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Goswami A, Ruhina Rahman SN, Ponneganti S, Gangipangi V, Vavialala H, Radhakrishnanand P, Selvaraju S, Mutheneni SR, Bharti S, Shunmugaperumal T. Intratympanic injections of emulsion-like dispersions to augment cinnarizine amount in a healthy rabbit inner ear model. Nanomedicine (Lond) 2024:1-25. [PMID: 39041668 DOI: 10.1080/17435889.2024.2373042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
Aim: To investigate eutectic liquid-based emulsion-like dispersions for intratympanic injections to augment cinnarizine permeability across round window membrane in a healthy rabbit inner ear model. Methods: Two-tier systematic optimization was used to get the injection formula. The drug concentrations in perilymph and plasma were analyzed via. Ultra-performance liquid chromatography-tandem mass spectrometry method after 30-, 60-, 90- and 120-min post intratympanic injection time points in rabbits. Results: A shear-thinning behavior, immediate drug release (∼98.80%, 10 min) and higher cell viability (>97.86%, 24 h) were observed in dispersions. The cinnarizine level of 8168.57 ± 1236.79 ng/ml was observed in perilymph at 30 min post intratympanic injection in rabbits. Conclusion: The emulsion-like dispersions can augment drug permeability through round window membrane.
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Affiliation(s)
- Abhinab Goswami
- Department of Pharmaceutics, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Syed Nazrin Ruhina Rahman
- Department of Pharmaceutics, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Srikanth Ponneganti
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Vijayakumar Gangipangi
- Department of Biotechnology, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Hariprasad Vavialala
- Bioinformatics Group, Applied Biology Division, CSIR-Indian Institute of Chemical Technology, Tarnaka, Hyderabad, Telangana 500007, India
| | - Pullapanthula Radhakrishnanand
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Sudhagar Selvaraju
- Department of Biotechnology, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Srinivasa Rao Mutheneni
- Bioinformatics Group, Applied Biology Division, CSIR-Indian Institute of Chemical Technology, Tarnaka, Hyderabad, Telangana 500007, India
| | - Shreekant Bharti
- Department of Pathology/Lab Medicine, All India Institute of Medical Sciences Patna, Phulwarisarif, Patna, Bihar 801507, India
| | - Tamilvanan Shunmugaperumal
- Department of Pharmaceutics, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
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Casani AP, Gufoni M, Ducci N. Episodic Vertigo: A Narrative Review Based on a Single-Center Clinical Experience. Audiol Res 2023; 13:845-858. [PMID: 37987332 PMCID: PMC10660529 DOI: 10.3390/audiolres13060074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
(1) Background: Usually, the majority of patients suffering from vertigo and dizziness can be identified in four major categories: acute spontaneous vertigo, episodic (recurrent) vertigo, recurrent positional vertigo, and chronic imbalance. Our purpose is to retrospectively evaluate the main causes of episodic vertigo and to find indications for a reliable clinical suspicion useful for a definitive diagnosis, comparing patients affected by different presenting symptomatology (acute vertigo, recurrent episodic vertigo, and imbalance). (2) Methods: we retrospectively evaluated the clinical records in a population of 249 consecutive patients observed for vertigo in our tertiary referral center in the period 1 January 2019-31 January 2020. On the basis of the reported clinical history, patients were divided into three groups: patients with their first ever attack of vertigo, patients with recurrent vertigo and dizziness, and patients with chronic imbalance. (3) Results: On the basis of the results of the instrumental examination, we arbitrarily divided (for each type of symptoms) the patients in a group with a normal vestibular instrumental examination and a group of patients in which the clinical-instrumental evaluation showed some pathological results; a highly significant difference (p: 0.157) was found between recurrent and acute vertigo and between recurrent vertigo and imbalance. (4) Conclusions: Patients with recurrent vertigo more frequently exhibit a negative otoneurological examination since they are often examined in the intercritical phase. A precise and in-depth research of the patient's clinical history is the key to suspect or make a diagnosis together with the search for some instrumental or clinical hallmark, especially in cases where the clinical picture does not fully meet the international diagnostic criteria.
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Affiliation(s)
- Augusto Pietro Casani
- ENT Section, Medical, Molecular and Critical Area, Department of Surgical Pathology, Pisa University Hospital, 56122 Pisa, Italy; (M.G.); (N.D.)
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Fernandes PC, Takegawa B, Ganança FF, Gil D. Speech Perception in Ménière Disease. Int Arch Otorhinolaryngol 2023; 27:e613-e619. [PMID: 37876685 PMCID: PMC10593521 DOI: 10.1055/s-0043-1767677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/11/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Ménière disease (MD) affects the inner ear, comprising the cochlea and semicircular canals. Symptoms include severe incapacitating vertigo, nausea, vomit, aural fullness, and sensorineural hearing loss - in which speech discrimination and intelligibility are impaired and can be quantified with speech audiometry. Objective To investigate the influence of the stimuli presentation level in speech audiometry and the quality of life in adults with and without a diagnosis of MD. Method Two groups were formed with nine individuals each - one with and the other without MD. The Speech Recognition Percentage Index was researched with stimuli presented above the self-reported comfort level or 5 dB below the discomfort level. Dizziness Handicap and Tinnitus Handicap Inventories were administered to individuals with tinnitus and vertigo complaints. Results Speech recognition was better in the study group with higher presentation levels, as 75% of the sample improved their performance. The presence of vertigo significantly impacted the quality of life of individuals in the study group. Conclusion Speech recognition improves with higher presentation levels. Also, MD impacts the quality of life, especially regarding limitations caused by vertigo.
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Affiliation(s)
| | - Bruno Takegawa
- Department of Speech Therapy, Universidade Federal de São Paulo, Escola Paulista de Medicina – UNIFESP, São Paulo, SP, Brazil
| | | | - Daniela Gil
- Departament of Phonoaudiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Sekulic M, Puche R, Bodmer D, Petkovic V. Human blood-labyrinth barrier model to study the effects of cytokines and inflammation. Front Mol Neurosci 2023; 16:1243370. [PMID: 37808472 PMCID: PMC10551159 DOI: 10.3389/fnmol.2023.1243370] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Hearing loss is one of the 10 leading causes of disability worldwide. No drug therapies are currently available to protect or restore hearing. Inner ear auditory hair cells and the blood-labyrinth barrier (BLB) are critical for normal hearing, and the BLB between the systemic circulation and stria vascularis is crucial for maintaining cochlear and vestibular homeostasis. BLB defects are associated with inner ear diseases that lead to hearing loss, including vascular malformations, inflammation, and Meniere's disease (MD). Antibodies against proteins in the inner ear and cytokines in the cochlea, including IL-1α, TNF-α, and NF-kβ, are detected in the blood of more than half of MD patients. There is also emerging evidence of inner ear inflammation in some diseases, including MD, progressive sensorineural hearing loss, otosclerosis, and sudden deafness. Here, we examined the effects of TNF-α, IL6, and LPS on human stria vascularis-derived primary endothelial cells cultured together with pericytes in a Transwell system. By measuring trans-endothelial electrical resistance, we found that TNF-α causes the most significant disruption of the endothelial barrier. IL6 had a moderate influence on the barrier, whereas LPS had a minimal impact on barrier integrity. The prominent effect of TNF-α on the barrier was confirmed in the expression of the major junctional genes responsible for forming the tight endothelial monolayer, the decreased expression of ZO1 and OCL. We further tested permeability using 2 μg of daptomycin (1,619 Da), which does not pass the BLB under normal conditions, by measuring its passage through the barrier by HPLC. Treatment with TNF-α resulted in higher permeability in treated samples compared to controls. LPS-treated cells behaved similarly to the untreated cells and did not show differences in permeability compared to control. The endothelial damage caused by TNF-α was confirmed by decreased expression of an essential endothelial proteoglycan, syndecan1. These results allowed us to create an inflammatory environment model that increased BLB permeability in culture and mimicked an inflammatory state within the stria vascularis.
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Affiliation(s)
- Marijana Sekulic
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raoul Puche
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Bodmer
- University Hospital Basel, Clinic for Otorhinolaryngology, Basel, Switzerland
| | - Vesna Petkovic
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
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Babu V, Bahari R, Laban N, Kulaga J, Abdul Z, Zakkar B, Al-Najjar A, Lesus J, Al-Rifai AAR, Sattar H, Irukulla S, Gunniya P, Requena T, Lysakowski A. RotaRod and acoustic startle reflex performance of two potential mouse models for Meniere's disease. Eur J Neurosci 2023; 58:2708-2723. [PMID: 37461313 DOI: 10.1111/ejn.16083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/11/2023] [Accepted: 06/17/2023] [Indexed: 08/04/2023]
Abstract
Meniere's disease (MD) is a disorder of the inner ear characterized by chronic episodes of vertigo, tinnitus, increased aural pressure, and sensorineural hearing loss. Causes of MD are unknown, but endolymphatic hydrops is a hallmark. In addition, 5%-15% of MD cases have been identified as familial. Whole-genome sequencing studies of individuals with familial MD identified DTNA and FAM136A as candidate genes for autosomal dominant inheritance of MD. Although the exact roles of these genes in MD are unknown, FAM136A encodes a mitochondrial protein, and DTNA encodes a cytoskeletal protein involved in synapse formation and maintenance, important for maintaining the blood-brain barrier. It is also associated with a particular aquaporin. We tested vestibular and auditory function in dtna and fam136a knockout (KO) mice, using RotaRod and startle reflex-based clicker tests, respectively. Three-factor analysis of variance (ANOVA) results indicated that sex, age, and genotype were significantly correlated with reduced mean latencies to fall ("latencies") for male dtna KO mice, while only age was a significant factor for fam136a KO mice. Fam136a KO mice lost their hearing months before WTs (9-11 months vs. 15-20 months). In male dtna KO mice, divergence in mean latencies compared with other genotypes was first evident at 4 months of age, with older males having an even greater decrease. Our results indicate that fam136a gene mutations generate hearing problems, while dtna gene mutations produce balance deficits. Both mouse models should help to elucidate hearing loss and balance-related symptoms associated with MD.
