP) in response to air-conducted sound (ACS) reflects functions of different parts of the vestibular labyrinth from cervical VEMP (cVEMP).

OBJECTIVE

To determine whether the origin of the vestibular end organs of the oVEMP in response to ACS (500 Hz tone bursts) is the same as that of cVEMP.

METHODS

Twenty patients definitively diagnosed with unilateral Meniere's disease (MD), 6 patients with unilateral vestibular neuritis (VN), and 7 healthy subjects were enrolled. In these subjects, the oVEMP and cVEMP to air-conducted 500 Hz tone bursts (125 dBSPL) were measured. The patients also underwent caloric tests.

RESULTS

The MD patients did not show a significant association between their ACS oVEMP findings and ACS cVEMP findings but there was an association of ACS oVEMP findings with caloric test findings. When the MD patients were classified into four stages based on their hearing levels, the patients showed abnormal findings at earlier stages on ACS cVEMP than on other tests. While all six VN patients showed abnormal findings on ACS oVEMP and caloric tests, only two patients showed abnormal ACS cVEMPs. These findings support the hypothesis that the oVEMP in response to ACS predominantly reflects utricular functions while ACS cVEMP reflects saccular functions.

Vasopressin in definite Meniere's disease with positive electrocochleographic findings

CONCLUSION

There was no evidence of a mean raised vasopressin level in 80 subjects suffering from definite Meniere's disease with positive electrocochleographic findings. There was no correlation with stress. The only group with a mildly raised level comprised those who had had a vertigo attack within a day. The most likely cause is nausea, which is the most potent trigger for vasopressin release.

OBJECTIVE

It has been claimed that patients with Meniere's disease have raised vasopressin levels. This has been linked with a long-standing notion that that there is a link between stress and Meniere's disease, so that an increase in vasopressin could trigger a vertigo attack.

METHODS

Serum vasopressin concentrations were measured in 80 patients with Meniere's disease whose diagnosis was based on conventional symptom criteria plus electrocochleographic evidence of endolymphatic hydrops.

RESULTS

The community mean for vasopressin is 2.2 pmol/L (SD = 2.4). For all 80 Meniere's patients the mean vasopressin concentration was 2.1 pmol/L (SD = 1.6), and 2.8 pmol/L (SD = 0.9) when the last attack was within a day.

Visualization of endolymphatic hydrops after administration of a standard dose of an intravenous gadolinium-based contrast agent

CONCLUSION

Even after the administration of a standard dose of an intravenous gadolinium-based contrast agent (GBCA), visualization of endolymphatic hydrops (ELH) became possible in patients with Meniere's disease. The next step would be to consistently visualize ELH in the upper part of the cochlea.

OBJECTIVE

To visualize ELH after routine administration of an intravenous GBCA.

METHODS

An intravenous GBCA (gadodiamide; 0.2 ml/kg) was administered to three patients with unilateral Meniere's disease and two healthy volunteers. Three-dimensional fluid attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) was performed with a 3 T MRI scanner 4 h later.

RESULTS

In all three patients, ELH was observed in the affected vestibules. In contrast, the endolymphatic space of both vestibules was the same size in healthy volunteers. ELH of the cochlea was not observed in any of the subjects. Gadolinium enhancement was insufficient in the upper turns of both cochleae in patients 1 and 3.

[Analysis with the logistic regression mode to the audiologic and vestibular functions in Meniere's disease]

OBJECTIVE

To investigate the clinical features, characteristic of cochlear and vestibular dysfunction in Meniere's disease (MD) by using the multiple factor Logistic regression analysis.

METHOD

The clinical data of 36 patients with the diagnosis of Meniere's disease according to 2006 Guiyang standard and 30 patients with peripheral vestibular disorders were investigated. All subjects received audiologic and vestibular assessments, including pure tone audiometry, Metz's recruitment test, electrocochleography (ECochG), auditory brainstem response (ABR), glycerol test, vestibular caloric test, head shaking nystagmus (HSN) and fukuda stepping test. The clinical features and audiovestibular tests in Meniere's disease were investigated by chi square test, and then analyzed by using the multiple factor Logistic regression mode.

