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Ueno Y, Imai T, Higashi-Shingai K, Ohta Y, Sato T, Kamakura T, Ozono Y, Inohara H. Stratification of patients with Menière's disease based on eye movement videos recorded from the beginning of vertigo attacks and contrast-enhanced MRI findings. Front Neurol 2024; 14:1348177. [PMID: 38274876 PMCID: PMC10809283 DOI: 10.3389/fneur.2023.1348177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Purpose Diagnosis of Menière's disease (MD) relies on subjective factors and the patients diagnosed with MD may have heterogeneous pathophysiologies. This study aims to stratify MD patients using two objective data, nystagmus videos and contrast-enhanced magnetic resonance imaging (CE-MRI). Methods This is a retrospective cross-sectional study. According to the Japan Society for Equilibrium Research criteria (c-JSER), adults diagnosed with definite MD and who obtained videos recorded by portable nystagmus recorder immediately following vertigo attacks and underwent CE-MRI of the inner ear were included (ss = 91). Patients who obtained no nystagmus videos, who had undergone sac surgery, and those with long examination intervals were excluded (n = 40). Results The gender of the subjects was 22 males and 29 females. The age range was 20-82 y, with a median of 54 y. Endolymphatic hydrops (EH) were observed on CE-MRI in 84% (43 patients). Thirty-one patients had unilateral EH. All of them demonstrated EH on the side of the presence of cochlear symptoms. The number of patients who had both nystagmus and EH was 38. Five patients only showed EH and 5 patients only exhibited nystagmus, while 3 patients did not have either. Of the 43 nystagmus records, 32 showed irritative nystagmus immediately after the vertigo episode. The direction of nystagmus later reversed in 44% of cases over 24 h. Conclusion Patients were stratified into subgroups based on the presence or absence of EH and nystagmus. The side with cochlear symptoms was consistent with EH. The c-JSER allows for the diagnosis of early-stage MD patients, and it can be used to treat early MD and preserve hearing; however, this approach may also include patients with different pathologies.
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Affiliation(s)
- Yuya Ueno
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takao Imai
- Department of Otorhinolaryngology and Head and Neck Surgery, Bellland General Hospital, Osaka, Japan
| | - Kayoko Higashi-Shingai
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takefumi Kamakura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiyuki Ozono
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Thomas L, Lepcha A, Reka K, Augustine AM, Alex A, Philip A, Mammen MD. Comparing Intratympanic Gentamicin with Methylprednisolone in Meniere's Disease with Non-Serviceable Hearing. Indian J Otolaryngol Head Neck Surg 2022; 74:3738-3745. [PMID: 36742746 PMCID: PMC9895489 DOI: 10.1007/s12070-021-02528-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
Abstract To compare the effectiveness of high dose fixed alternate day intratympanic gentamicin with methylprednisolone in the treatment of patients with unilateral, intractable Meniere's disease with poor hearing. Randomized single blind prospective parallel group trial in a tertiary referral centre. Twenty-two patients with definite unilateral Meniere's disease with average pure tone thresholds worse than 50 dB in the affected ear were enrolled. Eleven patients were treated with intratympanic buffered gentamicin and the other eleven were administered intratympanic methylprednisolone (both 4 injections, 40 mg/ml, on alternate days). Patients were assessed pre-intervention, 3 months post intervention and subsequently followed up for 2-4 years. Both groups of patients had significant control of vertigo, DHI scores and THI scores after treatment while the functional scores in the methylprednisolone group was not better than the pre- treatment scores in the long-term follow-up. 9 of 11(82%) patients in gentamicin group and 3 of 11(27%) patients in the methylprednisolone group achieved Class A vertigo control. The gentamicin group had better post intervention DHI scores (p = 0.016, 3 months and p = 0.046, long term) and Functional score (p = 0.014, 3 months and p = 0.05, long term). The hearing in both groups and THI scores, post intervention was similar between both groups. In patients with unilateral intractable MD with non-serviceable hearing, high fixed doses of both intratympanic gentamicin and methylprednisolone are effective in alleviating disease symptoms in long term follow-up. However, intratympanic gentamicin resulted in better control of vertigo, total DHI score and functional level scores than intratympanic methylprednisolone with no significant difference in hearing levels. Trail Registration Number Clinical Trials Registry of India (CTRI- REF/2016/10/012363).
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Affiliation(s)
- Leah Thomas
- Christian Medical College Vellore, Chittoor Campus, Chittoor, Andhra Pradesh India
| | - Anjali Lepcha
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - K. Reka
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu 632 002 India
| | - Ann Mary Augustine
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Anu Alex
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Ajay Philip
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Manju Deena Mammen
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
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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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Ng B, Crowson MG, Lin V. Management of sudden sensorineural hearing loss among primary care physicians in Canada: a survey study. J Otolaryngol Head Neck Surg 2021; 50:22. [PMID: 33795010 PMCID: PMC8015047 DOI: 10.1186/s40463-021-00498-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/17/2021] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Sudden Sensorineural Hearing Loss (SSNHL) is a medical emergency requiring immediate attention as delayed treatment can lead to permanent and devastating consequences. Primary care physicians are likely the first to be presented with SSNHL and therefore have the crucial role of recognizing it and initiating timely and appropriate management. The aim of this study was to gain insight into the current knowledge and practice trends pertaining to the diagnosis and management of SSNHL among family physicians in Canada. METHODS An 18-question survey targeting Canadian family physicians was marketed through two, physician-only discussion groups on the social media platform Facebook. Responses were collected between August 1st and December 22nd 2019 then aggregated and quantified. RESULTS 52 family physicians submitted responses. 94.2% (n = 49) reported that in their practice, unilateral SSNHL warrants urgent referral to otolaryngology and 84.6% (n = 44) reported that unilateral sudden-onset hearing loss warrants urgent referral for audiological testing. 73.1% of participants (n = 38) reported that they would attempt to differentiate between conductive and sensorineural hearing loss if presented with unilateral, acute or sudden-onset hearing loss. 61.5% (n = 32) would rely on tuning fork tests to inform management decisions, as compared to 94.2% (n = 49) relying on case history and 88.5% (n = 46) on otoscopy. 76.9% (n = 40) would prescribe corticosteroids if presented with confirmed, unilateral SSNHL. CONCLUSION The majority of family physicians in the study would make appropriate referral and treatment decisions in the management of SSNHL, understanding it is a medical emergency. Tuning fork tests are under-utilized for informing management decisions compared to other means of differentiating conductive and sensorineural hearing loss. Further research is needed to understand why some family physicians do not prescribe corticosteroids for treatment of SSNHL, which may then identify any gaps in knowledge or inform improvements in clinical protocol.
