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Carmona S, Fernandez MG, Espona CD. Vestibular Drop Attack: An Analysis of the Therapeutic Response. Audiol Res 2023; 14:27-34. [PMID: 38247560 PMCID: PMC10801597 DOI: 10.3390/audiolres14010004] [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: 09/08/2023] [Revised: 12/01/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
The present study evaluates the response to betahistine in patients who presented vestibular drops attacks in the context of Ménière's disease (MD) and the factors that can predict an unfavorable response to it. A total of 43 patients were analyzed, out of which 33 were diagnosed with MD. This is a descriptive, cross-sectional study with retrospective data collection. Data as regards age, accompanying symptoms, etiological diagnosis and response to MD treatment were collected. A statistical analysis was carried out, and we found that the disease evolution time and specific alterations in the vestibulospinal and oculomotor physical examination present an unfavorable response to betahistine. Failures for betahistine were treated with intratympanic gentamicin, with which symptomatic control was achieved in all cases.
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Affiliation(s)
- Sergio Carmona
- Fundación San Lucas Para la Neurociencia, Rosario 2000, Argentina
| | | | - Cristian David Espona
- Department of Neurology, Hospital Provincial del Centenario, Rosario 2000, Argentina;
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Filippi C, Covelli E, Elfarargy HH, Monini S, Barbara M. The role of cochlear implantation in alleviating Tumarkin drop attacks of Meniere's disease; a case report. J Otol 2023; 18:168-172. [PMID: 37497333 PMCID: PMC10366631 DOI: 10.1016/j.joto.2023.06.002] [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: 02/14/2023] [Revised: 06/06/2023] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
Ménière's disease (MD) patients may suffer episodes of sudden falls, named Tumarkin drop attacks (DAs). This fall occurs abruptly and without warning or loss of consciousness. DAs usually aggravate the clinical picture of MD and are challenging to manage. The present report describes a case treated by cochlear implantation (CI) due to concomitant deafness and offers some clinical considerations for this condition. A male patient aged 48 years with a 10-year history of definite bilateral MD had profound SNHL on the right and severe SNHL on the left side. He suffered from intermittent attacks of vertigo, ear fullness, and tinnitus and, in the last year, had developed DAs and experienced 14 episodes in the previous six months. The preoperative category of acoustic performance was 3. The Dizziness Handicap Inventory (DHI) questionnaire showed a total score of 46, which indicated a moderate degree of disability. A CI was planned for the right side. The patient did not report any further DAs episode for two years since then. The postoperative category of acoustic performance became 11, and the postoperative DHI questionnaire showed a decrease in the total score (from 46 to 19), which indicated a mild disability. Unilateral CI effectively alleviated the DAs associated with bilateral MD. Our report proposes a new modality for managing vertiginous symptoms in cases of MD with hearing loss without the need for more aggressive surgical interventions with the need for clinical trials to confirm our results.
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Affiliation(s)
- Chiara Filippi
- Department of Neuroscience, Mental Health, and Sense Organs (NEMOS), Sant’ Andrea University Hospital, Sapienza University, Rome, Italy
| | - Edoardo Covelli
- Department of Neuroscience, Mental Health, and Sense Organs (NEMOS), Sant’ Andrea University Hospital, Sapienza University, Rome, Italy
| | - Haitham H. Elfarargy
- Department of Neuroscience, Mental Health, and Sense Organs (NEMOS), Sant’ Andrea University Hospital, Sapienza University, Rome, Italy
- Otorhinolaryngology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Simonetta Monini
- Department of Neuroscience, Mental Health, and Sense Organs (NEMOS), Sant’ Andrea University Hospital, Sapienza University, Rome, Italy
| | - Maurizio Barbara
- Department of Neuroscience, Mental Health, and Sense Organs (NEMOS), Sant’ Andrea University Hospital, Sapienza University, Rome, Italy
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Wu Z, Liu B. [Expert consensus on the diagnosis of isolated otolith dysfunction]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:409-414. [PMID: 37253512 PMCID: PMC10495805 DOI: 10.13201/j.issn.2096-7993.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/15/2023] [Indexed: 06/01/2023]
Abstract
Isolated otolith dysfunction(iOD) involves a group of unexplained vestibular syndromes that manifest clinically as a sense of translation, tilting or floating, and blurred vision with head movement, with normal semicircular canal function but abnormal otolith function on laboratory vestibular testing. As vestibular medicine has gained widespread popularity in recent years, increasing attention has also been paid to iOD and case reports, clinical studies and diagnostic criteria have been published. However, there is no consensus document to guide the diagnosis of this disease in China. In this context, the Special Committee on Vertigo of China Medical Education Association organized a group of domestic experts in vestibular medicine and formulated this diagnostic consensus after thorough discussion based on the latest evidence in China and abroad, in order to promote the best clinical practice for iOD.