RESULT

(1) The fluctuating sensorineural hearing loss, the number of active symptoms, Tullio phenomenon,--SP/AP ratio, the Metz's recruitment test and the glycerol test demonstrated as the main characteristics in the discrimination between the MD group and non-MD group, the difference was statistically significant (P < 0.05). (2) The Logistic regression predictive equation for Meniere's disease was: Logit(p) = 9.443 + 3.110 X1 + 5.015 X2 + 2.506 X3 + 3.963 X4, in which the concomitant variables were curve of electrocochleography (EcochG) (X1), glycerol test (X2), the number of active symptoms (X3), the fluctuating sensorineural hearing loss (X4). The area under the ROC curve was 0.993. The percentage of correct prediction was 95.5%.

CONCLUSION

The clinical features of Meniere's disease are distinguished, combined with audiovestibular tests, which can be differentiated from other peripheral vestibular disorders. The multiple factor Logistic regression predictive equation for Meniere's disease is an auxiliary diagnosis method.

Endolymphatic hydrops and blood-labyrinth barrier in Ménière's disease

CONCLUSIONS

The blood-labyrinth barrier is impaired in association with the hydrops grade in Ménière's disease.

OBJECTIVES

To investigate the relationship between endolymphatic hydrops and the clinical characteristics of patients with Ménière's disease revealed by 3 T magnetic resonance imaging (MRI).

METHODS

A double dose of gadoteridol (Gd; 0.2 mmol/kg) was injected intravenously in 12 patients with Ménière's disease. We performed three-dimensional fluid attenuated inversion recovery MRI and three-dimensional real inversion recovery MRI 4 h later using a 3 T MRI unit. Ten patients had unilateral and two had bilateral Ménière's disease.

RESULTS

Fourteen ears with Ménière's disease showed intense Gd contrast on MRI compared with that in the 10 asymptomatic contralateral ears of patients with unilateral Ménière's disease (1.12 ± 0.36 vs 0.82 ± 0.15). The hydrops grade was correlated significantly with the contrast effect. The 14 ears with Ménière's disease had endolymphatic hydrops. Of the 10 contralateral ears of patients with unilateral Ménière's disease, 2 had endolymphatic hydrops in the cochlea and 6 had endolymphatic hydrops in the vestibule.

Correlation between subjective visual horizontal test and ocular vestibular-evoked myogenic potential test

CONCLUSION

The static subjective visual horizontal (SVH) test correlates with the dynamic ocular vestibular-evoked myogenic potential (oVEMP) test in healthy and pathological ears, and further confirms that both tests may, at least in part, share the same utricular reflex pathway.

OBJECTIVE

This study correlated the SVH test results with those of the oVEMP and cervical VEMP (cVEMP) tests to investigate their relationships.

METHODS

Twenty healthy subjects underwent the SVH test at a view pattern angle of 30° or 70° horizontal tilt under various background distractions to establish the optimal stimulation mode for SVH test. Thereafter, 20 patients with unilateral Meniere's disease underwent the SVH test using the optimal mode. In addition, oVEMP and cVEMP tests were performed in all subjects.

RESULTS

The preliminary study in 20 healthy subjects at a view pattern angle of 70° under counterclockwise square background distraction revealed that the mean deviation degree of the SVH test was -0.61 ± 1.17°. Based on the criteria, abnormal percentages of SVH in 20 Meniere's patients were 40%. All healthy subjects had normal oVEMPs and cVEMPs. In contrast, eight patients (40%) showed abnormal oVEMPs and nine (45%) revealed abnormal cVEMPs. The SVH test results correlated significantly with oVEMP results, but not with cVEMP results.

[Peripheral vestibular syndrome intricated pathogenic issues. A case report]

BACKGROUND

Ménière's syndrome appears to be the final common pathway of the mechanisms the inner ear responds to almost any injury. Although the autoimmune disease seems to play a major role, exposure to intense noise can also be a trigger in the appearance and/or aggravation of the disease.

MATERIAL AND METHODS

The case of 41 years old musician with a history of ankylosing spondylitis, diagnosed with Ménière's syndrome 5 years ago, is presented. Recently the symptoms became more polymorphic, revealing the association between benign paroxysmal positional vertigo (BPPV), Ménière's syndrome and high frequency hearing loss in an autoimmune background. Besides general, neurological and ENT examination, the diagnostic workup comprised of tonal audiogram, brain stem auditory evoked potentials, computerized dynamic posturography and videonistagmography.