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Affiliation(s)
- Vidya Babu
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Rose Bahari
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Nora Laban
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Jacob Kulaga
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Zahid Abdul
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Basil Zakkar
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Ahmad Al-Najjar
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Joseph Lesus
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | | | - Heba Sattar
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Suhitha Irukulla
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Pranav Gunniya
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Teresa Requena
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Anna Lysakowski
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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Taybeh EO, Naser AY. Hospital Admission Profile Related to Inner Ear Diseases in England and Wales. Healthcare (Basel) 2023; 11:healthcare11101457. [PMID: 37239743 DOI: 10.3390/healthcare11101457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Due to an expansion in the usage of medications (such as anticancer therapies), increased exposure to noise, and an increase in life expectancy, the prevalence of inner ear disease-related hearing loss is rising. Diseases of the inner ear are frequently accompanied by other conditions, such as chronic heart failure, systemic inflammation, arterial hypertension, and cerebrovascular disease. The aim of this study was to investigate the profile of hospital admissions linked to inner ear diseases in England and Wales. METHOD This was an ecological descriptive study using public medical databases in England and Wales. Diagnostic codes for diseases of the inner ear (H80-H83) were used to identify all hospital admissions. Between 1999 and 2020, the chi-squared test was used to assess the difference between the admission rates. RESULTS From 5704 in 1999 to 19,097 in 2020, the total annual number of hospital admissions increased by 234.8%, which corresponds to a 192.3% increase in the admission rate [from 10.94 (95% CI 10.66-11.22) in 1999 to 31.98 (95% CI 31.52-32.43) in 2020 per 100,000 people, p < 0.01]. "Disorders of vestibular function" and "other inner ear diseases" were the most frequent causes of hospital admissions due to inner ear diseases, accounting for 47.6% and 43.6%, respectively. The age range of 15 to 59 years accounted for 42.3% of all diseases of the inner ear hospital admissions. Around 59.6% of all admissions were made by females. The female admission rate increased by 210.1% (from 12.43 (95% CI 12.01-12.85) in 1999 to 38.54 (95% CI 37.84-39.24) in 2020 per 100,000 people). The male admission rate for diseases of the inner ear increased by 169.6% [from 9.37 (95% CI 9.00-9.75) in 1999 to 25.26 (95% CI 24.69-25.84) per 100,000 people] in 2020. CONCLUSION Inner ear disease admissions increased markedly in England and Wales during the past two decades. Females and the middle-aged population were at higher risk of being admitted for inner ear diseases. Further cohort studies are warranted to identify other risk factors and develop effective prevention strategies.
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Affiliation(s)
- Esra' O Taybeh
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman 11622, Jordan
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman 11622, Jordan
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7
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Bernkopf E, Capriotti V, Bernkopf G, Cancellieri E, D'Alessandro A, Marcuzzo AV, Gentili C, De Vincentiis GC, Tirelli G. Oral splint therapy in patients with Menière's disease and temporomandibular disorder: a long-term, controlled study. Eur Arch Otorhinolaryngol 2023; 280:1169-1182. [PMID: 36018357 DOI: 10.1007/s00405-022-07604-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/08/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the effect of oral splint therapy on audio-vestibular symptoms in patients with Menière's disease (MD) and temporomandibular disorder (TMD). METHODS Retrospective case-control study. Treatment group: 37 patients with MD and TMD who received gnatological treatment. CONTROL GROUP 26 patients with MD and TMD who had never received gnatological treatment. The number of vertigo spells in 6 months (primary endpoint), pure-tone audiometry average (PTA), MD stage, functional level, Dizziness handicap Index (DHI), Tinnitus handicap Index (THI) and Aural Fullness Scale (AFS) were compared at baseline and after 24 months according to groups. Analysis of Covariance was used to determine the treatment effect. RESULTS Groups were comparable for demographic, clinical data, baseline PTAs and the number of vertigo spells. Analysis of covariance showed a significant effect of gnathological treatment on number of vertigo spells ([Formula: see text] = 0.258, p < 0.001), PTA ([Formula: see text] = 0.201, p < 0.001), MD stage ([Formula: see text] = 0.224, p < 0.001), functional level ([Formula: see text] = 0.424, p < 0.001), DHI ([Formula: see text] = 0.421, p < 0.001), THI ([Formula: see text] = 0.183, p < 0.001), but not for AFS ([Formula: see text] = 0.005, p = 0.582). The treatment group showed vertigo control of class A in 86.5% and class B in 13.5% of patients. In the control group, vertigo control was of class A in 19.2% of patients and class B in 11.5%, class C in 30.8%, class D in 11.5%, class E in 19.2% and class F in 7.7%. Classes of vertigo control differed significantly (X2 test, p < 0.001). CONCLUSIONS Oral splint therapy could represent a viable treatment in patients with TMD and uncontrolled MD disease. The effects are maintained at least after 2 years.
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Affiliation(s)
| | - Vincenzo Capriotti
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada di Fiume 447, 39149, Trieste, Italy. .,Otorhinolaryngology and Head and Neck Surgery Unit, ASST Bergamo Ovest, Treviglio-Caravaggio Hospital, Piazzale Ospedale Luigi Meneguzzo 1, 20047, Treviglio, BG, Italy.
| | | | - Emilia Cancellieri
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada di Fiume 447, 39149, Trieste, Italy
| | - Andrea D'Alessandro
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada di Fiume 447, 39149, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada di Fiume 447, 39149, Trieste, Italy
| | - Caterina Gentili
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - Giancarlo Tirelli
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada di Fiume 447, 39149, Trieste, Italy
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Larsen CG, Karlberg M, Guldfred F, Devantier L, Maagaard M, Homøe P, Djurhuus BD. Transmyringeal ventilation tube insertion for unilateral Menière's disease: a protocol for a prospective, sham-controlled, double-blinded, randomized, clinical trial. Trials 2022; 23:877. [PMID: 36253829 PMCID: PMC9578195 DOI: 10.1186/s13063-022-06777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Menière’s disease is an idiopathic disorder characterized by recurrent episodes of vertigo lasting more than 20 min, unilateral sensorineural hearing loss, and tinnitus. If vertigo attacks occur frequently, the patient is usually severely incapacitated. Currently, there is no consensus on the treatment of Menière’s disease. The evidence regarding most treatment options is sparse due to a lack of randomized trials together with an often-spontaneous relief over time and a considerable placebo effect. Insertion of a transmyringeal tube is a simple and relatively safe, minimally invasive procedure and previous open-label trials have shown promising results. Study design This is a prospective, sham-controlled, double-blinded, randomized, clinical trial. Aim This trial aims to assess the effects of inserting a ventilation tube into the tympanic membrane compared with sham treatment for definite or probable unilateral Menière’s disease according to the criteria formulated by the Classification Committee of the Bàràny Society. Outcomes The primary outcome will be the number of spontaneous vertigo attacks lasting more than 20 min and time to treatment failure. In addition to the primary outcome, we will assess various secondary outcomes related to hearing, ear fullness, dizziness, and serious adverse events. Sample size An estimated 104 participants in total or 52 participants in each group will be necessary. The primary analysis will be according to the intention-to-treat principle. The trial will be initiated in 2021 and is expected to end in 2025. Trial status ClinicalTrials.gov: NCT04835688. Registered on April 8, 2021. Protocol version: 1.8, 26-09-2022. Date of first enrollment: October 1st, 2021. End of study: anticipated January 2025. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06777-w.
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Affiliation(s)
- Casper Grønlund Larsen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.
| | - Mikael Karlberg
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Frank Guldfred
- Ear, Nose, and Throat Private Practice, Roennede, Denmark
| | - Louise Devantier
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mathias Maagaard
- Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Bjarki Ditlev Djurhuus
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
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Abstract
PURPOSE OF REVIEW To explore recent developments in vestibular migraine (VM). RECENT FINDINGS This review discusses the current diagnostic criteria for VM in the adult and pediatric populations, as proposed by the International Headache Society and Bárány Society. Recent VM studies confirm the prior findings and reveal new insights, including the wide range of vestibular symptoms, symptoms in the attack-free period, and triggers. Many patients experience persistent vestibular symptoms, even in the absence of acute attacks, which often significantly impact patients' quality of life. The syndrome of benign recurrent vertigo and its relationship to migraine, VM, and Meniere's disease is also discussed. There is a dearth of randomized controlled trials in VM treatment. Prospective and retrospective studies support the benefit of many migraine treatments are effective in VM, including neuromodulation, and calcitonin gene-related peptide monoclonal antibodies. VM affects almost 3% of the population, but remains under-diagnosed. Recent diagnostic criteria can help clinicians diagnose VM in adults and children.
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Affiliation(s)
- Shin C Beh
- Beh Center for Vestibular & Migraine Disorders, 4500 Hillcrest Rd Ste 145, Frisco, TX, 75035, USA.
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10
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Smith CM, Curthoys IS, Plontke SK, Menzel M, Mukherjee P, Wong C, Laitman JT. Insights into Inner Ear Function and Disease Through Novel Visualization of the Ductus Reuniens, a Seminal Communication Between Hearing and Balance Mechanisms. J Assoc Res Otolaryngol 2022; 23:633-645. [PMID: 35804276 PMCID: PMC9613819 DOI: 10.1007/s10162-022-00858-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/29/2022] [Indexed: 11/27/2022] Open
Abstract
The sensory end-organs responsible for hearing and balance in the mammalian inner ear are connected via a small membranous duct known as the ductus reuniens (also known as the reuniting duct (DR)). The DR serves as a vital nexus linking the hearing and balance systems by providing the only endolymphatic connection between the cochlea and vestibular labyrinth. Recent studies have hypothesized new roles of the DR in inner ear function and disease, but a lack of knowledge regarding its 3D morphology and spatial configuration precludes testing of such hypotheses. We reconstructed the 3D morphology of the DR and surrounding anatomy using osmium tetroxide micro-computed tomography and digital visualizations of three human inner ear specimens. This provides a detailed, quantitative description of the DR's morphology, spatial relationships to surrounding structures, and an estimation of its orientation relative to head position. Univariate measurements of the DR, inner ear, and cranial planes were taken using the software packages 3D Slicer and Zbrush. The DR forms a narrow, curved, flattened tube varying in lumen size, shape, and wall thickness, with its middle third being the narrowest. The DR runs in a shallow bony sulcus superior to the osseus spiral lamina and adjacent to a ridge of bone that we term the "crista reuniens" oriented posteromedially within the cranium. The DR's morphology and structural configuration relative to surrounding anatomy has important implications for understanding aspects of inner ear function and disease, particularly after surgical alteration of the labyrinth and potential causative factors for Ménière's disease.
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Affiliation(s)
- Christopher M Smith
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, Annenberg Building Room 12-90, 1468 Madison Ave, New York, NY, 10029, USA.
- Department of Anthropology, The Graduate Center, City University of New York, New York, NY, USA.