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Niu Y, Chen W, Lin M, Sha Y. Progression of endolymphatic hydrops and vertigo during treatment in Meniere's disease. Acta Otolaryngol 2022; 142:653-657. [PMID: 36369788 DOI: 10.1080/00016489.2022.2138968] [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: 11/13/2022]
Abstract
BACKGROUND Patients with Meniere's disease (MD) receive treatment to reduce vertigo. PURPOSE To explore the fluctuation of vertigo symptoms and the changes in endolymphatic hydrops (EHs) in MD patients during long-term regular medication. MATERIALS AND METHODS We enrolled MD patients who had received two magnetic resonance imaging with intravenous contrast agents. RESULTS Of the 42 patients in the study, 18(42.9%) had progressive EHs and 3(7.1%) had remission. The change value of the signal intensity ratio (SIR; cochlear perilymph/cerebellum) on the affected side (1.2) was larger than that on the healthy side (0.9), but there was no statistical difference. Among the 30 patients followed up, two patients had complete control of vertigo, two patients had substantial control, and three patients had worse control. The other 23 patients had insignificant control of vertigo symptoms before and after treatment. The correlation between the progression of cochlear and vestibular hydrops and the improvement of vertigo symptoms in MD patients was not significant. CONCLUSIONS AND SIGNIFICANCE In treated patients with MD, EHs may progress or relieve over the long course of the disease. But there was no correlation between the development of EHs and changes in vertigo symptoms.
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Affiliation(s)
- Yue Niu
- Eye, Ear, Nose and Throat (EENT) Hospital, Fudan University, Shanghai, PR China
| | - Wei Chen
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, PR China
| | - Mengyan Lin
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, PR China
| | - Yan Sha
- Eye, Ear, Nose and Throat (EENT) Hospital, Fudan University, Shanghai, PR China
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Misale P, Hassannia F, Dabiri S, Brandstaetter T, Rutka J. Post-traumatic peripheral vestibular disorders (excluding positional vertigo) in workers following head injury. Sci Rep 2021; 11:23436. [PMID: 34873257 PMCID: PMC8648866 DOI: 10.1038/s41598-021-02987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/23/2021] [Indexed: 11/08/2022] Open
Abstract
Benign paroxysmal positional vertigo has typically been reported to be the most common cause of post-traumatic dizziness. There is however paucity in the literature about other peripheral vestibular disorders post-head injury. This article provides an overview of other causes of non-positional dizziness post-head trauma from our large institutional experience. The UHN WSIB Neurotology database (n = 4291) between 1998 and 2018 was retrospectively studied for those head-injured workers presenting with non-positional peripheral vestibular disorders. All subjects had a detailed neurotological history and examination and vestibular testing including video nystagmography, video head impulse testing (or a magnetic scleral search coil study), vestibular-evoked myogenic potentials, and audiometry. Imaging studies included routine brain and high-resolution temporal bone CT scans and/or brain MRI. Based on a database of 4291 head-injured workers with dizziness, 244 were diagnosed with non-positional peripheral vertigo. Recurrent vestibulopathy (RV) was the most common cause of non-positional post-traumatic vertigo. The incidence of Meniere's disease in the post-traumatic setting did not appear greater than found in the general population. The clinical spectrum pertaining to recurrent vestibulopathy, Meniere's disease, delayed endolymphatic hydrops, drop attacks, superior semicircular canal dehiscence syndrome, and uncompensated peripheral vestibular loss are discussed.