RESULTS

The final diagnosis was acute noise trauma, Ménière's syndrome, left horizontal semicircular canal BPPV, bilateral sensorineural sudden aggravated hearing loss in high frequencies (above 9 kHz) and allegedly autoimmune inner ear disease. Treatment with an association of corticosteroids, vasodilators and vitamins combined with Vannucchi's maneuver were followed by a significant relief of the symptoms.

CONCLUSION

Although no causal relationship was found between acoustic trauma and increased endolymphatic pressure, both literature data and the case presented show that intense and prolonged noise exposure may aggravate peripheral vestibular syndrome.

A comparison of three methods of using transtympanic electrocochleography for the diagnosis of Meniere's disease: click summating potential measurements, tone burst summating potential amplitude measurements, and biasing of the summating potential using a low frequency tone

CONCLUSION

Stimulus biasing modulated the amplitude of the tone burst evoked summating potential (SP) in ears affected by Meniere's disease less than in normal ears. A reduced SP bias ratio added diagnostic accuracy for the diagnosis of Meniere's disease.

OBJECTIVES

To evaluate the effect of stimulus biasing on the human tone burst SP, and to determine if stimulus biasing could contribute to the electrocochleography as a means of confirming the diagnosis of Meniere's disease.

PATIENTS AND METHODS

Patients referred for transtympanic electrocochleography (TT ECochG) were assessed prospectively on clinical grounds according to the AAO-HNS criteria and a scale devised by one of the authors. A Meniere's group of ears and a non-Meniere's group of ears was determined. The ears opposite a Meniere's ear were not included in the analysis. The ratio of the click SP amplitude and the action potential (AP) amplitude (SP/AP ratio), the tone burst SP amplitude at 500 Hz,1 kHz, 2 kHz and 8 kHz, and the effect of stimulus biasing on the tone burst SP were measured.

RESULTS

A unipolar stimulus biasing ratio established for the modulation of the 1 kHz tone burst SP separated the Meniere's ears from the non-Meniere's ears with a sensitivity of 85% at a specificity of 80.6% and the difference between groups reached statistical significance (p=0.016). The 1 kHz SP amplitude measurements and the stimulus biasing measurements were superior to the click SP/AP ratio for identifying the Meniere's group. A combination of 1 kHz SP amplitude measurements and SP bias ratio separated the Meniere's ears from the non-Meniere's ears with an accuracy of 85%.

[Analysis of factors affecting the pure tone threshold glycerol test]

OBJECTIVE

To probe the factors that affect the pure-tone threshold glycerol test and the distribution of frequencies in positive glycerol test.

METHOD

We tested the pure-tone threshold before and after glycerol intake in patients with Meniere's disease, and then analyzed the positive rates,distribution of positive frequencies and the time when the maximum threshold changes appeared.

RESULT

The positive rate of pure-tone glycerol test was 72.09%, of which the threshold descending rate was 47.67%, and the threshold rebounding rate was 24.42%; the pure-tone threshold changes of descending group and rebounding group were (17.41 +/- 9.92) dB, (13.53 +/- 4.64) dB respectively, and the differences were significant. The distribution of positive frequencies were 250 Hz, 125 Hz, 500 Hz, 1 kHz, 4 kHz, 2 kHz, 8 kHz in descending order. The maximum pure-tone threshold changes mostly appeared within 2 or 3 hours after glycerol intake.

CONCLUSIONS

Patient selection, test occasion and the judgement criteria may affect the positive rate of glycerol test; the positive frequencies distribute in the low-frequency region mainly; the maximum pure-tone threshold changes mostly appeared within 2 or 3 hours after glycerol intake.

10-year review of endolymphatic sac surgery for intractable meniere disease

OBJECTIVE

To review our 10-year experience of endolymphatic sac surgery (ESS) for intractable Meniere disease (MD).

DESIGN

Retrospective chart review and survey.

SETTING

Tertiary care centre.

METHODS

Patients presenting for ESS from 1998 to 2007 were reviewed using the 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. A quality of life (QOL) questionnaire was mailed out using the Dillman method.