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Affiliation(s)
- Benjamin Ng
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
| | - Matthew G Crowson
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Vincent Lin
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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Bakhshaee M, Moradi S, Mohebi M, Ghayour-Mobarhan M, Sharifan P, Yousefi R, Rezaei A, Rajati M. Association Between Serum Vitamin D Level and Ménière's Disease. Otolaryngol Head Neck Surg 2021; 166:146-150. [PMID: 33755501 DOI: 10.1177/01945998211000395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Ménière's disease (MD) is a well-known inner ear disease; however, the etiopathogenesis is unknown. Several factors may be involved. Meanwhile, vitamin D is reported to have an important role in inner ear physiology. The aim of this study is to evaluate the relation between vitamin D deficiency and MD. STUDY DESIGN This matched case-control study compared serum vitamin D levels between patients with definite MD and those without it. SETTING The study was done between August 2018 and December 2019 at Ghaem University Hospital in Mashhad, Iran. METHODS Twenty-eight patients with definite MD were matched with a group of 84 healthy individuals, regarding age, sex, body mass index, and occupation (indoor vs outdoor). The serum level of vitamin D (25-hydroxyvitamin D3) was measured in both groups. RESULTS The mean ± SD vitamin D level was 18.9 ± 9.7 ng/mL in the case group and 25.2 ± 13.7 ng/mL in the control group (P = .027). There was a significant difference between the case and control groups according to the results of the conditional logistic regression model (P = .03; adjusted odds ratio, 0.96). In the MD group, 17 (60.7%) patients were vitamin D deficient, 6 (21.4%) insufficient, and only 5 (17.9%) sufficient. CONCLUSIONS The results of this study show that serum vitamin D level in MD is significantly lower than that of the control group. However, the role of vitamin D supplementation in the management of MD needs further study. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Mehdi Bakhshaee
- Sinus and Surgical Endoscopic Research Center, Department of Otorhinolaryngology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Susan Moradi
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Mohebi
- Metabolic Syndrome Research Center School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Iranian UNESCO Centre of Excellence for Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Payam Sharifan
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Razieh Yousefi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Rezaei
- Islamic Azad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Rajati
- Ghaem University Hospital, Sinus and Surgical Endoscopic Research Center, Department of Otorhinolaryngology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Sarna B, Abouzari M, Lin HW, Djalilian HR. A hypothetical proposal for association between migraine and Meniere's disease. Med Hypotheses 2019; 134:109430. [PMID: 31629154 DOI: 10.1016/j.mehy.2019.109430] [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: 09/11/2019] [Revised: 10/01/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Abstract
Meniere's disease (MD) is a chronic condition affecting the inner ear whose precise etiology is currently unknown. We propose the hypothesis that MD is a migraine-related phenomenon which may have implications for future treatment options for both diseases. The association between MD and migraine is both an epidemiological and a mechanistic one, with up to 51% of individuals with MD experiencing migraine compared to 12% in the general population. The presence of endolymphatic hydrops in those with MD may be the factor that unites the two conditions, as hydropic inner ears have an impaired ability to maintain homeostasis. Migraine headaches are theorized to cause aura and symptoms via spreading cortical depression that ultimately results in substance P release, alterations in blood flow, and neurogenic inflammation. Chronically hydropic inner ears are less able to auto-regulate against the changes induced by active migraine attacks and may ultimately manifest as MD. This same vulnerability to derangements in homeostasis may also explain the common triggering factors of both MD attacks and migraine headaches, including stress, weather, and diet. Similarly, it may explain the efficacy of common treatments for both diseases: current migraine treatments such as anti-hypertensives and anti-convulsants have shown promise in managing MD. Though the etiology of both MD and migraine is likely multifactorial, further exploration of the association between the two conditions may illuminate how to best manage them in the future. MD is likely a manifestation of cochleovestibular migraine, which occurs as a result of migraine related changes in both the cochlea and vestibule.
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Affiliation(s)
- Brooke Sarna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA; Division of Pediatric Otolaryngology, Children's Hospital of Orange County, Orange, USA
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA; Department of Biomedical Engineering, University of California, Irvine, USA.
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Liu H, Zhou K, Zhang X, Peng KA. Fluctuating Sensorineural Hearing Loss. Audiol Neurootol 2019; 24:109-116. [PMID: 31315108 DOI: 10.1159/000500658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/29/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several otologic conditions can present with fluctuating sensorineural hearing loss, including Ménière's disease, autoimmune inner ear disease, and enlarged vestibular aqueduct. Although these 3 etiologies vary greatly, distinguishing between these conditions at initial presentation can be challenging. Furthermore, initial treatment of these conditions is often similar. In this review, we discuss historical and current perspectives on diagnosis and treatment of these conditions. SUMMARY A literature search was performed regarding fluctuating hearing loss, and current treatment of these etiologies of fluctuating hearing loss was summarized. Immediate measures at the onset of acute hearing loss include corticosteroid therapy, while preventative and chronic therapies, which can limit disease severity and frequency, vary based on the specific condition treated. Key Messages: Fluctuating hearing loss can represent a range of pathologies, but the precise etiology may not be clear at initial presentation. Timely treatment and long-term follow-up, along with appropriate diagnostics, are necessary to optimize long-term hearing.