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Affiliation(s)
- Priyanka Misale
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 8N-873, Toronto, ON, M5G 2C4, Canada
| | - Fatemeh Hassannia
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 8N-873, Toronto, ON, M5G 2C4, Canada.
| | - Sasan Dabiri
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 8N-873, Toronto, ON, M5G 2C4, Canada
| | - Tom Brandstaetter
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 8N-873, Toronto, ON, M5G 2C4, Canada
| | - John Rutka
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 8N-873, Toronto, ON, M5G 2C4, Canada
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Lee SY, Kim YS, Jeong B, Carandang M, Koo JW, Oh SH, Lee JH. Intratympanic steroid versus gentamicin for treatment of refractory Meniere's disease: A meta-analysis. Am J Otolaryngol 2021; 42:103086. [PMID: 34098455 DOI: 10.1016/j.amjoto.2021.103086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Intratympanic steroid injections (ITSI) have become a promising treatment for refractory Meniere's disease due to less cochleovestibular damage. However, whether ITSI would be a good alternative to intratympanic gentamicin injections (ITGI) for refractory Meniere's disease still remains controversial. Here we intended to compare the therapeutic effect of ITSI and ITGI in patients with Meniere's disease refractory to conservative treatments, in terms of vertigo control and hearing outcomes, via a meta-analysis. METHODS Using MEDLINE, PubMed, and EMBASE databases, we calculated pooled odds ratio (OR) estimates of vertigo control rate (i.e., class A according to AAO-HNS guideline) and standardized mean differences (SMD) of spell count, pure tone audiometry (PTA) threshold and speech discrimination score (SDS) with a 95% confidence interval (CI). The trim-and-fill method and sensitivity analysis were used as post-hoc analyses to verify the integrity of the quantitative analysis results. Furthermore, subgroup analyses were performed according to steroid type (methylprednisolone versus dexamethasone) and follow-up period (>1-year versus <1-year). RESULTS Five studies involving 332 patients with refractory unilateral Meniere's disease were included. In the pooled analysis, those treated with ITGI showed higher ORs than those treated with ITSI in terms of vertigo control rate (OR: 2.39, 95% CI: 0.84-6.79, P = 0.102) and spell counts (SMD: 0.24, 95% CI: -0.12-0.59, P = 0.195), but it did not reach statistical significance. However, a substantial amount of heterogeneity (I2 = 71.0%, Q = 13.79, P = 0.008) and publication bias was found, suggesting a significant small-study effect. Additionally, ITSI elicited better hearing outcomes of the mean PTA threshold (SMD: 3.08, 95% CI: -1.18-7.35) and mean SDS (SMD: 11.15, 95% CI: -23.21-0.90) compared with ITGI, although no statistical significance. In subgroup analysis, the difference in vertigo control rate between ITGI and ITSI was not significant, regardless of the follow-up period and steroid type. Further, methylprednisolone appeared to be superior to dexamethasone for vertigo control. No significant complications from either treatment were reported in the literature. CONCLUSION The results of this study further refine the recently proposed efficacy of ITSI for the treatment of refractory Meniere's disease, demonstrating the comparable value of ITGI on vertigo control as well as better hearing preservation. Collectively, ITSI could be a safe and the effective treatment for refractory Meniere's disease. However, the current evidence on efficacy of ITSI for refractory Meniere's disease needs to be further clarified, given the substantial heterogeneity and potential biases.