- New York Consortium in Evolutionary Primatology, New York, NY, USA.
| | - Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Menzel
- Fraunhofer Institute for Microstructure of Materials and Systems, Halle (Saale), Germany
| | - Payal Mukherjee
- RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Christopher Wong
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Jeffrey T Laitman
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, Annenberg Building Room 12-90, 1468 Madison Ave, New York, NY, 10029, USA
- Department of Anthropology, The Graduate Center, City University of New York, New York, NY, USA
- New York Consortium in Evolutionary Primatology, New York, NY, USA
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kim SY, Lee CH, Yoo DM, Kwon MJ, Kim JH, Kim JH, Park B, Lee HJ, Choi HG. Association Between Meniere Disease and Migraine. JAMA Otolaryngol Head Neck Surg 2022; 148:457-464. [PMID: 35389472 PMCID: PMC8990355 DOI: 10.1001/jamaoto.2022.0331] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance A connection between Meniere disease (MD) and migraine has been proposed, but the temporal association remains unknown. Objective To examine the bidirectional association of MD with migraine. Design, Setting, and Participants This case-control study included participants 40 years or older from the Korean National Health Insurance Service Health Screening Cohort from 2002 to 2015. Main Outcomes and Measures A total of 6919 patients with MD were matched with 27 676 control participants without MD for age, sex, income, region of residence, and index date. The incidence of migraine was analyzed in the MD and matched groups using a stratified Cox proportional hazard regression model. In addition, 35 889 patients with migraine were matched with 71 778 control participants without migraine. The incidence of MD was analyzed using a stratified Cox proportional hazard regression model. Results Of 142 262 total participants, 94 611 (66.5%) were women. Migraine occurred in 695 of 6919 patients with MD (10.0%) and 970 of 27 676 matched control participants (3.5%). The MD group demonstrated a 2.22-fold higher risk of migraine than the matched control group (95% CI, 1.99-2.49). Meniere disease was present in 1098 of 35 889 patients with migraine (3.1%) and 781 of 71 778 matched control participants (1.1%). The migraine group had a 1.95-fold higher risk of MD than the matched control group (95% CI, 1.77-2.15). Conclusions and Relevance The results of this case-control study suggest that patients with MD had a greater risk of migraine occurrence. Furthermore, patients with migraine had a higher risk of MD. Based on the bidirectional association, therapeutics for migraine could potentially be applied to MD and vice versa.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chang Ho Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dae Myoung Yoo
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University College of Medicine, Anyang, Gyeonggi-do, Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University College of Medicine, Anyang, Gyeonggi-do, Korea
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hallym University College of Medicine, Anyang, Gyeonggi-do, Korea
| | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Hyo-Jeong Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Hyo Geun Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea.,Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
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12
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Standardized Clinical Profiling in Spanish Patients with Chronic Tinnitus. J Clin Med 2022; 11:jcm11040978. [PMID: 35207250 PMCID: PMC8875075 DOI: 10.3390/jcm11040978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Tinnitus is a heterogeneous condition. The aim of this study as to compare the online and hospital responses to the Spanish version of European School for Interdisciplinary Tinnitus Research screening-questionnaire (ESIT-SQ) in tinnitus individuals by an unsupervised age clustering. Methods: A cross-sectional study was performed including 434 white Spanish patients with chronic tinnitus to assess the demographic and clinical profile through the ESIT-SQ, with 204 outpatients and 230 individuals from an online survey; a K-means clustering algorithm was used to classify both responses according to age. Results: Online survey showed a high proportion of Meniere’s disease (MD) patients compared to both the general population and the outpatient cohort. The responses showed statistically significant differences between groups regarding education level, tinnitus-related hearing disorders (MD, hyperacusis), sleep difficulties, dyslipidemia, and other tinnitus characteristics, including duration, type of onset, the report of mitigating factors and the use of treatments. However, these differences were partially confirmed after adjusting for age. Conclusions: Self-reported tinnitus surveys are a low confidence source for tinnitus phenotyping. Additional clinical evaluation is needed for tinnitus research to reach the diagnosis. Age-based cluster analysis might help to better define clinical profiles and to compare responses in ESIT-SQ among subgroups of patients with tinnitus.
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13
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Abstract
PURPOSE OF REVIEW This article reviews recent developments in Ménière's disease including etiologic, diagnostic, and therapeutic investigations that have changed the landscape for medical providers. These updates shed light onto the complex nature of Ménière's disease and generate additional means to provide optimal care to patients. RECENT FINDINGS Given the multifactorial cause of Ménière's disease, five subtypes of Ménière's disease have recently been proposed. A knowledge of these subtypes will aid in the development of an appropriate treatment algorithm. Although newer treatments have not been developed, stepwise treatment algorithms have been proposed and can improve patient care. New MRI modalities and serum testing hold promise as clinical clues and biomarkers. SUMMARY As these updated diagnostic criteria are used, Ménière's disease can be identified and treated more precisely. This will in turn allow for future randomized controlled studies to improve the quality of treatment options available. Future imaging, vestibular testing, and the potential for serum biomarkers may illuminate additional diagnostic criteria, only furthering the improvement in clinical care.
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Affiliation(s)
- Justin L Hoskin
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
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14
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Zhang S, Guo Z, Tian E, Liu D, Wang J, Kong W. Meniere disease subtyping: the direction of diagnosis and treatment in the future. Expert Rev Neurother 2022; 22:115-127. [PMID: 35057670 DOI: 10.1080/14737175.2022.2030221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
| | - Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
- Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
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15
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Guajardo-Vergara C, Suárez-Vega V, Dominguez P, Manrique-Huarte R, Arbizu L, Pérez-Fernández N. Endolymphatic hydrops in the unaffected ear of patients with unilateral Ménière's disease. Eur Arch Otorhinolaryngol 2022; 279:5591-5600. [PMID: 35578137 PMCID: PMC9649467 DOI: 10.1007/s00405-022-07412-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/19/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Current studies show that frequency tuning modification is a good marker for the detection of endolymphatic hydrops (EH) employing magnetic resonance imaging (MRI) in patients with Ménière's disease (MD). The purpose of the present study is to analyze the auditory and vestibular function with audiometric and vestibular-evoked myogenic potentials (VEMP) responses, respectively, in both the affected and unaffected ears of patients with unilateral MD using MRI as diagnostic support for the degree of EH. METHODS We retrospectively reviewed the medical records of 76 consecutive patients with unilateral definite MD (age 55 (28-75); 39 women, 37 men). MRI was used through intravenous gadolinium administration, audiometry, and VEMPs. Functional tests were performed up to a week after the MRI. All were followed up one year after imaging utilizing clinical, auditory, and vestibular testing to rule out bilateral involvement. RESULTS In the unaffected ear, the mean pure-tone average is normal even in cases with hydrops and, for a similar severity of hydrops is significantly lower than in the affected ear. Significant differences for the amplitude of the response at 0.5 kHz, at 1 kHz between the affected and unaffected ears were found to be lower in the affected ears. The relative amplitude ratio (1 Kz-0.5 kHz) was significantly lower in the affected ear and in the case of the oVEMP response depends on the degree of EH. The response in the unaffected ear was not modified by the presence or the degree of hydrops. CONCLUSION In the unaffected ear, hydrops is not associated with hearing deterioration. For a similar degree of hydrops, hearing loss is significantly greater in the affected ear. The endolymphatic hydrops in the vestibule induces a frequency bias in the VEMP response only in the affected ear and not in the unaffected ear. Because of these findings we consider that hydrops does not represent an active disorder in the unaffected ear.
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Affiliation(s)
- Carlos Guajardo-Vergara
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain ,Escuela de Fonoaudiología, Universidad Austral de Chile, Sede Puerto Montt, Los Lagos, Chile
| | | | - Pablo Dominguez
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Lorea Arbizu
- Department of Otorhinolaryngology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Nicolás Pérez-Fernández
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain ,Department of Otorhinolaryngology, Clínica Universidad de Navarra, Marquesado de Santa Marta 1, 28027 Madrid, Spain
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16
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Guan Y, Chari DA, Liu YH, Rauch SD. Efficacy and Durability of Intratympanic Gentamicin Treatment for Meniere's Disease. Front Neurol 2021; 12:765208. [PMID: 34956051 PMCID: PMC8695721 DOI: 10.3389/fneur.2021.765208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To study the success of intratympanic gentamicin (ITG) treatment in reducing vertigo attacks in Meniere's disease (MD) and the value of the Halmagyi head thrust test (HTT) in predicting treatment durability. Study Design: Retrospective cohort study. Setting: Tertiary care vestibular clinic. Patients: Unilateral MD patients treated with ITG from 2006-2019 with ≥6 months follow-up. Main Outcome Measures: Demographics, audiometric data, subjective symptomatology, and HTT results were collected. Treatment success was defined as sufficient symptom relief. Treatment failure indicated vertigo control of less than 6 months duration. Treatment relapse indicated vertigo recurrence after 6 months. Results: Of 255 patients, treatment success, failure, and relapse occurred in 226 (88.6%), 29 (11.4%), and 121 (47.1%) patients, respectively. 48 (18.8%) patients who failed to respond or relapsed underwent labyrinthectomy. Mean follow-up time was 3.7 yrs (range 0.5-12.8). After ITG treatment, 25% patients reported worse hearing; mean pure tone average (PTA) increased by 18.6 ± 11.3 dB and mean word recognition score (WRS) decreased by 33 ± 21%. Of the 148 patients with negative pre-treatment HHT, 103 (69.6%) converted to positive after ITG treatment. Mean time-to-relapse in the converted and non-converted HTT cohorts was significantly different (49.7 vs. 27.0 months, p = 0.009) even after adjusting for gender, age, laterality, duration of symptoms, and number of ITG treatments. There were no significant differences between the two groups in hearing outcomes or subjective symptoms (e.g. lingering disequilibrium). Conclusions: ITG treatment effectively reduces the number of vertigo attacks in MD. HTT is valuable in predicting durability of treatment benefit.
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Affiliation(s)
- Yafeng Guan
- Department of Otolaryngology, The Hong Kong University-Shenzhen Hospital, Shenzhen, China
| | - Divya A Chari
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, MA, United States.,Department of Otolaryngology, University of Massachusetts Medical School, Worcester, MA, United States.,Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, United States
| | - Yu-Hsi Liu
- Department of Otolaryngology - Head and Neck Surgery, Kaohsiung Vetereans General Hospital, Kaohsiung City, Taiwan
| | - Steven D Rauch
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, United States
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17
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Correia F, Medeiros AB, Castelhano L, Cavilhas P, Escada P. Personality and psychopathology in Ménière's disease. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:344-351. [PMID: 34844672 DOI: 10.1016/j.otoeng.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/18/2020] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Psychological factors in vertigo patients have been extensively studied but the role of anxiety and personality traits in the clinical course of Ménière's disease (MD) is unknown. The objectives of this study are to identify and characterize psychopathology in MD and to find risk factors for an increased rate and intensity of crisis and chronic symptoms. MATERIALS AND METHODS We performed a transversal study in all patients diagnosed with definite MD in our department during a 5-year period. Sample subjects were interviewed in 3 steps: first, an otorhinolaryngologist collected information about clinical and pharmacological background of MD; second, a psychiatrist screened for mood, anxiety and personality disorders; in a third stage, the patient completed the DHI (Dizziness Handicap Inventory), STAI-Y (State Trait Anxiety Inventory), NEO-PI-R (Neo Personality Inventory Reviewed) and VAS (Visual Analogue Scale) for vertigo and dizziness. Statistical analysis was performed to search for risk factors for multiple and intense crisis and chronic symptoms. RESULTS Thirty-four patients completed all 3 phases of the study. A predominant dysfunctional personality trait was identified in 80% of patients (predominantly cluster C type), 35% were being treated with psychiatric medication and 34.4% had a considerable mood or anxiety disorder. All patients scored high (>7) in VAS during crisis. There was a statistically significant positive correlation between crisis rate and STAI, anxiety-subscale (N1) in NEO-PI-R, VAS and DHI scores (p<.044). Crises were more common in bilateral MD (p=.041). DHI scores were higher with higher STAI and N1 (p=.001). Disease duration and pure tone average were found to have a positive moderate correlation (p=.017). CONCLUSIONS The positive correlations between crisis rate, chronic dizziness and anxiety-related personality traits reveal a bidirectional and intimate relationship between personality, anxiety and MD, affecting these patients' quality of life. These results support the relevance of prospecting adjuvant psychological and psychiatric approaches to these patients.
