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Thompson-Harvey A, Pyle M, Harvey E, Harris MS. Effect of Non-ablative Medical Therapy on Progression of Hearing Loss in Menière's Disease: A Systematic Review and meta-Analysis. Otol Neurotol 2024; 45:833-839. [PMID: 38956802 DOI: 10.1097/mao.0000000000004251] [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: 07/04/2024]
Abstract
OBJECTIVE To systematically review how audiometric data change over time in patients with Menière's disease (MD) undergoing non-ablative medical therapy. DATABASES REVIEWED Medline (via PubMed), Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Google Scholar. METHODS A systematic review and meta-analysis of the literature was performed. Adult patients undergoing non-ablative medical therapy and reported duration of disease or follow-up were included and pooled estimates of pure-tone average (PTA) were tabulated. Studies were excluded if they did not use established MD, did not have pure-tone average (PTA) audiometric data, underwent ear surgery or ablative therapies, and were systematic reviews or case reports. RESULTS Out of 198 articles meeting full eligibility, 13 studies, involving 950 patients with MD, were included in the review and further analyzed. No effect on progression of PTA from initial diagnosis was seen between the different medical therapies within 2 years of non-ablative medical treatment. There was a significant worsening of PTA after 2 year, regardless of treatment used. High levels of heterogeneity among studies were noted up to 6 months from diagnosis ( I2 = 79%), likely reflecting differences in patient characteristics, treatment regimens, and study design. Overall, the risk of bias was low for the majority of included studies. CONCLUSIONS Patients diagnosed with MD who are undergoing non-ablative medical therapy should be counseled on the likelihood of worsening of hearing loss over the course of the disease despite elected treatment.
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Affiliation(s)
- Adam Thompson-Harvey
- Department of Otolaryngology-Head & Neck Surgery, University of Virginia, Charlottesville, Virginia
| | - Madeline Pyle
- Department of Otolaryngology-Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Erin Harvey
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael S Harris
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
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Khalifa R, Touska P, Pai I, Padormo F, Goh V, Hajnal JV, Connor SEJ. Magnetic resonance imaging evaluation of cochlear and vestibular nerve calibre: a case-control study in Ménière's disease and endolymphatic hydrops. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08895-4. [PMID: 39152300 DOI: 10.1007/s00405-024-08895-4] [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: 05/06/2024] [Accepted: 08/05/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE To compare the calibre of the cochlear (CN), superior vestibular (SVN) and inferior vestibular (IVN) nerves on magnetic resonance imaging (MRI), both between Ménière's Disease (MD) ears and clinical controls, and between inner ears with and without endolymphatic hydrops (EH) on MRI. METHODS A retrospective case-control study evaluated patients undergoing MRI for suspected hydropic ear disease from 9/2017 to 8/2022. The CN, SVN, IVN and facial nerve (FN) diameters and cross-sectional areas (CSA) were measured on T2-weighted sequences whilst EH was evaluated on delayed post-gadolinium MRI. Absolute nerve calibre (and that relative to the FN) in unilateral definite MD ears (2015 Barany criteria) was compared to that in both asymptomatic contralateral ears and clinical control ears. Nerve calibre in ears with severe cochlear and vestibular EH was compared to ears without EH. t tests or Wilcoxon signed-rank test/Mann-Whitney U test were applied (p < 0.001). RESULTS 173 patients (mean age 51.3 ± 15.1, 65 men) with 84 MD (62 unilateral) and 62 clinical control ears were studied. Absolute and relative CN dimensions were decreased in both MD ears (CSA and diameter) and the contralateral asymptomatic ears (CSA) when compared to clinical controls (p < 0.001). Absolute nerve dimensions were reduced in both severe vestibular EH (CN, IVN and SVN) and severe cochlear EH (CN) (p < 0.001), however this was not evident when adjusted according to facial nerve calibre. CONCLUSION There is decreased absolute CN calibre in both symptomatic and asymptomatic MD ears as well as ears with severe cochlear and vestibular EH on MRI.
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Affiliation(s)
- Radwa Khalifa
- Faculty of Medicine, Helwan University, Cairo, Egypt
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Philip Touska
- Department of Radiology, Guy's and St Thomas' Hospital, London, UK
| | - Irumee Pai
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' Hospital, London, UK
| | - Francesco Padormo
- Medical Physics, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Hyperfine, Inc., Guilford, CT, USA
| | - Vicky Goh
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's and St Thomas' Hospital, London, UK
| | - Joseph V Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Steve E J Connor
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Radiology, Guy's and St Thomas' Hospital, London, UK.