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Affiliation(s)
- Hui Liu
- First Hospital of Shijiazhuang City, Shijiazhuang City, China,
| | - Kunpeng Zhou
- First Hospital of Shijiazhuang City, Shijiazhuang City, China
| | - Xuemei Zhang
- First Hospital of Shijiazhuang City, Shijiazhuang City, China
| | - Kevin A Peng
- House Clinic and House Ear Institute, Los Angeles, California, USA
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Xia P, Zhang SR, Zhou ZJ, Shao YQ, Hu XY. Benign paroxysmal positional vertigo in spontaneous intracranial hypotension. Neurol Res 2018; 40:868-873. [PMID: 30052143 DOI: 10.1080/01616412.2018.1495883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To assess the prevalence and related factors of benign paroxysmal positional vertigo (BPPV) in patients with spontaneous intracranial hypotension (SIH). METHODS We retrospectively reviewed 156 consecutive inpatients with SIH, and collected the clinical and radiological data. These patients were divided into BPPV group and non-BPPV group according to the clinical manifestation and the results of Dix-Hallpike or supine roll tests during hospitalization period. We performed a univariate analysis and a further multiple logistic regression analysis to identify the related factors of the development of BPPV in SIH patients. RESULTS BPPV was detected in 18 patients among the total 156 SIH patients (11.54%). The univariate analysis showed a low cerebrospinal fluid (CSF) pressure (P = 0.018), a small pontomesencephalic angle (P = 0.012) and a positive venous distension sign (VDS) (P = 0.045) were associated with the presence of BPPV. But the multivariate analysis only demonstrated a low CSF pressure was related to the presence of BPPV (OR = 1.022, 95% CI: 1.001-1.043, P = 0.044). CONCLUSION BPPV is common in SIH patients. SIH patients with low CSF pressure may be prone to develop BPPV.
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Affiliation(s)
- Ping Xia
- a Department of Neurology , Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University , Hangzhou , China
| | - Si-Ran Zhang
- b Department of Neurology , Zhejiang Hospital , Hangzhou , China
| | - Zhi-Jie Zhou
- c Department of Orthopaedic Surgery , Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University , Hangzhou , China
| | - Yu-Quan Shao
- a Department of Neurology , Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University , Hangzhou , China
| | - Xing-Yue Hu
- a Department of Neurology , Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University , Hangzhou , China
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Edlow JA, Gurley KL, Newman-Toker DE. A New Diagnostic Approach to the Adult Patient with Acute Dizziness. J Emerg Med 2018; 54:469-483. [PMID: 29395695 PMCID: PMC6049818 DOI: 10.1016/j.jemermed.2017.12.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/21/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dizziness, a common chief complaint, has an extensive differential diagnosis that includes both benign and serious conditions. Emergency physicians must distinguish the majority of patients with self-limiting conditions from those with serious illnesses that require acute treatment. OBJECTIVE OF THE REVIEW This article presents a new approach to diagnosis of the acutely dizzy patient that emphasizes different aspects of the history to guide a focused physical examination with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes in the emergency department. DISCUSSION Currently, misdiagnoses are frequent and diagnostic testing costs are high. This relates in part to use of an outdated, prevalent, diagnostic paradigm. The traditional approach, which relies on dizziness symptom quality or type (i.e., vertigo, presyncope, or disequilibrium) to guide inquiry, does not distinguish benign from dangerous causes, and is inconsistent with current best evidence. A new approach divides patients into three key categories using timing and triggers, guiding a differential diagnosis and targeted bedside examination protocol: 1) acute vestibular syndrome, where bedside physical examination differentiates vestibular neuritis from stroke; 2) spontaneous episodic vestibular syndrome, where associated symptoms help differentiate vestibular migraine from transient ischemic attack; and 3) triggered episodic vestibular syndrome, where the Dix-Hallpike and supine roll test help differentiate benign paroxysmal positional vertigo from posterior fossa structural lesions. CONCLUSIONS The timing and triggers diagnostic approach for the acutely dizzy patient derives from current best evidence and offers the potential to reduce misdiagnosis while simultaneously decreases diagnostic test overuse, unnecessary hospitalization, and incorrect treatments.
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Affiliation(s)
- Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kiersten L Gurley
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Mount Auburn Hospital, Cambridge, Massachusetts
| | - David E Newman-Toker
- Division of Neuro-Visual and Vestibular Disorders, Department of Neurology, Otolaryngology, and Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Piper TJ, Paulsen TD, Black L, Brees TN, Schulte JJ. Meniere's Disease: An Overview and Training Considerations. Strength Cond J 2017. [DOI: 10.1519/ssc.0000000000000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
OBJECTIVES 1) To evaluate the long-term (≥10 year) clinical incidence of endolymphatic hydrops (EH) after stapedectomy for otosclerosis, using low-frequency sensorineural hearing loss (LFSNHL) as a marker for EH. 2) To determine the histologic incidence of EH in human temporal bone specimens (TBS) with a history of stapedectomy for otosclerosis. 3) To determine the histologic incidence of EH in a control group of human TBS. STUDY DESIGN Retrospective review and temporal bone study. SETTING Tertiary medical center and temporal bone pathology laboratory. PATIENTS Patients with otosclerosis, human TBS with otosclerosis, and human TBS with presbycusis as the control group. INTERVENTION Pure-tone audiometry, temporal bone pathology. MAIN OUTCOME MEASURES 1) LFSNHL, defined as >10 decibel elevation of bone conduction thresholds at 250 and 500 Hz, after correcting for age-related hearing loss (per ISO 7029). 2) Histologic assessment of EH. RESULTS In patients with otosclerosis, 8 of 110 (7.3%) operated patients versus 3 of 123 (2.4%) nonoperated patients developed LFSNHL (p = 0.08). No patients with LFSNHL had other symptoms of EH. In TBS with otosclerosis, 11 of 93 (11.8%) operated TBS versus 3 of 156 (1.9%) nonoperated TBS had evidence of EH (p <0.001). In the control group of TBS with presbycusis, 9 of 253 (3.5%) had EH. CONCLUSION The long-term incidence of LFSNHL, a marker for EH, in patients with otosclerosis was not significantly higher in those who underwent stapedectomy. The histologic incidence of EH, however, was significantly higher in TBS that had undergone stapedectomy compared with nonoperated TBS or a control group of TBS.