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Kutlubaev MA, Xu Y, Manchaiah V, Zou J, Pyykkö I. Vestibular drop attacks in Ménière's disease: A systematic review and meta-analysis of frequency, correlates and consequences. J Vestib Res 2021; 32:171-182. [PMID: 33935127 DOI: 10.3233/ves-201514] [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: 01/11/2023]
Abstract
BACKGROUND Vestibular drop attacks (VDA), also called Tumarkin otolith crises as a complication of Ménière's disease (MD) were first described in 1936. Nevertheless, a clearer understanding of their prevalence and manifestations is needed. THE OBJECTIVE of this review is to determine the frequency, correlates and consequences of VDA in MD. METHOD Three databases were searched (i.e., MEDLINE, PubMed and Google Academia). A total of 1,791 references were identified, of which 18 studies were considered eligible. There was a large variation in the definition of VDA used in the studies. RESULTS The frequency of VDA in MD leading to a fall to the ground varied from 3 to 19% in 9 hospital-based studies. In studies where a less restrictive definition of VDA included attacks with postural perturbation, tripping and near-to-fall situations was used the prevalence ranged from 50 to 72%. The pooled frequency of VDA leading to fall to the ground was 8% (95% CI 4 to 12%) in hospital-based studies. In these studies, VDA often occurred in severe and advanced MD whereas in cohort studies such connection was not found. Co-morbidity with migraine increased the likelihood of VDA occurrence in MD. In 3 studies syncope was recorded in connection to VDA with falls. In terms of clinical manifestation, audiometry, MRI, vestibular evoked muscle response measures indicated endolymphatic hydrops with involvement of the otolith system. The hearing loss was more pronounced, and balance was worse in MD patients with VDA than in those without. Injury associated with VDA was reported in only one study. CONCLUSIONS VDA is a common phenomenon in MD, occurring even in mild MD and complicated with syncope. Some preliminary evidence suggests that VDA may lead to severe injuries.
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Affiliation(s)
- Mansur A Kutlubaev
- Department of Neurology, Bashkir State Medical University, Lenin str, 3, Ufa, Russia
| | - Ying Xu
- Neuroscience Research Australia (NeuRA), Barker Street, Randwick, NSW, Australia.,School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas, USA.,Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
| | - Jing Zou
- Hearing and Balance Research Unit, Field of Otolaryngology, School of Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head & Neck Surgery of the Chinese PLA, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ilmari Pyykkö
- Hearing and Balance Research Unit, Field of Otolaryngology, School of Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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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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9
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Xu LH, Yang Y, Liu HX, Xiao SF, Qiu WX, Wang JX, Zhao CC, Gui YH, Liu GZ, Peng B, Li X, Wang GH, Zhou X, Jiang ZL. Inner Ear Arginine Vasopressin-Vasopressin Receptor 2-Aquaporin 2 Signaling Pathway Is Involved in the Induction of Motion Sickness. J Pharmacol Exp Ther 2020; 373:248-260. [PMID: 32165443 DOI: 10.1124/jpet.119.264390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/24/2020] [Indexed: 11/22/2022] Open
Abstract
It has been identified that arginine vasopressin (AVP), vasopressin receptor 2(V2R), and the aquaporin 2 (AQP2) signaling pathway in the inner ear play important roles in hearing and balance functions through regulating the endolymph equilibrium; however, the contributions of this signaling pathway to the development of motion sickness are unclear. The present study was designed to investigate whether the activation of the AVP-V2R-AQP2 signaling pathway in the inner ear is involved in the induction of motion sickness and whether mozavaptan, a V2R antagonist, could reduce motion sickness. We found that both rotatory stimulus and intraperitoneal AVP injection induced conditioned taste aversion (a confirmed behavioral index for motion sickness) in rats and activated the AVP-V2R-AQP2 signaling pathway with a responsive V2R downregulation in the inner ears, and AVP perfusion in cultured epithelial cells from rat endolymphatic sacs induced similar changes in this pathway signaling. Vestibular training, V2R antagonist mozavaptan, or PKA inhibitor H89 blunted these changes in the V2R-AQP2 pathway signaling while reducing rotatory stimulus- or DDAVP (a V2R agonist)-induced motion sickness in rats and dogs. Therefore, our results suggest that activation of the inner ear AVP-V2R-AQP2 signaling pathway is potentially involved in the development of motion sickness; thus, mozavaptan targeting AVP V2Rs in the inner ear may provide us with a new application option to reduce motion sickness. SIGNIFICANCE STATEMENT: Motion sickness affects many people traveling or working. In the present study our results showed that activation of the inner ear arginine vasopressin-vaspopressin receptor 2 (V2R)-aquaporin 2 signaling pathway was potentially involved in the development of motion sickness and that blocking V2R with mozavaptan, a V2R antagonist, was much more effective in reducing motion sickness in both rat and dog; therefore, we demonstrated a new mechanism to underlie motion sickness and a new candidate drug to reduce motion sickness.