- Neuroradiology Department, Ruskin Wing, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
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Connor S, Grzeda MT, Jamshidi B, Ourselin S, Hajnal JV, Pai I. Delayed post gadolinium MRI descriptors for Meniere's disease: a systematic review and meta-analysis. Eur Radiol 2023; 33:7113-7135. [PMID: 37171493 PMCID: PMC10511628 DOI: 10.1007/s00330-023-09651-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/12/2023] [Accepted: 02/22/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Delayed post-gadolinium magnetic resonance imaging (MRI) detects changes of endolymphatic hydrops (EH) within the inner ear in Meniere's disease (MD). A systematic review with meta-analysis was conducted to summarise the diagnostic performance of MRI descriptors across the range of MD clinical classifications. MATERIALS AND METHODS Case-controlled studies documenting the diagnostic performance of MRI descriptors in distinguishing MD ears from asymptomatic ears or ears with other audio-vestibular conditions were identified (MEDLINE, EMBASE, Web of Science, Scopus databases: updated 17/2/2022). Methodological quality was evaluated with Quality Assessment of Diagnostic Accuracy Studies version 2. Results were pooled using a bivariate random-effects model for evaluation of sensitivity, specificity and diagnostic odds ratio (DOR). Meta-regression evaluated sources of heterogeneity, and subgroup analysis for individual clinical classifications was performed. RESULTS The meta-analysis included 66 unique studies and 3073 ears with MD (mean age 40.2-67.2 years), evaluating 11 MRI descriptors. The combination of increased perilymphatic enhancement (PLE) and EH (3 studies, 122 MD ears) achieved the highest sensitivity (87% (95% CI: 79.92%)) whilst maintaining high specificity (91% (95% CI: 85.95%)). The diagnostic performance of "high grade cochlear EH" and "any EH" descriptors did not significantly differ between monosymptomatic cochlear MD and the latest reference standard for definite MD (p = 0.3; p = 0.09). Potential sources of bias were case-controlled design, unblinded observers and variable reference standard, whilst differing MRI techniques introduced heterogeneity. CONCLUSIONS The combination of increased PLE and EH optimised sensitivity and specificity for MD, whilst some MRI descriptors also performed well in diagnosing monosymptomatic cochlear MD. KEY POINTS • A meta-analysis of delayed post-gadolinium magnetic resonance imaging (MRI) for the diagnosis of Meniere's disease is reported for the first time and comprised 66 studies (3073 ears). • Increased enhancement of the perilymphatic space of the inner ear is shown to be a key MRI feature for the diagnosis of Meniere's disease. • MRI diagnosis of Meniere's disease can be usefully applied across a range of clinical classifications including patients with cochlear symptoms alone.
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Affiliation(s)
- Steve Connor
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.
- Department of Neuroradiology, King's College Hospital, London, SE5 9RS, UK.
- Department of Radiology, Guy's Hospital and St Thomas' Hospital, London, SE1 9RT, UK.
| | - Mariusz T Grzeda
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College, London, SE1 7EH, UK
| | - Babak Jamshidi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College, London, SE1 7EH, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Joseph V Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Irumee Pai
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' Hospital, London, SE1 9RT, UK
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Mammarella F, Loperfido A, Keeling EG, Bellocchi G, Marsili L. Ménière's Disease: Insights from an Italian Nationwide Survey. Audiol Res 2023; 13:160-168. [PMID: 36960977 PMCID: PMC10037628 DOI: 10.3390/audiolres13020016] [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: 01/28/2023] [Revised: 02/12/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
The aim of the present study was to obtain data from a large community sample of patients with Ménière's disease (MD) in Italy through a web-based nationwide survey. Demographic, clinical, and epidemiological features of MD among members of the Italian Association of Ménière's Disease (AMMI) were collected through a web-based survey. The questionnaire was posted on the AMMI website between 01/SEP/2021 and 31/OCT/2021. A total of 520 patients (374 F, 146 M) with MD were included. The age at interview (average ± standard deviation, SD) was 51.4 ± 10.9 years, with a disease duration of 9.9 ± 9.8 years. Eighty percent of cases were unilateral. No patients reported neurocognitive disorders or Parkinson's disease. A positive family history of MD was reported in 13% of participants, while a history of allergic diseases was reported in 33%. Comorbid thyroid disorders were present in 25% of participants, and 28% used betahistine as the main treatment. To our knowledge, this is the first study that has investigated the epidemiology and current patterns of care of MD in Italy, using an anonymous survey directly sent to patients, thus implying their active participation. We hope that future studies will support the utilization of web-based surveys to address the unmet needs in the management of patients with MD.