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Affiliation(s)
- Filipe Correia
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova, Lisboa, Portugal.
| | - Ana Beatriz Medeiros
- Serviço de Psiquiatria e Saúde Mental, Hospital Garcia de Orta, Almada, Portugal
| | - Luís Castelhano
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova, Lisboa, Portugal
| | - Pedro Cavilhas
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova, Lisboa, Portugal
| | - Pedro Escada
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova, Lisboa, Portugal
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18
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A Predictive Model of Bilateral Sensorineural Hearing Loss in Meniere Disease Using Clinical Data. Ear Hear 2021; 43:1079-1085. [PMID: 34799494 DOI: 10.1097/aud.0000000000001169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Meniere disease (MD) is defined by a clinical syndrome of recurrent attacks of spontaneous vertigo associated with tinnitus, aural fullness, and sensorineural hearing loss (SNHL). Most patients have unilateral SNHL, but some of them will develop contralateral SNHL during the course of the disease. Several studies have reported a frequency of 2 to 73% SNHL in the second ear, according to the duration of disease and the period of follow-up. We hypothesize that unilateral and bilateral MD are different conditions, the first would initially involve the apical turn of the cochlea, while bilateral MD would affect the entire length of the cochlea. The aim of the study is to search for clinical predictors of bilateral SNHL in MD to build a predictive model of bilateral involvement. DESIGN A retrospective, longitudinal study including two cohorts with a total of 400 patients with definite MD was carried out. The inception cohort consisted of 150 patients with MD and the validation cohort included 250 cases. All of the cases were diagnosed of unilateral MD according to their hearing loss thresholds. The following variables were assessed as predictors of bilateral SNHL for the two cohorts: sex, age of onset, familiar history of MD, migraine and high-frequency hearing loss (HFHL, defined if hearing threshold >20 dB in two or more consecutive frequencies from 2 to 8 KHz). A descriptive analysis was carried out according to the presence of HFHL in the first audiogram for the main variables. By using multiple logistic regression, we built-up several predictive models for the inception cohort and validated it with the replication cohort and merged dataset. RESULTS Twenty-three (19.3%) and 78 (41%) of patients with HFHL developed contralateral SNHL during the follow-up, in the inception and validation cohorts, respectively. In the inception cohort, the best predictive model included HFHL in the first audiogram (OR = 6.985, p = 0.063) and the absence of migraine (OR = 0.215, p = 0.144) as clinical predictors for bilateral SNHL [area under the curve (AUC) = 0.641, p = 0.002]. The model was validated in the second cohort (AUC = 0.621, p < 0.001). Finally, we merged both datasets to improve the precision of the model including HFHL in the first audiogram (OR = 3.168, p = 0.001), migraine (OR = 0.482, p = 0.036) and age of onset >35 years old (OR = 2.422, p = 0.006) as clinical predictors (AUC = 0.639, p < 0.001). CONCLUSIONS A predictive model including the age of onset, HFHL in the first audiogram and migraine can help to assess the risk of bilateral SNHL in MD. This model may have significant implications for clinical management of patients with MD.
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Machine Learning Techniques for Differential Diagnosis of Vertigo and Dizziness: A Review. SENSORS 2021; 21:s21227565. [PMID: 34833641 PMCID: PMC8621477 DOI: 10.3390/s21227565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 01/23/2023]
Abstract
Vertigo is a sensation of movement that results from disorders of the inner ear balance organs and their central connections, with aetiologies that are often benign and sometimes serious. An individual who develops vertigo can be effectively treated only after a correct diagnosis of the underlying vestibular disorder is reached. Recent advances in artificial intelligence promise novel strategies for the diagnosis and treatment of patients with this common symptom. Human analysts may experience difficulties manually extracting patterns from large clinical datasets. Machine learning techniques can be used to visualize, understand, and classify clinical data to create a computerized, faster, and more accurate evaluation of vertiginous disorders. Practitioners can also use them as a teaching tool to gain knowledge and valuable insights from medical data. This paper provides a review of the literatures from 1999 to 2021 using various feature extraction and machine learning techniques to diagnose vertigo disorders. This paper aims to provide a better understanding of the work done thus far and to provide future directions for research into the use of machine learning in vertigo diagnosis.
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20
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Isherwood B, Gonçalves AC, Cousins R, Holme R. The global hearing therapeutic pipeline: 2021. Drug Discov Today 2021; 27:912-922. [PMID: 34775104 DOI: 10.1016/j.drudis.2021.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/20/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022]
Abstract
Hearing loss is a serious condition affecting more than 1.5 billion people globally. Many affected people benefit from the use of devices, such as hearing aids, but these do not restore natural hearing, and many users still struggle to follow speech in the presence of background noise. Consequently, there is rapid growth in work to discover therapeutics to address this need. Our analysis of the therapeutic pipeline for inner ear and central processing disorders identified 23 assets in clinical trials and 56 in preclinical development, of which 25% have entered the pipeline in the past three years. The innovative potential of this pipeline is encouraging, but there are translational hurdles to be overcome. We highlight challenges for the pipeline and comment on opportunities to support and strengthen it.
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Affiliation(s)
| | | | - Rick Cousins
- University College London Ear Institute, London, UK; Cinnabar Consulting, Bedford, UK
| | - Ralph Holme
- Royal National Institute for Deaf People, Peterborough, UK.
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21
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Roman-Naranjo P, Gallego-Martinez A, Soto-Varela A, Aran I, Moleon MDC, Espinosa-Sanchez JM, Amor-Dorado JC, Batuecas-Caletrio A, Perez-Vazquez P, Lopez-Escamez JA. Burden of Rare Variants in the OTOG Gene in Familial Meniere's Disease. Ear Hear 2021; 41:1598-1605. [PMID: 33136635 DOI: 10.1097/aud.0000000000000878] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Meniere's disease (MD) is a rare inner ear disorder characterized by sensorineural hearing loss, episodic vertigo, and tinnitus. Familial MD has been reported in 6 to 9% of sporadic cases, and few genes including FAM136A, DTNA, PRKCB, SEMA3D, and DPT have been involved in single families, suggesting genetic heterogeneity. In this study, the authors recruited 46 families with MD to search for relevant candidate genes for hearing loss in familial MD. DESIGN Exome sequencing data from MD patients were analyzed to search for rare variants in hearing loss genes in a case-control study. A total of 109 patients with MD (73 familial cases and 36 early-onset sporadic patients) diagnosed according to the diagnostic criteria defined by the Barany Society were recruited in 11 hospitals. The allelic frequencies of rare variants in hearing loss genes were calculated in individuals with familial MD. A single rare variant analysis and a gene burden analysis (GBA) were conducted in the dataset selecting 1 patient from each family. Allelic frequencies from European and Spanish reference datasets were used as controls. RESULTS A total of 5136 single-nucleotide variants in hearing loss genes were considered for single rare variant analysis in familial MD cases, but only 1 heterozygous likely pathogenic variant in the OTOG gene (rs552304627) was found in 2 unrelated families. The gene burden analysis found an enrichment of rare missense variants in the OTOG gene in familial MD. So, 15 of 46 families (33%) showed at least 1 rare missense variant in the OTOG gene, suggesting a key role in familial MD. CONCLUSIONS The authors found an enrichment of multiplex rare missense variants in the OTOG gene in familial MD. This finding supports OTOG as a relevant gene in familial MD and set the groundwork for genetic testing in MD.
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Affiliation(s)
- Pablo Roman-Naranjo
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigación Oncológica, Granada, Spain
| | - Alvaro Gallego-Martinez
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigación Oncológica, Granada, Spain
| | - Andrés Soto-Varela
- Division of Otoneurology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Ismael Aran
- Department of Otolaryngology, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Maria Del Carmen Moleon
- Department of Otolaryngology, Instituto de Investigación Biosanitaria, ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Juan Manuel Espinosa-Sanchez
- Department of Otolaryngology, Instituto de Investigación Biosanitaria, ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Angel Batuecas-Caletrio
- Department of Otolaryngology, Hospital Universitario Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Paz Perez-Vazquez
- Department of Otorhinolaryngology, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Jose Antonio Lopez-Escamez
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigación Oncológica, Granada, Spain
- Department of Otolaryngology, Instituto de Investigación Biosanitaria, ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Department of Surgery, Division of Otolaryngology, Universidad de Granada, Granada, Spain
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22
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Progressive and Degenerative Peripheral Vestibular Disorders. Otolaryngol Clin North Am 2021; 54:959-971. [PMID: 34301401 DOI: 10.1016/j.otc.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Initial diagnosis of peripheral vestibulopathy requires a detailed history, physical examination, and, in some cases, audiovestibular testing, radiographic imaging, or serology. Differentiation of a peripheral vestibulopathy as progressive or degenerative is often nuanced and influenced by a characterization of a patient's symptoms or natural history over time. A diverse group of vestibular pathology may fit into this category, including Ménière's disease, autoimmune conditions, congenital pathologies, ototoxic medications, radiation therapy, and perilymphatic fistula. Differentiation among these entities may be guided by initial or subsequent symptomatology, with various combinations of audiovestibular testing, serology, and imaging. Treatment options are disparate and disease-specific, ranging from observation to medical management or surgical intervention, underscoring the need for astute investigation and diagnosis.