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MORENO-BRAVO A, SÁNCHEZ-GÓMEZ H, AGUILERA-AGUILERA GA, GONZÁLEZ-SÁNCHEZ M, SANTA CRUZ-RUIZ S, BATUECAS-CALETRÍO Á. Implante coclear en enfermedad de Ménière bilateral. Descripción de un caso. REVISTA ORL 2017. [DOI: 10.14201/orl201674.14699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Canzi P, Manfrin M, Perotti M, Aprile F, Quaglieri S, Rebecchi E, Locatelli G, Benazzo M. Translabyrinthine vestibular neurectomy and simultaneous cochlear implant for Ménière's disease. Acta Neurochir (Wien) 2017; 159:123-130. [PMID: 27812817 DOI: 10.1007/s00701-016-2996-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgical management of Ménière's disease (MD) is recommended in case of medical and intratympanic treatment failures. Translabyrinthine vestibular nerve section has been considered the gold standard for denervation procedures in order to control vertigo attacks, although at the cost of sacrificing residual hearing. To the best of our knowledge, no work has been published with regard to a group of patients submitted to translabyrinthine vestibular neurectomy and simultaneous cochlear implant for MD. The aim of the present study was to assess the effectiveness of translabyrinthine vestibular nerve section and simultaneous cochlear implant in a prospective study. METHODS All adult patients (over 18 years of age) with a diagnosis of intractable unilateral definite MD and useless residual hearing function were enrolled after medical and intratympanic treatment failures. Pre- and postoperative otoneurological evaluation concerned: frequency of vertigo attacks, head impulse test and caloric testing, pure tone average and speech perception audiometry in quiet conditions, tinnitus handicap inventory test, functional level scale and rate of vertigo control, dizziness handicap inventory test, and MD patient-oriented severity index. At least 6 months of follow-up were needed to be enrolled in the study. RESULTS Four patients were included in the study. Translabyrinthine vestibular nerve section and simultaneous cochlear implant seemed to considerably improve the disabling effects of MD, achieving a good control of vestibular symptoms (mean pre/postoperative vertigo attacks per month: 16.5/0), resolving hearing loss (mean pre/postoperative pure tone average in the affected ear: 86.2/32.5 dB), improving the tinnitus (mean pre/postoperative tinnitus handicap inventory test: 77.2/6), and finally increasing the overall quality-of-life parameters. CONCLUSIONS In our preliminary report, translabyrinthine vestibular nerve section and simultaneous cochlear implant showed encouraging results in order to definitively control both vestibular and cochlear symptoms during the same therapeutic procedure.
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Li YJ, Jin ZG, Xu XR. Variants in the KCNE1 or KCNE3 gene and risk of Ménière's disease: A meta-analysis. J Vestib Res 2016; 25:211-8. [PMID: 26890422 DOI: 10.3233/ves-160569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ménière's disease (MD) is defined as an idiopathic disorder of the inner ear characterized by the triad of tinnitus, vertigo, and sensorineural hearing loss. Although many studies have evaluated the association between variants in the KCNE1 or KCNE3 gene and MD risk, debates still exist. OBJECTIVE Our aim is to evaluate the association between KCNE gene variants, including KCNE1 rs1805127 and KCNE3 rs2270676, and the risk of MD by a systematic review. METHODS We searched the literature in PubMed, SCOPUS and EMBASE through May 2015. We calculated pooled odds ratios (OR) and 95% confidence intervals (CIs) using a fixed-effects model or a random-effects model for the risk to MD associated with different KCNE gene variants. The heterogeneity assumption decided the effect model. RESULTS A total of three relevant studies, with 302 MD cases and 515 controls, were included in this meta-analysis. The results indicated that neither the KCNE1 rs1805127 variant (for G vs. A: OR = 0.724, 95%CI 0.320, 1.638, P= 0.438), nor the KCNE3 rs2270676 variant (for T vs. C: OR = 0.714, 95%CI 0.327, 1.559, P = 0.398) was associated with MD risk. CONCLUSIONS Based on current evidence from published studies, neither of the two variants from KCNE was significantly associated with the risk of MD. Larger studies with mixed ethnicity subjects and stratified by clinical and sub-clinical characteristics are needed to validate our findings.
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Changes in endolymphatic hydrops visualized by magnetic resonance imaging after sac surgery. ACTA ACUST UNITED AC 2016; 36:736-740. [DOI: 10.1007/s11596-016-1654-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/06/2016] [Indexed: 10/20/2022]
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Abstract
Dizziness is a common chief complaint in emergency medicine. The differential diagnosis is broad and includes serious conditions, such as stroke, cardiac arrhythmia, hypovolemic states, and acute toxic and metabolic disturbances. Emergency physicians must distinguish the majority of patients who suffer from benign self-limiting conditions from those with serious illnesses that require acute treatment. Misdiagnoses are frequent and diagnostic test costs high. The traditional approach does not distinguish benign from dangerous causes and is not consistent with best current evidence. This article presents a new approach to the diagnosis of acutely dizzy patients that highly leverages the history and the physical examination.
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Moshtaghi O, Sahyouni R, Lin HW, Ghavami Y, Djalilian HR. A Historical Recount: Discovering Menière's Disease and Its Association With Migraine Headaches. Otol Neurotol 2016; 37:1199-203. [PMID: 27362737 PMCID: PMC5854155 DOI: 10.1097/mao.0000000000001122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES In evaluating the historical context of the first description of Menière's disease, its association with migraine headaches is compelling. We have outlined the events and observations of Prosper Menière, which led him to establish a link between migraine headaches and his eponymous disease. STUDY DESIGN Prosper Menière's original French writings were translated by our group and used to recount his observations and thoughts. Miles Atkinson's English translations were used as a reference. Additional otological texts of the era were also reviewed as it relates to Menière's disease. METHODS Prosper Menière wrote a series of four articles 1 year before his death. In one of these articles, he makes references to migraine headaches on several occasions. These original writings were analyzed, and the physical findings he described were interpreted based on their relation to migraine headaches. RESULTS The passages in his published articles provide historical insight into Menière's observations. His writings describe in detail symptoms of migraine headaches uniquely evident in his patient population. Through his observations, he recognized that in addition to exhibiting symptoms of tinnitus, hearing loss and vertigo his patients also suffered from migraine headaches. CONCLUSIONS Although his colleagues discounted Menière's theory concerning migraine headaches, he continued to make deductive inferences and publish his findings, leading to the association of migraine headaches and Menière's disease. Today, this association continues to be debated, adding to Prosper Menière's legacy.