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Affiliation(s)
- Fulvio Mammarella
- Otolaryngology Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | | | | | | | - Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
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Abstract
PURPOSE OF REVIEW To explore recent developments in vestibular migraine (VM). RECENT FINDINGS This review discusses the current diagnostic criteria for VM in the adult and pediatric populations, as proposed by the International Headache Society and Bárány Society. Recent VM studies confirm the prior findings and reveal new insights, including the wide range of vestibular symptoms, symptoms in the attack-free period, and triggers. Many patients experience persistent vestibular symptoms, even in the absence of acute attacks, which often significantly impact patients' quality of life. The syndrome of benign recurrent vertigo and its relationship to migraine, VM, and Meniere's disease is also discussed. There is a dearth of randomized controlled trials in VM treatment. Prospective and retrospective studies support the benefit of many migraine treatments are effective in VM, including neuromodulation, and calcitonin gene-related peptide monoclonal antibodies. VM affects almost 3% of the population, but remains under-diagnosed. Recent diagnostic criteria can help clinicians diagnose VM in adults and children.
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Affiliation(s)
- Shin C Beh
- Beh Center for Vestibular & Migraine Disorders, 4500 Hillcrest Rd Ste 145, Frisco, TX, 75035, USA.
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Pérez-Carbonell T, Orts-Alborch M, Pérez-Guillén V, Tenías-Burillo JM, Pla-Gil I, Marco-Algarra J, Pérez-Garrigues H. A longitudinal study of unilateral Ménière's disease and clinical evolutionary models. J Laryngol Otol 2022:1-8. [PMID: 35924453 DOI: 10.1017/s0022215122001773] [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: 11/05/2022]
Abstract
OBJECTIVE The heterogeneity of Ménière's disease is presently defined by a variety of subtypes. This study introduced three different subtypes of unilateral Ménière's disease based on the evolution of vertigo crises from their inception. METHOD A longitudinal descriptive study of 327 unilateral Ménière's disease patients was performed. In a subgroup of patients followed from the onset of the disease, 3 subtypes of unilateral Ménière's disease were defined according to the vertiginous crises suffered during the first 10 years of the disorder. RESULTS Data was available for 87 patients with unilateral Ménière's disease from the start of their disease (26.6 per cent of the original sample). These patients were grouped into three models according to their symptomatic evolution. Model 3 was associated with a worse hearing prognosis, a greater number of Tumarkin's otolithic crises and the need for surgery. Model 1 presented less hearing loss. CONCLUSION Unilateral Ménière's disease models based on the evolution of vertiginous crises present differences according to aspects such as hearing loss, vertiginous crisis, Tumarkin's otolithic crisis and the need for surgery.
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Affiliation(s)
- T Pérez-Carbonell
- Department of Otorhinolaryngology, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Spain
| | - M Orts-Alborch
- Department of Otorhinolaryngology, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Spain
| | - V Pérez-Guillén
- Otoneurology Unit, Department of Otorhinolaryngology, Hospital Universitario La Fe, Valencia, Spain
| | - J M Tenías-Burillo
- Medicina Preventiva, Pare Jofrè Hospital, Conselleria de Sanitat Universal i Salut Pública, Valencia, Spain
| | - I Pla-Gil
- Department of Otorhinolaryngology, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Spain
| | - J Marco-Algarra
- Department of Otorhinolaryngology, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Spain
| | - H Pérez-Garrigues
- Otoneurology Unit, Department of Otorhinolaryngology, Hospital Universitario La Fe, Valencia, Spain
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Zhang Y, Wei C, Sun Z, Wu Y, Chen Z, Liu B. Hearing Benefits of Clinical Management for Meniere's Disease. J Clin Med 2022; 11:3131. [PMID: 35683514 PMCID: PMC9181791 DOI: 10.3390/jcm11113131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 02/01/2023] Open
Abstract
Meniere’s disease is a progressive hearing−disabling condition. Patients can benefit from strict clinical management, including lifestyle and dietary counseling, and medical treatment. A prospective cohort study was carried out with 154 patients with definite Meniere’s disease, with an average age of 43.53 ± 11.40, and a male to female ratio of 0.97:1. The pure-tone thresholds of all 165 affected ears, over a one-year clinical management period, were analyzed. After one year, 87.27% of patients had improved or preserved their hearing at a low frequency, and 71.51% at a high frequency. The hearing threshold at frequencies from 250 Hz to 2000 Hz had improved significantly (p < 0.001, p < 0.001, p < 0.001, p < 0.01), and deteriorated slightly at 8000 Hz (p < 0.05). Of all the patients, 40.00% had a hearing average threshold that reached ≤25 dB HL after the clinical management period, among whom 27.27% were patients in stage 3. The restoration time was 2.5 (1.0, 4.125) months, with a range of 0.5−11.0 months, and the restoration time was longer for stage 3 than for stages 1 and 2 (u = −2.542, p < 0.05). The rising curves improved the most (p < 0.05), with most becoming peaks, whereas most peaks and flats remained the same. Patients who were initially in the earlier stages (95% CI 1.710~4.717, OR 2.840, p < 0.001), have an increased odds ratio of hearing by an average of ≤25 dB HL. Age (95% CI 1.003~1.074, OR 1.038, p = 0.031), peak curve (95% CI 1.038~5.945, OR = 2.484, p = 0.041), and flat curve (95% CI 1.056~19.590, OR = 4.549, p = 0.042), compared with the rising curve, increase the odds ratio of hearing on average by >25 dB HL. Most patients can have their hearing preserved or improved through strict clinical management, and sufficient follow-up is also essential. Stage 3 patients also have the potential for hearing improvement, although the restoration time is longer than in the early stages. The initial hearing stage, age, and audiogram pattern are related to the hearing benefits.