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23
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Diao T, Han L, Jing Y, Wang Y, Ma X, Yu L, Zhang J, Zheng H, Wang L, Li X, Chen N. The clinical characteristics and anatomical variations in patients with intractable unilateral Meniere's Disease with and without migraine. J Vestib Res 2021; 32:57-67. [PMID: 34180440 DOI: 10.3233/ves-190755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Migraine is more common in Meniere's disease patients, who have some certain anatomical variations. But there are limited studies focusing on the anatomical variations in patients with Meniere's disease and migraine. OBJECTIVE To explore the clinical and anatomical features in Meniere's disease patients with and without migraine, determining whether the coexistence of migraine can be used as a basis for clinical subtyping of Meniere's disease. METHODS Ninety-five Meniere's disease patients and ninety-five healthy subjects matched with age, sex were selected. A detailed questionnaire based on the diagnosis criteria of Meniere's disease and migraine was designed. According to the CT scan, we divided the mastoid cell system of all the subjects into two types: well-pneumatization type and poor-pneumatization type. Meanwhile, the shortest distance between the sigmoid sinus and the posterior wall of the external acoustic canal was measured. RESULTS Compared with those without migraine, Meniere's disease patients with migraine had a higher female comorbidity, poorer mastoid pneumatization, shorter distance between the sigmoid sinus and posterior wall of the external acoustic canal, longer history, higher frequency of vertigo attacks and better average hearing threshold. CONCLUSIONS In our study, anatomical features as well as several clinical manifestations were proved to differ significantly between Meniere's disease patients with and without migraine, indicating the coexistence of migraine may be one standard for the clinical subtyping of Meniere's disease.
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Affiliation(s)
- Tongxiang Diao
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Lin Han
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Yuanyuan Jing
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Yixu Wang
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Xin Ma
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Lisheng Yu
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Jilei Zhang
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Hongwei Zheng
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Lin Wang
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Xueshi Li
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Nishan Chen
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
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Liao AH, Shih CP, Li MW, Lin YC, Chuang HC, Wang CH. Development of thermosensitive poloxamer 407-based microbubble gel with ultrasound mediation for inner ear drug delivery. Drug Deliv 2021; 28:1256-1271. [PMID: 34142922 PMCID: PMC8216251 DOI: 10.1080/10717544.2021.1938758] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
ABSTRACTSOur previous study first investigated feasibility of applying ultrasound (US) and microbubbles (MBs) via external auditory canal to facilitate drug delivery into inner ear. However, most drugs are in aqueous formulae and eliminated via Eustachian tubes after drug application. In this study, feasibility of sustained release of thermosensitive poloxamer 407 (P407)-based MB gel for US mediation-enhanced inner ear drug (dexamethasone, DEX) delivery was investigated. The sol-to-gel transition temperature showed that mixture of DEX and only 10% and 12.5% P407 in MBs can be used for in vitro and in vivo drug delivery experiments. In in vitro Franz diffusion experiments, the release rates of 12.5% P407-MBs + US groups in the model using DEX as the delivered reagent at 3 h resulted in values 1.52 times greater than those of 12.5% P407-MBs groups. In guinea pigs, by filling tympanic bulla with DEX in 12.5% P407-MBs (DEX-P407-MBs), USMB applied at post-treatment days 1 and 7 induced 109.13% and 66.67% increases in DEX delivery efficiencies, respectively, compared to the group without US. On the 28th day after US-mediated P407-MB treatment, the safety assessment showed no significant changes in the hearing thresholds and no damage to the integrity of cochlea or middle ear. These are the first results to demonstrate feasibility of US-modified liquid form DEX-P407-MB cavitation for enhancing permeability of round window membrane. Then, a gel form of DEX-P407-MBs was generated and thus prolonged the release of DEX in middle ear to maintain the therapeutic DEX level in inner ear for at least 7 days.
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Affiliation(s)
- Ai-Ho Liao
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan.,Department of Biomedical Engineering, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Ping Shih
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Wei Li
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Yi-Chun Lin
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ho-Chiao Chuang
- Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Taichung Armed Forces General Hospital, Taichung, Taiwan
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25
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Gallego-Martinez A, Lopez-Escamez JA. Genetic architecture of Meniere’s disease. Hear Res 2020; 397:107872. [DOI: 10.1016/j.heares.2019.107872] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/12/2019] [Accepted: 12/09/2019] [Indexed: 01/26/2023]
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Correia F, Medeiros AB, Castelhano L, Cavilhas P, Escada P. Personality and psychopathology in Ménière's disease. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:S0001-6519(20)30152-7. [PMID: 33059851 DOI: 10.1016/j.otorri.2020.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES Psychological factors in vertigo patients have been extensively studied but the role of anxiety and personality traits in the clinical course of Ménière's disease (MD) is unknown. The objectives of this study are to identify and characterize psychopathology in MD and to find risk factors for an increased rate and intensity of crisis and chronic symptoms. MATERIALS AND METHODS We performed a transversal study in all patients diagnosed with definite MD in our department during a 5-year period. Sample subjects were interviewed in 3 steps: first, an otorhinolaryngologist collected information about clinical and pharmacological background of MD; second, a psychiatrist screened for mood, anxiety and personality disorders; in a third stage, the patient completed the DHI (Dizziness Handicap Inventory), STAI-Y (State Trait Anxiety Inventory), NEO-PI-R (Neo Personality Inventory Reviewed) and VAS (Visual Analogue Scale) for vertigo and dizziness. Statistical analysis was performed to search for risk factors for multiple and intense crisis and chronic symptoms. RESULTS Thirty-four patients completed all 3 phases of the study. A predominant dysfunctional personality trait was identified in 80% of patients (predominantly cluster C type), 35% were being treated with psychiatric medication and 34.4% had a considerable mood or anxiety disorder. All patients scored high (>7) in VAS during crisis. There was a statistically significant positive correlation between crisis rate and STAI, anxiety-subscale (N1) in NEO-PI-R, VAS and DHI scores (p<.044). Crises were more common in bilateral MD (p=.041). DHI scores were higher with higher STAI and N1 (p=.001). Disease duration and pure tone average were found to have a positive moderate correlation (p=.017). CONCLUSIONS The positive correlations between crisis rate, chronic dizziness and anxiety-related personality traits reveal a bidirectional and intimate relationship between personality, anxiety and MD, affecting these patients' quality of life. These results support the relevance of prospecting adjuvant psychological and psychiatric approaches to these patients.
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Affiliation(s)
- Filipe Correia
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova, Lisboa, Portugal.
| | - Ana Beatriz Medeiros
- Serviço de Psiquiatria e Saúde Mental, Hospital Garcia de Orta, Almada, Portugal
| | - Luís Castelhano
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova, Lisboa, Portugal
| | - Pedro Cavilhas
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova, Lisboa, Portugal
| | - Pedro Escada
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova, Lisboa, Portugal
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Grønlund C, Devantier L, Callesen HE, Hougaard DD, Händel MN, Schmidt JH, Guldfred FLA, Djurhuus BD. Vertiginous Episodes in Menière Disease following Transmyringeal Ventilation Tube Insertion: A Systematic Review on the Current State of Evidence. Int Arch Otorhinolaryngol 2020; 25:e463-e470. [PMID: 34377186 PMCID: PMC8321650 DOI: 10.1055/s-0040-1714131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction Menière disease (MD) is a disorder characterized by episodes of vertigo, sensorineural hearing loss, tinnitus and aural fullness. Objectives To assess the effect of ventilation tube insertion (VTI) on vertiginous episodes in patients (≥ 18 years old) with MD. Data Synthesis A systematic literature search on randomized clinical trials (RCTs), nonrandomized trials and other systematic reviews was performed. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to assess the overall certainty of evidence. Two RCTs and four nonrandomized studies were identified. Data extraction was only possible for one RCT. Results showed that the number of patients with no vertigo attacks significantly increased following active treatment (relative risk 1.52; [95% confidence interval: 1.19-1.94]). The quality of evidence was rated as low. None of the nonrandomized trials included a proper control group, which hindered data extraction and quality assessment. Conclusion There are currently no RCTs that specifically assess the efficacy of VTI in patients with MD. Current limited data suggest a considerable positive effect on the number of vertiginous episodes in patients with MD. However, due to poor evidence, a fluctuating course and a substantial placebo-effect associated with MD-treatment, no solid conclusion(s) regarding the efficacy of VTI can be made. There is a need for high-quality RCTs.
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Affiliation(s)
- Casper Grønlund
- Department of Ear, Nose, Throat and Maxillofacial Surgery, Zealand University Hospital, Koege, Denmark
| | - Louise Devantier
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Dan Dupont Hougaard
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mina Nicole Händel
- The Danish Health Authority, Copenhagen, Denmark.,The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jesper Hvass Schmidt
- Department of ORL, Head and Neck Surgery and Audiology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Bjarki Ditlev Djurhuus
- Department of Ear, Nose, Throat and Maxillofacial Surgery, Zealand University Hospital, Koege, Denmark
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Martinez-Gomez E, Gallego-Martinez A, Roman-Naranjo P, Lopez-Escamez JA. Clinical and molecular genetics of Meniere disease. MED GENET-BERLIN 2020. [DOI: 10.1515/medgen-2020-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Meniere disease (MD) represents a heterogeneous group of relatively rare disorders of the inner ear that causes vertigo attacks, fluctuating sensorineural hearing loss (SNHL) involving low and medium frequencies, tinnitus, and aural fullness. MD has been attributed to an accumulation of endolymph in the cochlear duct. The diagnosis of MD is based on the phenomenological association of clinical symptoms including SNHL during the vertigo attacks. At least two mechanisms are involved in MD: (a) a pro-inflammatory immune response mediated by interleukin-1 beta (IL-1β), tumor necrosis factor alpha (TNFα), and IL-6, and (b) nuclear factor-kappa B (NF-κB)-mediated inflammation in the carriers of the single nucleotide variant rs4947296. The majority of MD cases are considered sporadic, although familial aggregation has been recognized in European and East Asian populations in multiplex families, supporting a genetic contribution to the disease. In sporadic MD cases, the main genetic findings involve multiplex rare variants in several SNHL genes, such as GJB2, USH1G, SLC26A4, ESRRB, and CLDN14, and axonal guidance signaling genes, such as NTN4 and NOX3. Familial aggregation has been reported in 6–8 % of MD cases, and most families show an autosomal dominant inheritance. Few rare missense heterozygous variants have been described in simplex families in six genes (COCH, FAM136A, DTNA, PRKCB, SEMA3D, and DPT). Of note, 33 % of familial MD individuals show singleton and multiplex rare missense variants in the OTOG gene, suggesting a multiallelic inheritance. Moreover, potentially pathogenic rare variants in the familial genes FAM136A, DTNA, and DPT have been reported in Korean singletons with sporadic MD. Rare variants may have a significant contribution to sporadic and familial MD. The interaction of common cis-regulatory variants located in non-coding regions and rare variants in coding regions in one or more genes will determine the variation on the phenotype in MD. Further studies on genotype–phenotype correlations are required to improve the yield of genetic diagnosis, and different types of variants seem to contribute to the genetic structure of MD.