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Affiliation(s)
- Li-Hua Xu
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Yao Yang
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Hong-Xia Liu
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Shui-Feng Xiao
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Wen-Xia Qiu
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Jin-Xing Wang
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Chen-Chen Zhao
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Yuan-Hong Gui
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Gui-Zhu Liu
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Bin Peng
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Xia Li
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Guo-Hua Wang
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Xin Zhou
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Zheng-Lin Jiang
- Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine, Institute of Nautical Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
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10
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Wu Q, Li X, Sha Y, Dai C. Clinical features and management of Meniere’s disease patients with drop attacks. Eur Arch Otorhinolaryngol 2019; 276:665-672. [DOI: 10.1007/s00405-018-5260-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
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11
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Bos JE, Lubeck AJA, Vente PEM. Treatment of vestibular disorders with weak asymmetric base-in prisms: An hypothesis with a focus on Ménière's disease. J Vestib Res 2018; 27:251-263. [PMID: 29400688 PMCID: PMC9249307 DOI: 10.3233/ves-170630] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Regular treatments of Ménière’s disease (MD) vary largely, and no single satisfactory treatment exists. A complementary treatment popular among Dutch and Belgian patients involves eyeglasses with weak asymmetric base-in prisms, with a perceived high success rate. An explanatory mechanism is, however, lacking. OBJECTIVE: To speculate on a working mechanism explaining an effectiveness of weak asymmetric base-in prims in MD, based on available knowledge. METHODS: After describing the way these prisms are prescribed using a walking test and its effect reported on, we give an explanation of its underlying mechanism, based on the literature. RESULTS: The presumed effect can be explained by considering the typical star-like walking pattern in MD, induced by a drifting after-image comparable to the oculogyral illusion. Weak asymmetric base-in prisms can furthermore eliminate the conflict between a net vestibular angular velocity bias in the efferent signal controlling the VOR, and a net re-afferent ocular signal. CONCLUSIONS: The positive findings with these glasses reported on, the fact that the treatment itself is simple, low-cost, and socially acceptable, and the fact that an explanation is at hand, speak in favour of elaborating further on this treatment.
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Affiliation(s)
- Jelte E Bos
- Department of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.,Perceptual and Cognitive Systems, TNO, Soesterberg, The Netherlands
| | - Astrid J A Lubeck
- Department of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - P Eric M Vente
- Utermöhlen Working Group, Alphen a/d Rijn, The Netherlands
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12
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Masoumi E, Dabiri S, Khorsandi Ashtiani MT, Erfanian R, Sohrabpour S, Yazdani N, Safaee A, Firouzifar M. Methylprednisolone versus Dexamethasone for Control of Vertigo in Patients with Definite Meniere's disease. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2017; 29:341-346. [PMID: 29383315 PMCID: PMC5785114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/03/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Definite Meniere's disease is associated with two or more definitive periods of vertigo along with hearing loss, plus tinnitus or aural fullness or both. This study aimed to compare the effect of intratympanic dexamethasone and methylprednisolone on the functional-level scale of pure-tone audiometry (PTA), and class outcome measures of vertigo. MATERIALS AND METHODS In this clinical study, 69 patients with definite Meniere's disease, referred to the tertiary otolaryngology center, were randomly assigned to two groups: 36 patients were treated with intratympanic dexamethasone (4mg/dl) and 33 patients were treated with intratympanicmethylprednisolone (40mg/dl). Each group received three weekly injections. After a follow-up of 1 and 6 months, PTA changes and vertigo control were evaluated. RESULTS There was no statistically significant difference between the two groups with regard to control of vertigo (P=0.866, P=0.879 for 1 and 6 months post injection, respectively). PTA improvement was statistically significantly higher in the methylprednisolone group (P=0.006). CONCLUSION In summary, intratympanic corticosteroid is an effective treatment for Meniere's disease and can prevent other invasive treatments. Intratympanic methylprednisolone can improve hearing level to a greater extent than intratympanic dexamethasone, but the two groups were similarly beneficial in controlling vertigo. However, there was a trend toward a more sustained benefit with methylprednisolone.