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Affiliation(s)
- Yi Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; (Y.Z.); (C.W.); (Z.S.); (Y.W.); (Z.C.)
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China
| | - Chenyi Wei
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; (Y.Z.); (C.W.); (Z.S.); (Y.W.); (Z.C.)
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China
| | - Zhengtao Sun
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; (Y.Z.); (C.W.); (Z.S.); (Y.W.); (Z.C.)
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China
| | - Yue Wu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; (Y.Z.); (C.W.); (Z.S.); (Y.W.); (Z.C.)
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China
| | - Zhengli Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; (Y.Z.); (C.W.); (Z.S.); (Y.W.); (Z.C.)
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China
| | - Bo Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; (Y.Z.); (C.W.); (Z.S.); (Y.W.); (Z.C.)
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China
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Progressive and Degenerative Peripheral Vestibular Disorders. Otolaryngol Clin North Am 2021; 54:959-971. [PMID: 34301401 DOI: 10.1016/j.otc.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Initial diagnosis of peripheral vestibulopathy requires a detailed history, physical examination, and, in some cases, audiovestibular testing, radiographic imaging, or serology. Differentiation of a peripheral vestibulopathy as progressive or degenerative is often nuanced and influenced by a characterization of a patient's symptoms or natural history over time. A diverse group of vestibular pathology may fit into this category, including Ménière's disease, autoimmune conditions, congenital pathologies, ototoxic medications, radiation therapy, and perilymphatic fistula. Differentiation among these entities may be guided by initial or subsequent symptomatology, with various combinations of audiovestibular testing, serology, and imaging. Treatment options are disparate and disease-specific, ranging from observation to medical management or surgical intervention, underscoring the need for astute investigation and diagnosis.
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The Physiologic Role of Corticosteroids in Menière's Disease: An Update on Glucocorticoid-mediated Pathophysiology and Corticosteroid Inner Ear Distribution. Otol Neurotol 2021; 41:271-276. [PMID: 31821251 DOI: 10.1097/mao.0000000000002467] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
: There are multiple treatment options for Ménière's disease (MD), including dietary modifications, aminoglycoside therapy, and surgery. All have limitations, ranging from limited effectiveness to permanent hearing loss. Corticosteroids have long been used to manage MD due to their relative efficacy and tolerability, but the exact mechanism for disease alleviation is uncertain. Until recently, the precise distribution and role that glucocorticoid receptors play in inner ear diseases have remained largely uninvestigated. Several studies propose they influence mechanisms of fluid regulation through ion and water homeostasis. This review will provide an update on the basic science literature describing the activity of endogenous glucocorticoids and exogenous corticosteroids in the inner ear and the relevance to MD, as well as early clinical trial data pertaining to the application of novel technologies for more effective administration of corticosteroids for the treatment of MD.
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Connor SEJ, Pai I. Endolymphatic hydrops magnetic resonance imaging in Ménière's disease. Clin Radiol 2020; 76:76.e1-76.e19. [PMID: 32892985 DOI: 10.1016/j.crad.2020.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022]
Abstract
This review is designed to help radiologists interested in developing a magnetic resonance imaging service for patients with symptoms of Ménière's disease. Examples are selected from our experience with delayed post-gadolinium three-dimensional (3D) fluid attenuated inversion recovery (FLAIR) inner ear imaging of endolymphatic hydrops. The imaging features of the normal and hydropic endolymphatic structures, semiquantitative grading systems, normal variations, and differential diagnoses will be illustrated, whilst appropriate clinical referrals, approaches to reporting and diagnostic pitfalls will be discussed.