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Affiliation(s)
- Estrella Martinez-Gomez
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government , PTS Granada , Avenida de la Ilustración, 114 , Granada , Spain
| | - Alvaro Gallego-Martinez
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government , PTS Granada , Avenida de la Ilustración, 114 , Granada , Spain
| | - Pablo Roman-Naranjo
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government , PTS Granada , Avenida de la Ilustración, 114 , Granada , Spain
| | - Jose A. Lopez-Escamez
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government , PTS Granada , Avenida de la Ilustración, 114 , Granada , Spain
- Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs.GRANADA , Hospital Universitario Virgen de las Nieves, Universidad de Granada , Granada , Spain
- Department of Surgery, Division of Otolaryngology , Universidad de Granada , Granada , Spain
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Yang TH, Xirasagar S, Cheng YF, Wu CS, Kuo NW, Lin HC. Peripheral Vestibular Disorders: Nationwide Evidence From Taiwan. Laryngoscope 2020; 131:639-643. [PMID: 32621538 DOI: 10.1002/lary.28877] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to evaluate the prevalence of peripheral vestibular disorders in an Asian population of predominantly Han Chinese ethnicity. STUDY DESIGN Cross-sectional study. METHODS Patients with a peripheral vertigo disorder were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of 2 million enrollees of Taiwan's National Health Insurance system covering over 99% of Taiwan's citizens. In 2016, 59,986 patients received a diagnosis of peripheral vestibular disorders in Taiwan. We calculated the population-wide prevalence rates of peripheral vestibular disorders in 2016 by sex and age group (20 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, 45 to 49, 50 to 54, 55 to 59, 60 to 64, 65 to 69, and ≥ 70 years) stratified into five urbanization levels. RESULTS The prevalence rate of peripheral vestibular disorders was 2,833.4 per 100,000 population during the year. Prevalence of Meniere's disease was 70.4 per 100,000, benign paroxysmal positional vertigo, 446.4, vestibular neuritis 307.2, and other or unspecified peripheral vestibular dizziness, 2,009.5 per 100,000. Prevalence rates steadily increased with age for every type of peripheral vestibular disorder, and were higher among females compared to males. The female-to-male gender ratios were 1.84, 1.89, and 1.93 for Meniere's disease, vestibular neuritis, and other peripheral vestibular dizziness, respectively. Counties with the lowest urbanization level had the highest prevalence rates of all types of peripheral vestibular disorders except vestibular neuritis. CONCLUSIONS Results showed that peripheral vestibular disorders are common in Taiwan, increase with age, are predominantly female, and show higher prevalence in rural areas. LEVEL OF EVIDENCE 2b Laryngoscope, 131:639-643, 2021.
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Affiliation(s)
- Tzong-Hann Yang
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan.,Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, U.S.A
| | - Yen-Fu Cheng
- Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chuan-Song Wu
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,College of Science and Engineering, Fu Jen University, New Taipei City, Taiwan
| | - Nai-Wen Kuo
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Espinosa-Sanchez JM, Lopez-Escamez JA. The pharmacological management of vertigo in Meniere disease. Expert Opin Pharmacother 2020; 21:1753-1763. [DOI: 10.1080/14656566.2020.1775812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Juan Manuel Espinosa-Sanchez
- Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Granada, Spain
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional, Government PTS Granada, Granada, Spain
| | - José A. Lopez-Escamez
- Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Granada, Spain
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional, Government PTS Granada, Granada, Spain
- Department of Surgery, Division of Otolaryngology, Universidad de Granada, Granada, Spain
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31
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Di Stadio A, Ricci G, Ralli M, Paolo T, Agostini G, Faralli M. Head-Shaking Nystagmus in the Early Stage of Unilateral Meniere's Disease. J Int Adv Otol 2020; 15:425-430. [PMID: 31846924 DOI: 10.5152/iao.2019.7338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The aim of the present study was to evaluate the ability of head-shaking nystagmus (HSNy), evoked after the resolution of a vertigo spell, to predict an imminent crisis in the early stage of Meniere's disease (MD). MATERIALS AND METHODS A total of 20 patients in the early stage of MD were included in the study. The head-shaking test (HST) was performed twice, during the first visit within 24 h of vertigo spell (T0) and 48 h later (T1). The onset of a new vertigo episode during the 2 weeks following the first visit was recorded in each patient's medical record. The sensitivity and specificity of HSNy toward predicting a new vertigo episode were calculated. RESULTS At T0, an evoked ipsilesional HSNy in 15 (75%) patients was observed; in four of them, the HSNy had a biphasic component. The HSNy was present and persistent at T1 in 8 (42.1%) patients; among these cases, 6 patients had ipsilesional HSNy, and 2 patients a contralesional HSNy. None of the patients presented with a biphasic HSNy at T1. Seven (36.8%) patients experienced the recurrence of a vertigo crisis. Among these, 6 patients had ipsilesional HSNy at T1. Only 8 patients with ipsilesional HSNy at T0 did not have recurrence. The sensitivity of the ipsilesional HSNy in predicting the recurrence of vertigo in patients with MD was 100% at T0 and 85.7% at T1. The specificity was 46.6% and 100% at T0 and T1, respectively. CONCLUSION The HST can be a useful test in the early stages of MD to predict a new vertigo attack.
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Affiliation(s)
| | - Giampietro Ricci
- Department of Otolaryngology, University of Perugia, Perugia, Italy
| | - Massimo Ralli
- Department of Organ of Sense, University La Sapienza, Rome, Italy
| | - Tropiano Paolo
- Department of Otolaryngology, University of Perugia, Perugia, Italy
| | | | - Mario Faralli
- Department of Otolaryngology, Silvestrini Hospital, Perugia, Italy
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32
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The association between vitamin deficiency and otolaryngologic diseases: A therapeutic target. Med Hypotheses 2020; 135:109448. [DOI: 10.1016/j.mehy.2019.109448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/22/2019] [Indexed: 11/21/2022]
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Kutlubaev MA, Zamergrad MV. [A role of vascular risk factors in the development of peripheral vestibulopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:85-89. [PMID: 31825395 DOI: 10.17116/jnevro201911909285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The development of peripheral vestibular disorders are often thought to be associated with vascular mechanisms, taking into account terminal type of inner ear blood supply and other predisposing factors. A number of studies indicates a high frequency of vascular risk factors in the patients with vestibular neuronitis and benign paroxysmal positional vertigo (BPPV). According to other results, migraine is widely spread among patients with Meniere's disease and BPPV. However currently there is no evidence for casual relationship between vascular factors and development of peripheral vestibulopathy. The only exclusion is labyrinthine infarction, which develops as a result of posterior circulation disorder. More research is needed in this area.
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Affiliation(s)
- M A Kutlubaev
- Kuvatov Republican Clinical Hospital, Ufa, Russia; Bashkir State Medical University, Ufa, Russia
| | - M V Zamergrad
- Russian Medical Aacademy for Contuning Postgraduate Education, Moscow, Russia
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Masood MM, Farquhar DR, Brown KD, Pillsbury HC, King ER, O'Connell BP. Hearing Preservation and Speech Outcomes After Cochlear Implantation in Meniere's Disease. Laryngoscope 2019; 130:2874-2878. [PMID: 31821566 DOI: 10.1002/lary.28470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/09/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate speech perception outcomes and hearing preservation after cochlear implantation in patients with Meniere's disease (MD). STUDY DESIGN Retrospective chart review. METHODS Fifty-one adult patients, accounting for a total of 63 implants, with MD treated at a tertiary care center were included in the study. Patients with unaided preoperative air-conduction thresholds ≤80 dB at 250 Hz were included in hearing preservation analyses. The primary outcome measure was Consonant-Nucleus-Consonant (CNC) score. Hearing preservation was assessed as follows: 1) maintenance of functional hearing, defined as a postoperative unaided air-conduction threshold ≤80 dB at 250 Hz and 2) low-frequency pure-tone average (LFPTA) shift. RESULTS Speech perception scores improved significantly postimplantation; specifically, the CNC mean score was 9% preoperatively and increased to 57% by 1 year postoperatively (P < .001). Eighteen ears were included in hearing preservation analysis; the mean preoperative LFPTA was 65 dB (standard deviation [SD] = 10). The mean postoperative LFPTA at activation was 93 dB (SD = 21), and at 1 year was 102 dB (SD = 11). Twenty-seven percent of patients achieved short-term functional hearing preservation, whereas the longer-term outcomes were less favorable (11%). CONCLUSIONS Speech perception scores improve after implantation in patients with MD. Hearing preservation is possible in patients with MD, albeit at lower rates than reported non-MD populations. Our data suggest that there can be degradation in acoustic hearing over time. LEVEL OF EVIDENCE 4 Laryngoscope, 2019.
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Affiliation(s)
- Maheer M Masood
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.,Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Douglas R Farquhar
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Kevin D Brown
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Harold C Pillsbury
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - English R King
- Department of Audiology, University of North Carolina Hospitals, University of North Carolina Health Care, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Brendan P O'Connell
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Oliveira LNDR, Oliveira CLDA, Lopes KDC, Ganança FF. Diagnostic assessment of patients with Meniere's disease through caloric testing and the video-head-impulse test. Braz J Otorhinolaryngol 2019; 87:428-433. [PMID: 31870737 PMCID: PMC9422366 DOI: 10.1016/j.bjorl.2019.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/11/2019] [Accepted: 10/08/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Meniere's disease is a labyrinth disease that usually presents with episodes of spontaneous vertigo associated with sensorineural hearing loss, tinnitus and ipsi- and unilateral aural fullness in most cases. Vestibular function tests, video-head-impulse test and the caloric test, are not specific for diagnosis of the disease, but may show alterations that help to evaluate the functional impairment. Objective To describe the results obtained at the caloric test and video-head-impulse test in patients with definite Meniere's disease and compare them between symptomatic, asymptomatic ears and those of the control group. Methods Cross-sectional and observational study including patients with definite Meniere's disease diagnosed according to the Bárány Society criteria (2015) and healthy individuals (control group) undergoing caloric test and video-head-impulse test. All subjects were assessed by neurotological anamnesis and audiological evaluation (pure-tone, vocal and immittance audiometry) to characterize the sample. The findings obtained at the caloric test and video-head-impulse test were described and compared between the symptomatic and asymptomatic ears of patients with Meniere's disease and those of the control group. Results Thirty-two patients with definite Meniere's disease were evaluated, with a mean age of 45.7 years, mostly females (68.8%) and unilateral disease. The control group consisted of 20 healthy individuals, with a mean age of 44.7 years, mostly females (70.0%). The groups were homogeneous in relation to age and gender. The patients’ main complaint was vertigo (71.9%), and most patients had more than six episodes in the last six months (71.9%). Moderate sensorineural hearing loss was present in 38.5% of patients. The prevalence of hyporeflexia at the caloric test was higher in symptomatic (56.4%) and asymptomatic (36%) ears of patients with Meniere's disease compared to the ears of control subjects (7.5%), p < 0.001 and p = 0.004, respectively. Video-head-impulse test alterations in the lateral semicircular canals were more frequent in the symptomatic ears of patients with Meniere's disease than in the ears of control subjects (p = 0.026). Conclusion Most patients with definite Meniere's disease showed hyporeflexia at the caloric test and video-head-impulse test with normal function in the symptomatic ear. Vestibular hyporeflexia at the caloric test was more frequent in the symptomatic and asymptomatic ears of patients with Meniere's disease than in the control group. The video-head-impulse test showed more alterations in the lateral semicircular canals.