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Affiliation(s)
- Omid Moshtaghi
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - Ronald Sahyouni
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - Harrison W. Lin
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - Yaser Ghavami
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R. Djalilian
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
- Department of Biomedical Engineering, University of California, Irvine, USA
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Martín-Sierra C, Requena T, Frejo L, Price SD, Gallego-Martinez A, Batuecas-Caletrio A, Santos-Pérez S, Soto-Varela A, Lysakowski A, Lopez-Escamez JA. A novel missense variant in PRKCB segregates low-frequency hearing loss in an autosomal dominant family with Meniere's disease. Hum Mol Genet 2016; 25:3407-3415. [PMID: 27329761 DOI: 10.1093/hmg/ddw183] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 12/13/2022] Open
Abstract
Meniere's Disease (MD) is a complex disorder associated with an accumulation of endolymph in the membranous labyrinth in the inner ear. It is characterized by recurrent attacks of spontaneous vertigo associated with sensorineural hearing loss (SNHL) and tinnitus. The SNHL usually starts at low and medium frequencies with a variable progression to high frequencies. We identified a novel missense variant in the PRKCB gene in a Spanish family with MD segregating low-to-middle frequency SNHL. Confocal imaging showed strong PKCB II protein labelling in non-sensory cells, the tectal cells and inner border cells of the rat organ of Corti with a tonotopic expression gradient. The PKCB II signal was more pronounced in the apical turn of the cochlea when compared with the middle and basal turns. It was also much higher in cochlear tissue than in vestibular tissue. Taken together, our findings identify PRKCB gene as a novel candidate gene for familial MD and its expression gradient in supporting cells of the organ of Corti deserves attention, given the role of supporting cells in K+ recycling within the endolymph, and its apical turn location may explain the onset of hearing loss at low frequencies in MD.
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Affiliation(s)
- Carmen Martín-Sierra
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta de Andalucía, PTS, Granada 18016, Spain
| | - Teresa Requena
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta de Andalucía, PTS, Granada 18016, Spain
| | - Lidia Frejo
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta de Andalucía, PTS, Granada 18016, Spain
| | - Steven D Price
- Dept. of Anatomy and Cell Biology, Univ. of Illinois at Chicago, Chicago, IL 60612, USA
| | - Alvaro Gallego-Martinez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta de Andalucía, PTS, Granada 18016, Spain
| | | | - Sofía Santos-Pérez
- Division of Otoneurology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela 15706, Spain
| | - Andrés Soto-Varela
- Division of Otoneurology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela 15706, Spain
| | - Anna Lysakowski
- Dept. of Anatomy and Cell Biology, Univ. of Illinois at Chicago, Chicago, IL 60612, USA.,Dept. of Otolaryngology-Head and Neck Surgery, Univ. of Illinois at Chicago, Chicago IL 60612, USA
| | - Jose A Lopez-Escamez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta de Andalucía, PTS, Granada 18016, Spain .,Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitalario Universidad de Granada (CHUGRA) Granada 18016, Spain
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Newman-Toker DE, Edlow JA. TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo. Neurol Clin 2016; 33:577-99, viii. [PMID: 26231273 DOI: 10.1016/j.ncl.2015.04.011] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Diagnosing dizziness can be challenging, and the consequences of missing dangerous causes, such as stroke, can be substantial. Most physicians use a diagnostic paradigm developed more than 40 years ago that focuses on the type of dizziness, but this approach is flawed. This article proposes a new paradigm based on symptom timing, triggers, and targeted bedside eye examinations (TiTrATE). Patients fall into 1 of 4 major syndrome categories, each with its own differential diagnosis and set of targeted examination techniques that help make a specific diagnosis. Following an evidence-based approach could help reduce the frequency of misdiagnosis of serious causes of dizziness. In the spirit of the flipped classroom, the editors of this Neurologic Clinics issue on emergency neuro-otology have assembled a collection of unknown cases to be accessed electronically in multimedia format. By design, cases are not linked with specific articles, to avoid untoward cueing effects for the learner. The cases are real and are meant to demonstrate and reinforce lessons provided in this and subsequent articles. In addition to pertinent elements of medical history, cases include videos of key examination findings.
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Affiliation(s)
- David E Newman-Toker
- Johns Hopkins Hospital, CRB-II, Room 2M-03 North, 1550 Orleans Street, Baltimore, MD 21231, USA.
| | - Jonathan A Edlow
- Department of Emergency Medicine Administrative Offices, Beth Israel Deaconess Medical Center, West CC-2, 1 Deaconess Place, Boston, MA 02215, USA
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Alicandri-Ciufelli M, Aggazzotti-Cavazza E, Cunsolo E, Marchioni D, Monzani D, Genovese E, Presutti L. Is Ménière’s disease the ‘inner ear migraine’? A neurovascular region-based hypothesis supported by epidemiological appraisal and pathophysiological considerations. HEARING BALANCE AND COMMUNICATION 2016. [DOI: 10.3109/21695717.2016.1132938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Relationship between hearing threshold at the affected and unaffected ear in unilateral Meniere’s disease. Eur Arch Otorhinolaryngol 2015; 273:51-6. [DOI: 10.1007/s00405-014-3466-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/19/2014] [Indexed: 10/24/2022]
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Abstract
OBJECTIVE A significant portion of the Ménière's disease (MD) population will ultimately have severe-to-profound hearing loss in their affected ear. When this occurs bilaterally or when a patient has poor hearing in the contralateral ear, these patients may meet criteria for cochlear implantation (CI). Here, we describe our institution's CI outcomes in MD patients. STUDY DESIGN Retrospective chart and literature review. SETTING Tertiary referral center. PATIENTS Twenty-one patients with either bilateral MD or unilateral MD who underwent CI in their ear affected with MD. INTERVENTION(S) Cochlear implantation. MAIN OUTCOME MEASURE(S) Postoperative speech perception. RESULTS Results for the MD patients were also compared with a standard sample of 178 adult recipients implanted with newest generation technology. Collapsing across status of MD activity, there was a significant difference between the MD CNC word recognition scores and that of the standard sample (43.2 versus 59.1%, p = 0.02). When separating the MD patients into groups according to the status of disease activity, those with active MD achieved scores that were not significantly different from the standard sample (55.7 versus 59.1%, p = 0.94), although those without active MD were significantly different from the standard group (38.2 versus, p = 0.002). Patients undergoing surgical or ablative procedures for their MD symptoms had statistically significant improvement in their CI hearing outcomes compared with those who did not (CNC words: p = 0.014; CNC phonemes: p = 0.035). Six patients had persistent vertiginous symptoms of MD before CI. After CI, 2 had complete resolution of vertigo, 3 had subjective improvement in their symptoms, and 1 noticed no change. CONCLUSION Ménière's disease patients' hearing outcomes seem to be worse than the general CI population. However, those with active MD perform similarly to the general CI population.