MAIN OUTCOME MEASURES

(1) 1995 AAO-HNS hearing stage, vertigo class, and functional level; (2) complications and secondary treatments; (3) a 40-question, disease-specific, validated QOL questionnaire (Meniere's Disease Outcome Questionnaire).

RESULTS

Thirty patients (33 ears) had ESS (63.6% male, mean age 49 years, mean follow-up 30.6 months). Vertigo control was 35.5% class A, 29.0% class B, 6.5% class C, 0% class D, 3.2% class E, and 25.8% class F. If class A and B are considered successful, then 64.5% were successful. Hearing stage improved in 14.8%, remained the same in 51.9%, and worsened in 33.3%. Average preoperative functional level was 4.3 and postoperative level was 3.5 (p = .0016). Secondary treatment after ESS was performed in 26%. Three patients (10.0%) had profound sensorineural hearing loss. Twenty-five questionnaire responses (75.8%) were received. There was a significant increase in QOL scores (p = .000001), and 80% had an improvement in QOL scores.

CONCLUSIONS

ESS is a surgical option for MD that offers relief from vertigo in selected patients, but patients need to be cautioned about the risk of hearing loss and the requirement for subsequent destructive treatment in a significant proportion of cases.

Vestibular evoked myogenic potential latencies in Meniere disease and vestibular schwannoma

OBJECTIVE

To evaluate vestibular evoked myogenic potentials (VEMPs) in Meniere disease and vestibular schwannoma. Given that the saccule and inferior vestibular nerve may be damaged in Meniere disease and vestibular schwannoma, respectively, VEMP latency may be prolonged in the patient's affected ear.

DESIGN

Prospective study.

SETTING

Urban otolaryngology practice.

METHODS

Ten Meniere disease and 12 vestibular schwannoma patients. Subjects were tested with the VEMP head rotation protocol.

MAIN OUTCOME MEASURE

VEMP latency.

RESULTS

In Meniere disease patients, the pI latencies (mean +/- SEM, milliseconds) were 12.26 +/- 0.75 (healthy ear) and 14.20 +/- 0.73 (affected ear) (p = .041). The nI latencies were 20.29 +/- 1.06 (healthy ear) and 25.06 +/- 1.64 (affected ear) (p = .013). In vestibular schwannoma patients, the pI latencies were 12.02 +/- 0.93 (healthy ear) and 15.88 +/- 1.35 (affected ear) (p = .016). The nI latencies were 20.98 +/- 1.59 (healthy ear) and 24.84 +/- 1.08 (affected ear) (p = .031).

CONCLUSION

VEMP pI and nI latencies were prolonged in the affected ear of Meniere disease and vestibular schwannoma patients. We propose classifying VEMP as abnormal if both the pI latency is > 1 ms longer and the nI latency is > 2 ms longer (sensitivity 66.7%, specificity 86.4%) compared with the other ear. This study suggests a role for VEMP in the clinical testing of these patients.

[Pure tone audiology for Meniere disease: a clinical analysis of 75 cases]

OBJECTIVE

To analyze clinical pure tone test data in patients with Meniere disease and study the changes in the audiometic curve configuration.

METHODS

A retrospective analysis was conducted of the pure tone test data in 75 cases (82 ears) from 1984 to 2008. The audiometic curve configuration was divided into 6 categories to analyze the relationship between the main curve types and the clinical stages. RESULTS The most common audiogram was the peak type (46.34%), followed by the falling type (19.51%) and the mountain type (12.19%), and the dip type was relatively rare (2.43%). No significant differences were found in the rate of peak audiograms between the clinical stages. The common audiogram peak frequency occurred at 2 kHz (47.39%). The top curve of 1-2 kHz had the largest proportion in mountain type audiograms (70%, 7/10 ears).

CONCLUSION

The peak type and mountain type configuration are one of the audiological characteristics of Meniere disease, especially for 2 kHz peak, which may serve as the diagnostic features of Meniere disease in the vertigo patients on their first visit.