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Affiliation(s)
- Lívia Noleto de Rezende Oliveira
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil.
| | | | - Karen de Carvalho Lopes
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil
| | - Fernando Freitas Ganança
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil
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Kim JY, Ko I, Cho BJ, Kim DK. Association of Obstructive Sleep Apnea With the Risk of Ménière's Disease and Sudden Sensorineural Hearing Loss: A Study Using Data From the Korean National Health Insurance Service. J Clin Sleep Med 2019; 15:1293-1301. [PMID: 31538600 PMCID: PMC6760412 DOI: 10.5664/jcsm.7922] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Several studies have reported an association between obstructive sleep apnea (OSA) and neuro-otologic diseases, such as Ménière's disease or sudden sensorineural hearing loss (SSNHL). However, the exact relationship between OSA and those diseases has not been fully evaluated. Therefore, the aim of this study was to investigate the prospective link between OSA and Ménière's disease or SSNHL. METHODS We used a nationwide cohort sample of data for 2002-2013 representing approximately 1 million patients. The OSA group (n = 942) included patients diagnosed between 2004 and 2006; the comparison group was selected using propensity score matching (n = 3,768). We investigated Ménière's disease and SSNHL events over a 9-year follow-up period. Survival analysis, log-rank test, and Cox proportional hazards regression models were used to calculate incidence, survival rate, and hazard ratios for each group. RESULTS In the OSA group, the incidences of Ménière's disease and SSNHL were 7,854.4 and 7,876.3 person-years, respectively. Cox proportional hazards analysis revealed no overall association between patients with OSA and the risk of subsequent Ménière's disease or SSNHL. In a subgroup analysis, female and middle-aged patients with OSA were independently associated with a two-fold higher incidence of subsequent Ménière's disease, compared to those without OSA. However, we could not find any significant association between patients with OSA and SSNHL even in the subgroup analysis. CONCLUSIONS Our findings suggest that female or middle-aged patients with OSA are associated with an increased incidence of Ménière's disease. However, there was no association between OSA and SSNHL. CITATION Kim J-Y, Ko I, Cho B-J, Kim D-K. Association of obstructive sleep apnea with the risk of Ménière's disease and sudden sensorineural hearing loss: a study using data from the Korean National Health Insurance Service. J Clin Sleep Med. 2019;15(9):1293-1301.
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Affiliation(s)
- Jong-Yeup Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Inseok Ko
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Bum-Joo Cho
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Dong-Kyu Kim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
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Benign paroxysmal positional vertigo in Meniere's disease: systematic review and meta-analysis of frequency and clinical characteristics. J Neurol 2019; 268:1608-1614. [PMID: 31410549 DOI: 10.1007/s00415-019-09502-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
There is a recognized association of Meniere's disease (MD) and benign paroxysmal positional vertigo (BPPV). However, the frequency and clinical characteristics of BPPV in MD are unclear. The aim of this review was to determine the mean frequency and clinical features of BPPV in MD. Three databases were searched: MEDLINE, PubMed and Google Academia. Studies reporting the frequency of BPPV in MD were pooled. A total of 4198 references were identified, of which 20 studies were considered eligible. The pooled frequency of BPPV in MD was 14% (95% CI 9-18%). It was 38% (95% CI 26-49%) in longitudinal studies and 8% (95% CI 6-11%) in cross-sectional ones. BPPV comorbid with MD was mostly observed in the ear affected by hydrops, in females, in patients with more advanced disease. Canalolithiasis of the horizontal semicircular canal was more common in patients with BPPV associated with MD than in idiopathic BPPV. BPPV in MD was more prone to recurrence and required more canal repositioning maneuvers.
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Flook M, Frejo L, Gallego-Martinez A, Martin-Sanz E, Rossi-Izquierdo M, Amor-Dorado JC, Soto-Varela A, Santos-Perez S, Batuecas-Caletrio A, Espinosa-Sanchez JM, Pérez-Carpena P, Martinez-Martinez M, Aran I, Lopez-Escamez JA. Differential Proinflammatory Signature in Vestibular Migraine and Meniere Disease. Front Immunol 2019; 10:1229. [PMID: 31214186 PMCID: PMC6558181 DOI: 10.3389/fimmu.2019.01229] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/14/2019] [Indexed: 12/20/2022] Open
Abstract
Vestibular Migraine (VM) and Meniere's Disease (MD) are episodic vestibular syndromes defined by a set of associated symptoms such as tinnitus, hearing loss or migraine features during the attacks. Both conditions may show symptom overlap and there is no biological marker to distinguish them. Two subgroups of MD patients have been reported, according to their IL-1β profile. Therefore, considering the clinical similarity between VM and MD, we aimed to investigate the cytokine profile of MD and VM as a means to distinguish these patients. We have also carried out gene expression microarrays and measured the levels of 14 cytokines and 11 chemokines in 129 MD patients, 82 VM patients, and 66 healthy controls. Gene expression profile in peripheral blood mononuclear cells (PBMC) showed significant differences in MD patients with high and low basal levels of IL- 1β and VM patients. MD patients with high basal levels of IL- 1β (MDH) had overall higher levels of cytokines/chemokines when compared to the other subsets. CCL4 levels were significantly different between MDH, MD with low basal levels of IL- 1β (MDL), VM and controls. Logistic regression identified IL- 1β, CCL3, CCL22, and CXCL1 levels as capable of differentiating VM patients from MD patients (area under the curve = 0.995), suggesting a high diagnostic value in patients with symptoms overlap.
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Affiliation(s)
- Marisa Flook
- Otology and Neurotology Group CTS495, Department of Genomic Medicine, Centre for Genomics and Oncological Research-Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain
| | - Lidia Frejo
- Otology and Neurotology Group CTS495, Department of Genomic Medicine, Centre for Genomics and Oncological Research-Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Department of Pediatric Otolaryngology and Department of Orthopedics, The Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY, United States
| | - Alvaro Gallego-Martinez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine, Centre for Genomics and Oncological Research-Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain
| | - Eduardo Martin-Sanz
- Department of Otolaryngology, Hospital Universitario de Getafe, Getafe, Spain
| | | | | | - Andres Soto-Varela
- Division of Otoneurology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Sofia Santos-Perez
- Division of Otoneurology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Juan Manuel Espinosa-Sanchez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine, Centre for Genomics and Oncological Research-Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Patricia Pérez-Carpena
- Otology and Neurotology Group CTS495, Department of Genomic Medicine, Centre for Genomics and Oncological Research-Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Department of Otolaryngology, Hospital Universitario San Cecilio, Granada, Spain
| | | | - Ismael Aran
- Department of Otolaryngology, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Jose Antonio Lopez-Escamez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine, Centre for Genomics and Oncological Research-Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Rego ÂR, Dias D, Pinto A, e Castro SS, Feliciano T, e Sousa CA. The cardiovascular aspects of a Ménière's disease population - A pilot study. J Otol 2019; 14:51-56. [PMID: 31223301 PMCID: PMC6570641 DOI: 10.1016/j.joto.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/15/2018] [Accepted: 01/22/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION MD is considered a rare disease. An adequate model that explains MD's pathophysiology is not well established. Recently, the vascular theory of the disease has been revived. OBJECTIVES To characterize a MD population according to its cardiovascular risk and correlate it to the MD clinical course. METHODS In this retrospective chart study the data of 31 MD patients observed between January 2017 and April 2018 in a tertiary university hospital were reviewed. Patients included in the study were diagnosed according to the Bárány Society criteria. Lost follow-ups, patients with autoimmune disease, atopy or allergy, major psychiatric disease and migraine were excluded. Age, gender, cardiovascular risk factors, audiometric and vestibular parameters, occurrence of MD attacks in the previous 6 months, vestibular medication in course and time course of MD were recorded and compared between groups (with and without cardiovascular risk factors). RESULTS 31 patients (61.3% females) mean aged 60.3 years (±9.7) were studied. 74% of the population had at least one risk factor and 51.6% of patients had attacks in the last 6 months. There was a statistically significant difference in the occurrence of MD attacks in the last 6 months (p = 0.014) between MD patients with and without risk factors. Mean PTA thresholds were higher and speech discrimination was lower in individuals with more cardiovascular risk factors. CONCLUSIONS Treatment of MD focusing on vascular risk factors may allow a better control of symptoms and result in a decreased need for ablative procedures in this disorder.
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Affiliation(s)
- Ângela Reis Rego
- ENT Department, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
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Wang SJ, Yang H, Yao YY, Gu HY, Lin LL, Zhang C, Luo J. The Clinical Benefit of Device Therapy for Meniere's Disease in Adults: Systematic Review and Meta-Analysis. J Int Adv Otol 2019; 15:121-129. [PMID: 31058601 DOI: 10.5152/iao.2019.5937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This study aimed to assess the clinical benefit of device therapy on controlling the symptoms of Meniere's disease (MD). MATERIALS AND METHODS We searched PubMed, Embase, the Cochrane Library, China National Knowledge Internet, and Wanfang Data before January 13, 2018. We selected randomized controlled clinical trials, case-controlled studies, and cohort studies that dealt with outcomes of device therapy for the treatment of MD. RESULTS Sixteen trials met our inclusion criteria. The use of device therapy resulted in improved vertigo control, which was described as a reduction in the number of vertigo days by month (weighted mean difference [WMD]: 3.15, 95% confidence interval [CI]: 2.00-4.31), in the number of vertigo episodes by month (WMD: 7.37, 95% CI: 2.40-12.35), and in the vertigo visual analog score (WMD: 41.51, 95% CI: 34.68-48.34). In addition, the overall complete vertigo control (class A) rate was 50% (95% CI: 37%-64%). The device therapy also reduced the number of sick days by month (WMD: 4.56, 95% CI: 2.15-6.97), and the functional level improved (WMD: 2.66, 95% CI: 2.15-3.17). The electrocochleographic parameters decreased. The device therapy proved beneficial for hearing changes (WMD: 3.19, 95% CI: 0.66-5.71). No publication bias was found in the funnel plot and the results of Egger's test. CONCLUSION This study showed that the device therapy might reduce vertigo attacks and sick days in patients with MD. Additionally, the function level and hearing level may improve after the device therapy. In addition, the decrease in electrocochleographic parameters showed that inner ear electrophysiology improved after device therapy.