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Yazdani N, Mojbafan M, Taleba M, Amiri P, Nejadian F, Ashtiani MK, Amoli MM. Sex-specific association of RANTES gene -403 variant in Meniere's disease. Eur Arch Otorhinolaryngol 2014; 272:2221-5. [PMID: 24961438 DOI: 10.1007/s00405-014-3151-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 06/11/2014] [Indexed: 11/28/2022]
Abstract
Several studies have shown the correlation between RANTES gene and inflammatory disorders; the aim of the present study was to investigate the association between RANTES promoter gene polymorphism and Meniere's disease (MD) in an Iranian population. In this study patients with MD comprising definite MD (N = 56) and probable MD (N = 15) were selected according to diagnostic criteria of AAO-HNS. The control group (N = 101) were healthy normal subjects who did not have a history of ear disease and vertigo. PCR-RFLP for RANTES -403G>A has been performed. We found a protective role for RANTES -403A allele in male group in our population. None of the male patients with MD were carrier of allele A which was significantly different from the presence of allele A in the male control group (AA+GA vs. GG: p = 0.0004, OR 0.05, 95 % CI 0.001-0.39). This difference was not significant in female group. There was no significant association between RANTES gene polymorphism and the level of hearing loss. our results showed a sex-specific association between RANTES gene polymorphism and MD but more studies are necessary to further assess this association.
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Affiliation(s)
- Nasrin Yazdani
- Otorhinolaryngology Research Center, Amir-Alam Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Martín-Sanz E, Esteban Sánchez J, González Juliao M, Zschaeck Luzardo C, Mato Patino T, Rodrigañez Riesco L, Sanz Fernández R. Electrococleografía extratimpánica en la enfermedad de Ménière. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 63:421-8. [DOI: 10.1016/j.otorri.2012.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 03/25/2012] [Accepted: 03/28/2012] [Indexed: 11/26/2022]
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Arweiler-Harbeck D, Saidi F, Lang S, Peters J, Siffert W, Adamzik M. The -1364A/C Aquaporin 5 Gene Promoter Polymorphism Is Not Associated with Menière's Disease. ISRN OTOLARYNGOLOGY 2012; 2012:706896. [PMID: 23762616 PMCID: PMC3671710 DOI: 10.5402/2012/706896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 09/03/2012] [Indexed: 11/25/2022]
Abstract
Objective. Aquaporin 5 plays an important role in maintaining inner ear water and fluid homeostasis. Since the aquaporin (AQP) 5 promoter-1364A/C polymorphism is associated with altered AQP5 expression and this could impact upon key mechanisms of Menière's disease, we tested the hypothesis that genotypes of the AQP5 promoter-1364A/C polymorphism are associated with the incidences of Menière's disease (MD), familial Menière's disease (FMD), or endolymphatic hydrops (EH). Methods. With approval of the local ethics committee, DNA of 102 patients (39 with MD, 54 with FMD, and 9 with EH) and of 292-matched Caucasian controls was isolated from blood samples and genotyped for the AQP 5 promoter-1364A/C polymorphism. The χ2-test was applied to compare genotype distributions and allele frequencies between patients and controls. Results. Overall, genotype frequencies were not different between controls (AA 69%, AC 30%, CC 1%) and patients with MD AA: 65.7% (23 MD, 37 FMD, and 8 EH); AC: 23.5% (12 MD, 11 FMD, and 1 EH); CC: 3.9% (1 MD, 3 FMD, and 0 EH). However, subgroup analysis revealed the CC genotype to be more frequent in patients with FMD (5.9%) than in healthy controls (1%) (P = 0.042).
Conclusions. Overall, genotypes of the -1364A/C AQP5 gene polymorphism are not associated with a significant increased risk for Menière's disease.
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Affiliation(s)
- Diana Arweiler-Harbeck
- Klinik für Hals-Nasen-Ohrenheilkunde, University of Duisburg-Essen, 45122 Essen, Germany
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Belinchon A, Perez-Garrigues H, Tenias JM. Evolution of symptoms in Ménière's disease. Audiol Neurootol 2011; 17:126-32. [PMID: 21985844 DOI: 10.1159/000331945] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/13/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the sequence and correlation of symptoms of Ménière's disease (MD) depending on their order of manifestation. METHODS Descriptive, longitudinal study of the symptoms in 237 tertiary hospital patients who had been diagnosed with definite MD according to the criteria of the American Academy of Otolaryngology. Patients were followed for 1-31 years. RESULTS Disease began with the three classic symptoms in only 40% of the patients. We recorded the mean, median and maximum time needed to complete the symptoms as well as the time elapsed in some patients from disease onset in one ear to bilateral involvement. CONCLUSIONS We reckon that this study may be of great help in ruling out a diagnosis of MD when the patient presents with only one or two symptoms of the triad. Furthermore, regarding the planning of treatment, the time interval between unilateral and bilateral involvement (5-7 years) is very important since bilateral involvement has great repercussions on treatment, especially surgical treatment.
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Affiliation(s)
- Antonio Belinchon
- Department of Otorhinolaryngology, Complejo Hospitalario Universitario Albacete, Albacete, Spain.