Evidence of unilateral isolated utricular hypofunction

CONCLUSIONS

The findings demonstrate that an enduring unilateral utricular dysfunction, possibly together with canal hypofunction, can occur after labyrinthine disease or injury. They also suggest that unilateral, isolated utricular dysfunction - or utricle paresis - can occur, representing a novel entity in the differential diagnosis of peripheral vestibular function. The occurrence of subjective visual vertical (SVV) asymmetry in the presence of symmetric vestibular evoked myogenic potentials (VEMPs) also confirms that the information from the utricles, rather than the saccules, dominates SVV estimation.

OBJECTIVES

To determine the incidence of unilateral utricular hypofunction.

METHODS

The retrospective clinical study deals with a selection of those vestibular patients who showed pathological responses to utricle testing. Peripheral vestibular function was examined in a group of 110 patients. Utricular function was evaluated by estimation of SVV during unilateral centrifugation. Bithermal caloric testing was performed to assess unilateral semicircular canal function. Saccular function was tested by measurement of VEMPs.

RESULTS

A total of 46 patients were found with asymmetric SVV findings (p < 0.001 for healthy versus lesioned ear), but symmetric caloric responses and VEMPs. Statistical testing also verified that their SVV asymmetry factors were significantly higher than those calculated for caloric responses and VEMPs (p < 0.001).

A preliminary theoretical model of hydrodynamics in the inner ear

Head movement should create a transient pressure imbalance across the membranous inner ear. We used basic concepts of fluid dynamics to develop a theoretical model of the inner ear. According to this model, two contiguous fluidic systems-the perilymphatic system and the endolymphatic system-are in hydrostatic equilibrium across a compliant membrane. Our model demonstrates that changes in resistance or compliance in one system results in a transient distortion of the membranous inner ear until equilibrium between the two systems is restored. The concept of hydrodynamic pressure changes in the inner ear has received little attention, but it may represent a new approach to understanding the inner ear and treating inner ear diseases.

Postural stability during visual stimulation and the contribution from the vestibular apparatus

CONCLUSION

When combined with vestibular dysfunction, visual flow can exacerbate reductions in postural stability. This effect may be one of the mechanisms underlying visual vertigo, which can be evaluated using frequency analysis of body sway elicited by optokinetic stimulation (OKS).

OBJECTIVE

To clarify the interaction between the postural responses to visual flow and to input from the vestibular apparatus as a mediator of visual vertigo.

METHODS

Horizontal and vertical OKS with a stable fixation target were presented to 14 healthy subjects and 38 peripheral vestibular patients standing in a Romberg's posture, and the center of standing pressure was monitored using a force platform. The direction and amplitude of induced body sway were analyzed, along with the power spectra of the body mass fluctuations.

RESULTS

Each directional optokinetic stimulus induced body sway that would compensate for the virtual inclination of the subject's gravitational reference frame. However, the amplitude of this body sway was not increased by vestibular dysfunction. Healthy subjects showed increased stability in response to downward OKS and decreased stability in response to upward OKS, whereas no specific changes were seen in response to horizontal OKS. This stability was greatly diminished in patients with vestibular dysfunction subjected to the same directional OKS.

A novel model for prognosis of Meniere's disease using oxidative stress susceptibility of lymphoblastoid cell lines

The aim of this study was to examine differences of susceptibility to oxidative stress of Epstein-Barr virus (EBV)-transformed lymphoblastoid cell lines (LCLs) established from Meniere's disease (MD) patients and to examine the effect of ATP treatment in the prognosis and treatment MD. LCLs were established from 10 patients with MD and 10 healthy donors by EBV. Cell viabilities were calculated after treatment of H(2)O(2) with or without ATP. The relationship between the sensitivity of H(2)O(2)-treated LCLs to ATP and the staging scale of MD was examined. The nuclear morphological changes of Hoechst 33258-stained LCLs after H(2)O(2)-treatment were observed under a fluorescence microscope. LCLs from MD were significantly more sensitive (p < 0.001) to H(2)O(2) than LCLs from healthy donors after 3 h of H(2)O(2) treatment. All of the ATP-sensitive LCLs were categorized as Stage 1 or 2, while others categorized as Stage 3 or 4 were not sensitive to ATP. There were significant differences (p < 0.01) of cell viabilities after addition of ATP between H(2)O(2)-treated LCLs classified as Stage 1 or 2 and as Stage 3 or 4 in MD. Both chromatin condensation and swelling of the cell body were observed in H(2)O(2)-treated LCLs. Our findings indicate that LCLs established from MD patients might be used as a unique model to detect susceptibility to oxidative stress and ATP treatment in MD patients. Also, the difference of the sensitivity of H(2)O(2)-treated LCLs to ATP might relate to prognosis and treatment of MD. This system may form the basis of tailor-made therapy for MD.