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Affiliation(s)
- Elham Masoumi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Dabiri
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Erfanian
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sohrabpour
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Yazdani
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Safaee
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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13
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Patel M. Intratympanic corticosteroids in Ménière's disease: A mini-review. J Otol 2017; 12:117-124. [PMID: 29937846 PMCID: PMC5963463 DOI: 10.1016/j.joto.2017.06.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/27/2017] [Accepted: 06/01/2017] [Indexed: 02/04/2023] Open
Abstract
This article reviews the effectiveness of intratympanic corticosteroids for vertigo control in Ménière's disease at 2-years follow-up according to the guidelines expressed by the American Academy of Otolaryngology-Head & Neck Surgery. Despite the increased use of intratympanic corticosteroids for vertigo control in Ménière's disease there is debate as to their effectiveness, particularly compared to gentamicin. Even so, after just a single course of injections, corticosteroids can reliably provide complete vertigo control (Class A) at 2-years in about 50% of cases as indicated in a recent double-blind randomized controlled clinical trial (Patel et al., 2016). But the effectiveness of intratympanic corticosteroids truly increases when treatment is provided 'as-needed', whereby complete vertigo control is established in up to 91% of cases. On the basis of available literature, there is good evidence to recommend the use of intratympanic steroid treatment for vertigo control in Ménière's disease, but patients must be monitored for non-response. The rationale for treating patients as-needed and the possible reasons for corticosteroid non-response are discussed.
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Unilateral Enlarged Vestibular Aqueduct Syndrome and Bilateral Endolymphatic Hydrops. Case Rep Otolaryngol 2017; 2017:6195317. [PMID: 28607789 PMCID: PMC5451758 DOI: 10.1155/2017/6195317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/16/2017] [Indexed: 02/06/2023] Open
Abstract
Enlarged vestibular aqueduct (EVA) syndrome is a common congenital inner ear malformation characterized by a vestibular aqueduct with a diameter larger than 1.5 mm, mixed or sensorineural hearing loss that ranges from mild to profound, and vestibular disorders that may be present with a range from mild imbalance to episodic objective vertigo. In our study, we present the case of a patient with unilateral enlarged vestibular aqueduct and bilateral endolymphatic hydrops (EH). EH was confirmed through anamnestic history and audiological exams; EVA was diagnosed using high-resolution CT scans and MRI images. Therapy included intratympanic infusion of corticosteroids with a significant hearing improvement, more evident in the ear contralateral to EVA. Although most probably unrelated, EVA and EH may present with similar symptoms and therefore the diagnostic workup should always include the proper steps to perform a correct diagnosis. Association between progression of hearing loss and head trauma in patients with a diagnosis of EVA syndrome is still uncertain; however, these individuals should be advised to avoid activities that increase intracranial pressure to prevent further hearing deterioration. Intratympanic treatment with steroids is a safe and well-tolerated procedure that has demonstrated its efficacy in hearing, tinnitus, and vertigo control in EH.
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Zamergrad MV, Parfenov VA, Matsnev EI, Morozova SV, Melnikov OA, Sigaleva EE, Antonenko LM. Seven principles in the treatment of vestibular vertigo and results of the study of VIRTUOSO. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:106-110. [DOI: 10.17116/jnevro2017117121106-110] [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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