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Affiliation(s)
- Shu Jia Wang
- Hubei University of Medicine, Taihe Hospital, Center for Evidence-Based Medicine and Clinical Research, Shiyan, China
| | - Hong Yang
- Department of Neurology, Hubei University of Medicine, Taihe Hospital, Shiyan, China
| | - Yang-Yang Yao
- Department of Rehabilitation Medicine, Hubei University of Medicine, Taihe Hospital, Shiyan, China
| | - Hui-Yun Gu
- Department of Rehabilitation Medicine, Hubei University of Medicine, Taihe Hospital, Shiyan, China
| | - Lu-Lu Lin
- Hubei University of Medicine, Taihe Hospital, Center for Evidence-Based Medicine and Clinical Research, Shiyan, China
| | - Chao Zhang
- Hubei University of Medicine, Taihe Hospital, Center for Evidence-Based Medicine and Clinical Research, Shiyan, China
| | - Jie Luo
- Department of Neurology, Hubei University of Medicine, Taihe Hospital, Shiyan, China
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Holmberg J, de Amesti M, Rosenbaum A, Winter M. Positive pressure therapy for Ménière’s disease. Medwave 2019; 19:e7610. [DOI: 10.5867/medwave.2019.03.7609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 12/28/2018] [Indexed: 11/27/2022] Open
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Lee J, Kim ES, Lee Y, Lee K, Yoon DY, Ju YS, Lee HJ, Hong SK, Kwon MJ. Quantitative analysis of cochlear signal intensity on three-dimensional and contrast-enhanced fluid-attenuated inversion recovery images in patients with Meniere's disease: Correlation with the pure tone audiometry test. J Neuroradiol 2019; 46:307-311. [PMID: 30953681 DOI: 10.1016/j.neurad.2019.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to correlate the quantitative analysis of cochlear signal intensity (SI) on 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and contrast-enhanced (CE) 3D-FLAIR images with results of the pure tone audiometry (PTA) test in patients with Meniere's disease (MD). MATERIALS AND METHODS Over a 3-year period, 123 patients with MD underwent 3-Tesla (3 T) temporal magnetic resonance imaging (MRI), including 3D-FLAIR and CE-FLAIR sequences. The SI of membranous labyrinth of the cochlea in both ears of each patient was measured by drawing a region of interest (ROI) with a seed growing technique. The correlation between measured cochlear SIs on 3D-FLAIR and CE-FLAIR images, contrast enhancement index (CEI), and contrast enhancement ratio (CER) and clinical findings and pre- and post-treatment PTA results were assessed. RESULTS Cochlear signal ratios of symptomatic ears on 3D-FLAIR and CE-FLAIR images were significantly higher than those of asymptomatic ears (P < 0.001). The area under the curve, from the receiver operating characteristic curve of cochlear SIs on 3D-FLAIR and CE-FLAIR images for discrimination between symptomatic and asymptomatic ears, was 0.729 and 0.728, respectively. Cochlear SIs on 3D-FLAIR and CE-FLAIR images were significantly correlated with patients' sex (P < 0.05 and P < 0.01, respectively), symptomatic ear (both P < 0.0001), and pre-treatment PTA (P < 0.0001 and P < 0.005, respectively), but were not significantly correlated with patients' age, post-treatment PTA or hearing threshold level at 0.5, 1.0, 2.0, or 4.0 kHz. CONCLUSION Quantitative analysis of cochlear SI on 3D-FLAIR and CE-FLAIR images may be a helpful diagnostic adjunct for MD, but may be of little value in predicting the prognosis of MD.
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Affiliation(s)
- Jaehyung Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam City, Kyeonggi-do, South Korea
| | - Eun Soo Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea.
| | - Yul Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
| | - Kwanseop Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Young-Su Ju
- Department of Industrial Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
| | - Hyo-Jeong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
| | - Sung Kwang Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, South Korea
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REY-MARTÍNEZ J, ESPINOSA-SÁNCHEZ JM. Diseño y desarrollo de una aplicación para dispositivos móviles para el seguimiento y control de la enfermedad de Ménière. REVISTA ORL 2019. [DOI: 10.14201/orl.18194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Penêda JF, Lima NB, Monteiro F, Silva JV, Gama R, Condé A. Immune-Mediated Inner Ear Disease: Diagnostic and therapeutic approaches. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otorri.2017.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Penêda JF, Lima NB, Monteiro F, Silva JV, Gama R, Condé A. Immune-Mediated Inner Ear Disease: Diagnostic and therapeutic approaches. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2017.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Stölzel K, Droste J, Voß LJ, Olze H, Szczepek AJ. Comorbid Symptoms Occurring During Acute Low-Tone Hearing Loss (AHLH) as Potential Predictors of Menière's Disease. Front Neurol 2018; 9:884. [PMID: 30420828 PMCID: PMC6215849 DOI: 10.3389/fneur.2018.00884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/01/2018] [Indexed: 11/13/2022] Open
Abstract
Acute low-tone sensorineural hearing loss (ALHL) is a type of idiopathic sudden sensorineural hearing loss. ALHL is rarely a solitary condition but rather co-occurs with vertigo and tinnitus, being an element of contemporary diagnostic criteria for Menière's disease (MD). The goal of our present study was to determine the value of ALHL for the early diagnosis of MD in patients presenting in the emergency room with ALHL as a main complaint. The files of 106 patients with ALHL who were admitted to the emergency room over the period of 7 years and 104 patients with acute high- tone sensorineural hearing loss (AHHL) from the same period were included in this retrospective study. Forty ALHL patients presented with recurrent episode of hearing loss and 66 remaining patients presented with ALHL for the first time. Of the latter group, 25 patients gave consent for the follow-up. First, we analyzed the difference in the occurrence of tinnitus and vertigo between the ALHL and AHHL groups. In patients with ALHL, the incidence of vertigo with tinnitus and the number of recurrent episodes were statistically higher than in patients with AHHL. Next, we focused on the ALHL follow-up group (25 patients). In that group, two patients had all MD symptoms at presentation, 18 had ALHL and tinnitus and five ALHL only. Of 18 patients with ALHL and tinnitus at admission, five developed vertigo and thus the triad of Menière's disease. None of the five patients with AHLH as a sole symptom developed MD during the follow-up time but four of them have developed tinnitus. Patients with recurrent ALHL had significantly higher incidence of MD than the patients with first episode. We conclude that some patients who present with ALHL and concomitant tinnitus or have recurrent episodes of ALHL are more likely to develop Menière's disease than these patients, who present with ALHL as a sole symptom. Nonetheless, we recommend otological follow-up for all patients presenting with ALHL.
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Affiliation(s)
- Katharina Stölzel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Judith Droste
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Linda Josephine Voß
- Department of Audiology and Phoniatrics, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Agnieszka J Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Sequential Imaging in Patient With Suspected Menière's Disease Identifies Endolymphatic Sac Tumor. Otol Neurotol 2018; 39:e856-e859. [DOI: 10.1097/mao.0000000000001952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Ménière's disease (MD) represents a heterogeneous group of relatively rare disorders with three core symptoms: episodic vertigo, tinnitus, and sensorineural hearing loss involving 125 to 2,000 Hz frequencies. The majority of cases are considered sporadic, although familial aggregation has been recognized in European and Korean populations, and the search for familial MD genes has been elusive until the last few years. Detailed phenotyping and cluster analyses have found several clinical predictors for different subgroups of patients, which may indicate different mechanisms, including genetic and immune factors. The genes associated with familial MD are COCH, FAM136A, DTNA, PRKCB, SEMA3D, and DPT. At least two mechanisms have been involved in MD: (a) a pro-inflammatory immune response mediated by interleukin-1 beta (IL-1β), tumor necrosis factor alpha (TNFα), and IL-6, and (b) a nuclear factor-kappa B (NF-κB)-mediated inflammation in the carriers of the single-nucleotide variant rs4947296. It is conceivable that microbial antigens trigger inflammation with release of pro-inflammatory cytokines at different sites within the cochlea, such as the endolymphatic sac, the stria vascularis, or the spiral ligament, leading to fluid imbalance with an accumulation of endolymph. Computational integration of clinical and "omics" data eventually should transform the management of MD from "one pill fits all" to precise patient stratification and a personalized approach. This article lays out a proposal for an algorithm for the genetic diagnosis of MD. This approach will facilitate the identification of new molecular targets for individualized treatment, including immunosuppressant and gene therapy, in the near future.
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Affiliation(s)
- Jose Antonio Lopez-Escamez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, Centro de Genómica e Investigación Oncológica, Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Department of Otolaryngology, Instituto de Investigación Biosanitaria, ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Granada, Spain
| | | | - Alexandre Bisdorff
- Clinique du Vertige, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
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Nevoux J, Barbara M, Dornhoffer J, Gibson W, Kitahara T, Darrouzet V. International consensus (ICON) on treatment of Ménière's disease. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S29-S32. [PMID: 29338942 DOI: 10.1016/j.anorl.2017.12.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/07/2017] [Accepted: 12/12/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To present the international consensus for recommendations for Ménière's disease (MD) treatment. METHODS Based on a literature review and report of 4 experts from 4 continents, the recommendations have been presented during the 21st IFOS congress in Paris, in June 2017 and are presented in this work. RESULTS The recommendation is to change the lifestyle, to use the vestibular rehabilitation in the intercritic period and to propose psychotherapy. As a conservative medical treatment of first line, the authors recommend to use diuretics and Betahistine or local pressure therapy. When medical treatment fails, the recommendation is to use a second line treatment, which consists in the intratympanic injection of steroids. Then as a third line treatment, depending on the hearing function, could be either the endolymphatic sac surgery (when hearing is worth being preserved) or the intratympanic injection of gentamicin (with higher risks of hearing loss). The very last option is the destructive surgical treatment labyrinthectomy, associated or not to cochlear implantation or vestibular nerve section (when hearing is worth being preserved), which is the most frequent option.
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Affiliation(s)
- J Nevoux
- Department of otology and neurotology, CHU de Bicetre, AP-HP, 94270 Le Kremlin-Bicêtre, France; Saclay university, Paris-Sud Medical School, 94270 Le Kremlin-Bicêtre, France.
| | - M Barbara
- Department of otology and neurotology, Sapienza university, Rome, Italy
| | - J Dornhoffer
- Department of otolaryngology, head and neck surgery, university of Arkansas for medical sciences and Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - W Gibson
- Department of otolaryngology, head and neck surgery, university of Sidney, Australia
| | - T Kitahara
- Department of otolaryngology, Nara medical university, Japan
| | - V Darrouzet
- Department of otolaryngology, Skull Base Surgery, CHU de Bordeaux, université de Bordeaux, 33000 Bordeaux, France
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