Blockage of reuniting duct in Meniere's disease

CONCLUSION

The bony saccular orifice to the bony groove of the ductus reuniens (reuniting duct) could not be visualized in the Meniere's ear with significantly greater frequency compared with normal subjects, which suggests that the reuniting duct is affected by radio-opaque substances in CT findings.

OBJECTIVE

This study investigated a more specific, objective, and simpler strategy to diagnose Meniere's disease by assessing the reuniting duct.

SUBJECTS AND METHODS

We examined the ears of 12 patients with definitely diagnosed unilateral Meniere's disease in stage 3 based on Meniere's disease criteria proposed by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), and the ears of 12 normal control subjects using three-dimensional (3D) cone beam CT.

RESULTS

The bony groove of the reuniting duct between the saccule and cochlea was visualized in all control subjects. However, the bony saccular orifice to the bony groove could not be visualized in the lesional ear of Meniere's patients with significantly greater frequency compared with those of the contralateral non-lesional ears and control ears (p < 0.01). This orifice was not patent in 66.7% (8 of 12 ears) on the lesional side but all contralateral non-lesional ears of the patients and normal control ears were patent.

Antisecretory factor-inducing therapy improves the clinical outcome in patients with Ménière's disease

CONCLUSION

Intake of antisecretory factor (AF)-inducing SPC-flakes significantly reduced vertigo in patients suffering from Ménière's disease (MD). The positive effect may be due to a modulation of the transport of water and ions in the endolymphatic space.

OBJECTIVE

To evaluate the effects of a 3-month treatment period with SPC-flakes in patients suffering from MD.

PATIENTS AND METHODS

A prospective, double-blind, placebo-controlled study was performed. A total of 51 adult patients with MD were included in the study: 27 subjects treated with SPC-flakes and 24 subjects with control cereals. The patients received SPC-flakes or control cereals (1 g per kg body weight per 24 h in two servings) for 3 months. Otoneurological examinations were carried out before and after this period.

RESULTS

The severity of MD was classified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) grading system. Fourteen of the 27 patients randomized to intake of the AF-inducing SPC-flakes reported decreased vertigo, compared with 2 of 24 in the control group (p < 0.001). No consistent change in the otoneurological examinations could be demonstrated in any of the groups of patients.

Semi-quantitative evaluation of endolymphatic hydrops by bilateral intratympanic gadolinium-based contrast agent (GBCA) administration with MRI for Meniere's disease

CONCLUSION

Bilateral intratympanic administration of a gadolinium-based contrast agent (GBCA) in MRI was successfully performed and proved to be beneficial in the semi-quantitative evaluation of endolymphatic hydrops. Such image-based diagnosis will lead to re-revaluation and reclassification of the diagnostic criteria for Meniere's disease (MD).

OBJECTIVE

To visualize endolymphatic hydrops semi-quantitatively in patients with MD, by using bilateral intratympanic GBCA administration with MRI.

PATIENTS AND METHODS

A total of 13 patients were evaluated, including 12 with MD and one with acute low-tone sensorineural hearing loss. Diluted gadodiamide (a kind of GBCA) was administered to the bilateral tympanic cavity by injection through the tympanic membrane. After 24 h, the endolymphatic hydrops was evaluated with a 3.0 T MR scanner. The areas enhanced by gadodiamide were measured semi-quantitatively.

RESULTS

Three-dimensional, fluid-attenuated inversion recovery (3D-FLAIR) MRI showed that the gadodiamide successfully penetrated the round window membrane, entering the perilymphatic space and delineating the gadodiamide-enhanced perilymphatic and gadodiamide-negative endolymphatic spaces of the inner ear. All the patients with MD showed a reduced gadodiamide-enhanced area representing the perilymphatic space, and the quantitative ratio was 0.15 to 0.85. Furthermore, endolymphatic hydrops was also demonstrated in the patient with atypical MD who had fluctuating low frequency sensorineural hearing loss without vertigo.