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Vassiliou A, Vlastarakos PV, Maragoudakis P, Candiloros D, Nikolopoulos TP. Meniere's disease: Still a mystery disease with difficult differential diagnosis. Ann Indian Acad Neurol 2011; 14:12-8. [PMID: 21633608 PMCID: PMC3098516 DOI: 10.4103/0972-2327.78043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 09/20/2010] [Accepted: 12/13/2010] [Indexed: 11/11/2022] Open
Abstract
One hundred and forty-six years after its first description, the differential diagnosis of Meniere’s disease remains very challenging. The aim of the present study is to review the current knowledge on the advantages and disadvantages of the new diagnostic methods for Meniere’s disease. The importance of accurate diagnosis for primary healthcare systems is also discussed. An extensive search of the literature was performed in Medline and other available database sources. Information from electronic links and related books were also included. Controlled clinical studies, prospective cohort studies, retrospective cohort studies, cross-sectional studies, case reports, written guidelines, systematic reviews, and books were selected. The typical clinical triad of symptoms from the vestibular and cochlear systems (recurrent vertigo, fluctuating sensorineural hearing loss and tinnitus) is usually the key for clinical diagnosis. Glycerol dehydration test and electrocochleography are the main diagnostic tests in current practice, while vestibular evoked myogenic potentials may be used in disease staging. Imagine techniques are not specific enough to set alone the diagnosis of Meniere’s disease, although they may be necessary to exclude other pathologies. Recently developed 3D MRI protocols can delineate the perilymphatic/endolymphatic spaces of the inner ear and aid diagnosis. Meniere’s disease is a continuous problem for the patients and affects their quality of life. Taking into account the frequent nature of the disease in certain countries, efforts for reliable diagnosis, prompt referral, and successful management are undoubtedly cost-effective for healthcare systems.
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Affiliation(s)
- A Vassiliou
- National Institute for the Deaf, Athens, Greece
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Shimizu S, Cureoglu S, Yoda S, Suzuki M, Paparella MM. Blockage of longitudinal flow in Meniere's disease: A human temporal bone study. Acta Otolaryngol 2011; 131:263-8. [PMID: 21319945 PMCID: PMC3055713 DOI: 10.3109/00016489.2010.532155] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 10/07/2010] [Indexed: 12/04/2022]
Abstract
CONCLUSION Blockage of the endolymphatic duct is a significant finding in Meniere's disease. The position of the utriculo-endolymphatic valve (UEV) and blockage of the ductus reuniens in the temporal bones were not found to be directly indicative of Meniere's disease. OBJECTIVE Comparison of blockage of the longitudinal flow of endolymph between ears affected by Meniere's disease and normal ears. METHODS We examined 21 temporal bones from 13 subjects who had Meniere's disease and 21 normal temporal bones from 12 controls. RESULTS The endolymphatic duct was blocked in five (23%) ears affected by Meniere's disease (p = 0.016). The utricular duct was blocked in 16 (76%) ears affected by Meniere's disease and 11 (52%) normal ears (p = 0.112). The saccular duct was blocked in 6 (28%) of ears affected by Meniere's disease and 16 (76%) normal ears (p = 0.001). The ductus reuniens was blocked in 10 (47%) ears affected by Meniere's disease and 10 (47%) normal ears (p = 1.000).
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Affiliation(s)
- Shigetaka Shimizu
- Department of Otolaryngology, Tokyo Medical University, Tokyo, Japan
| | | | - Shigetoshi Yoda
- Department of Otolaryngology, Kawasaki Medical School, Kurashiki, Japan
| | - Mamoru Suzuki
- Department of Otolaryngology, Tokyo Medical University, Tokyo, Japan
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Belinchon A, Perez-Garrigues H, Tenias JM, Lopez A. Hearing assessment in Menière's disease. Laryngoscope 2011; 121:622-6. [PMID: 21305548 DOI: 10.1002/lary.21335] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the level of hearing loss and the configuration of the mean audiometric curve over the course of Menière's disease, correcting the data according to patient age. STUDY DESIGN A retrospective study of 3,963 hearing tests. METHODS Descriptive, longitudinal study of pure-tone audiometries of 237 patients at a tertiary hospital who had been diagnosed with definitive Menière's disease according to the American Academy of Otorhinolaryngology criteria. All audiometric results were age-corrected, and patients were followed for 1 to 31 years. In patients who had undergone surgery, only the data collected before the operation were assessed. RESULTS In patients with unilateral disease, the mean hearing loss was characteristically low frequency, even in very advanced stages of the disease. Hearing loss was accentuated at 5 and 15 years from onset. In bilateral cases, hearing loss was slightly more severe and the average loss produced a flatter audiometric curve than in unilateral cases. CONCLUSIONS In Menière's disease, audiometry results corrected for patient age show an inherent upward-sloping configuration of the mean audiometric curve at all time points during the disease. The hearing pattern differs between unilateral and bilateral disease. The audiometric curve configuration may be an indicator of future bilateral disease.
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Affiliation(s)
- Antonio Belinchon
- Department of Otorhinolaryngology, Complejo Hospitalario Universitario Albacete, Albacete, Spain.
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Abstract
Menière disease usually begins in adults from 20 to 60 years old, and occurs in more than 10% of patients older than 65. The treatment of Menière disease in the elderly represents a challenge because of polymedication. Antivertiginous drugs such as betahistine and cinnarizin give good results with minor secondary effects. In contrast, major vestibular suppressor drugs such as thiethylperazin must be avoided as long-term treatment because of their side effects. Definitive vestibular surgical deafferentations such as labyrinthectomy and selective vestibular neurectomy represent optional procedures but must be carefully evaluated from case to case. Ablative procedures remain the efficient treatment of drop attacks, which represent a high potential risk of severe injuries by older patients sometimes with important social consequences.
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Affiliation(s)
- Dominique Vibert
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University of Berne, 3010 Berne, Switzerland.
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Emary PC. Chiropractic management of a 40-year-old female patient with Ménière disease. J Chiropr Med 2010; 9:22-7. [PMID: 21629395 PMCID: PMC3081245 DOI: 10.1016/j.jcm.2009.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 09/21/2009] [Accepted: 10/02/2009] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe the chiropractic management of a patient with Ménière disease. CLINICAL FEATURES A 40-year-old woman presented with a diagnosis of Ménière disease including a 2-month history of vertigo and a 16-month history of left-sided tinnitus, low-frequency hearing loss, and aural fullness. The patient's other symptoms included left-sided neck pain, temporomandibular joint pain, and headaches. Examination revealed left-sided upper cervical joint dysfunction along with myofascial trigger points in the middle and upper trapezius muscle. INTERVENTION AND OUTCOME Treatment included primarily high-velocity, low-amplitude spinal manipulation to the upper cervical and thoracic spine, along with soft-tissue trigger-point therapy, and stretching exercises. Within 2 weeks of treatment, the patient's tinnitus had resolved; and all other symptoms (including vertigo) were improved. The patient's headaches, neck pain, and vertigo were subsequently resolved within 3 months of treatment. The patient experienced only 2 minor episodes of self-resolving "light-headedness" over that time. After 2½ years of follow-up, any occasional episodes of mild aural fullness and/or light-headedness are either self-resolving or relieved with cervical spinal manipulation and soft-tissue treatment. CONCLUSION This case report suggests that chiropractic care, including upper cervical spinal manipulation and soft-tissue therapy, may be beneficial in treating some patients with Ménière disease.
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Affiliation(s)
- Peter C. Emary
- Private Practice, Parkway Back Clinic, Cambridge, Ontario, Canada
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Campbell CA, Della Santina CC, Meyer NC, Smith NB, Myrie OA, Stone EM, Fukushima K, Califano J, Carey JP, Hansen MR, Gantz BJ, Minor LB, Smith RJ. Polymorphisms in KCNE1 or KCNE3 are not associated with Ménière disease in the Caucasian population. Am J Med Genet A 2009; 152A:67-74. [DOI: 10.1002/ajmg.a.33114] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Takumida M, Akagi N, Anniko M. Effect of inner ear blood flow changes in Ménière's model mice. Acta Otolaryngol 2009; 129:244-53. [PMID: 18615328 DOI: 10.1080/00016480802241980] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSIONS The endolymphatic sac (ES) is important for inner ear fluid homeostasis. A dysfunctional ES can cause vertigo attacks following additional stress such as a sudden change in endolymphatic volume and/or pressure, or restricted inner ear blood flow. OBJECTIVE The purpose of this study was to elucidate the mechanism of vertigo attacks in Ménière's disease. MATERIALS AND METHODS Adult CBA/J mice were given an intratympanic injection of lipopolysaccharide and an intraperitoneal injection of aldosterone. These 'model' animals had epinephrine or sodium nitroprusside (SNP) instilled into the middle ear cavity. Cochleae, vestibules, and endolymphatic sacs were studied morphologically by light microscopy. RESULTS The injection of epinephrine into the model animals reduced the endolymphatic hydrops in the cochlea, but also produced mild hydrops in the vestibule, which was never observed in untreated (control) animals. The ES did not react to epinephrine in the normal way. Injection of SNP did not cause any changes.
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Pérez-Fernandez N, Der-Musa C, Boleas-Aguirre MS, Martinez-Vila E. Analysis of the vestibulo-ocular reflex time constant in patients with benign recurrent vertigo associated with head-shaking nystagmus. Acta Otolaryngol 2006; 126:358-63. [PMID: 16608786 DOI: 10.1080/00016480500415605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSIONS When considering benign recurrent vertigo and a similar peripheral vestibular deficiency, the asymmetry of the vestibulo-ocular reflex (VOR) time constant (Tc) is lower in those patients with paretic head-shaking nystagmus (HSN) than in those with reversed HSN or without HSN. OBJECTIVE To determine whether the existence of HSN is related to the time constant of the VOR in patients with benign recurrent vertigo (BRV). PATIENTS AND METHODS This was a prospective study conducted at a tertiary care center in which patients were subjected to the head-shaking test, the caloric test and rotatory chair impulsive test on the same day. The clinical features of the disease analyzed were the disease duration, frequency of vertigo spells, time since the last vertigo spell and the existence of migraine. The results of the head-shaking test were considered positive when nystagmus appeared after head-shaking had ended. Two groups of patients were established on the basis of these results and the group that displayed HSN was divided according to the direction of nystagmus. In the impulsive test, the time constant of the VOR after ipsilesional and contralesional acceleration was analyzed, as was the symmetry of the response. The differences in the means were calculated. RESULTS BRV was diagnosed in 25% of patients suffering recurrent spells of vertigo, of which 33 patients were HSN- and 29 were HSN+. In the latter group, vestibular migraine was frequently observed (83% of the patients), the spells of vertigo were more frequent and the patients were seen closer to the previous spell of vertigo. No differences were observed in the Tc of the VOR between HSN+ and HSN- patients, although the asymmetry of this Tc was higher in HSN- patients than in HSN+ patients. Nevertheless, the differences observed were only significant between paretic and reversed HSN patients and paretic HSN patients and HSN- patients.
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Affiliation(s)
- Nicolás Pérez-Fernandez
- Department of Otorhinolaryngology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain.
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Abstract
Inflammatory processes and the mechanisms by which they are initiated and controlled within the central nervous system (CNS) involve a vast array of cell types and molecules. One cell type believed to be involved in the control of inflammation in the CNS is the microglial cell. The TLD antibodies are a panel of monoclonal antibodies reactive to rat microglial antigens. One antibody from this panel, clone TLD-1A8A, is specific for antisecretory factor (ASF). ASF is a previously identified protein characterized as a potent inhibitor of enterotoxin-induced intestinal fluid secretion. Our results extend the function of this molecule to include the regulation of immune reactions. Administration of TLD-1A8A to T-cell proliferation or mixed leukocyte response assays resulted in increased proliferation of T cells. Flow cytometric analysis indicates that ASF is expressed on macrophages, B cells and dendritic cells, but not on T cells or granulocytes. Immunohistochemical analysis indicates that ASF is expressed by macrophages and cells of dendritic morphology in the spleen, thymus, lymph nodes, Peyer's patch, and in the perivascular area in the CNS. Furthermore, Western blot analysis indicates that ASF is expressed in many tissues including all secondary lymphoid organs. These data suggest that ASF may have a previously unsuspected role in regulating the immune system.
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Affiliation(s)
- Todd S Davidson
- 1Department of Pathology, Borwell Building, Dartmouth Medical School -DHMC, Lebanon, NH 03756, USA
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