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Affiliation(s)
- S E J Connor
- School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, London, UK; Department of Neuroradiology, King's College Hospital, London, UK; Department of Radiology, Guy's and St Thomas' Hospital, London, UK.
| | - I Pai
- School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, London, UK; Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' Hospital, London, UK
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Magnetic resonance imaging of Ménière's disease: early clinical experience in a UK centre. The Journal of Laryngology & Otology 2020; 134:302-310. [PMID: 32241307 DOI: 10.1017/s0022215120000626] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recent developments in magnetic resonance imaging have enabled demonstration of endolymphatic hydrops, and the clinical application of these imaging studies in Ménière's disease is being explored. OBJECTIVE To evaluate our centre's experience to date of hydrops magnetic resonance imaging in patients with episodic vertigo. METHODS Magnetic resonance imaging was performed using a high-resolution three-dimensional fluid-attenuated inversion recovery sequence on a 3 Tesla scanner at 4 hours following double-dose gadolinium administration. RESULTS The study included 31 patients, 28 of whom had a clinical diagnosis of Ménière's disease. In unilateral Ménière's disease, magnetic resonance imaging was able to lateralise endolymphatic hydrops to the clinically symptomatic ear in all cases. Mild hydrops was often seen in clinically asymptomatic ears. CONCLUSION There is a good correlation between the clinical symptoms and lateralisation of hydropic changes on magnetic resonance imaging. Further refinements of imaging techniques and grading system will likely improve the diagnostic accuracy and clinical utilisation of hydrops magnetic resonance imaging.
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12
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Attanasio G, Califano L, Bruno A, Giugliano V, Ralli M, Martellucci S, Milella C, de Vincentiis M, Russo FY, Greco A. Chronic cerebrospinal venous insufficiency and menière's disease: Interventional versus medical therapy. Laryngoscope 2019; 130:2040-2046. [PMID: 31710712 DOI: 10.1002/lary.28389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/20/2019] [Accepted: 10/15/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the incidence of chronic cerebrospinal venous insufficiency in Menière's disease patients and the effect of bilateral percutaneous transluminal angioplasty of the jugular/azygos veins compared to medical therapy. STUDY DESIGN Prospective case-control study. METHODS Five hundred fourteen subjects were included in the study, 412 affected by definite Menière's disease, and 102 healthy controls. All patients underwent audiovestibular and vascular examination. Patients with Menière's disease and concomitant cerebrospinal venous insufficiency were divided in two subgroups: patients who underwent vascular intervention with bilateral percutaneous transluminal angioplasty (PTA) of the jugular/azygos veins and patients treated with medical therapy. RESULTS Chronic cerebrospinal venous insufficiency was diagnosed in 330/412 (80.1%) Menière's disease patients and in 12/102 healthy individuals (11.8%) (P < .001). In the two chronic cerebrospinal venous insufficiency subgroups, a significant difference in Dizziness Handicap Inventory scores was found between patients in the PTA group compared to patients treated with medical therapy (31 ± 8.6 vs. 48.1 ± 14.4; P < .001); no significant differences were found for the Tinnitus Handicap Inventory scores (50.8 ± 16.58 vs. 49.6 ± 17.5; P = .23). Subjective evaluation of aural fullness was significantly better in patients in the PTA group (P = .003) as well as pure-tone average, which was significantly different between groups (49.8 ± 16.5 dB in the PTA group vs. 55.8 ± 13 in the medical therapy group; P = .035). CONCLUSIONS The results of the present study confirm the close relationship between vascular disorders and Menière's disease. The encouraging responses to vascular interventional therapy on Meniére's disease symptoms suggest that this may be a promising path for interpretation and treatment of this complex disease. LEVEL OF EVIDENCE 2b Laryngoscope, 130: 2040-2046, 2020.
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Affiliation(s)
| | - Luigi Califano
- Departmental Unit of Audiology and Phoniatrics, G. Rummo Hospital Group, Benevento, Italy
| | - Aldo Bruno
- Vascular Surgery Division, GEPOS Clinic, Telese Terme, Italy
| | | | - Massimo Ralli
- Department of Oral and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Salvatore Martellucci
- Department of Sense Organs and Ear, Nose, and Throat Department, Sapienza University of Rome, Rome, Italy
| | - Claudia Milella
- Departmental Unit of Audiology and Phoniatrics, G. Rummo Hospital Group, Benevento, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Francesca Y Russo
- Department of Sense Organs and Ear, Nose, and Throat Department, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs and Ear, Nose, and Throat Department, Sapienza University of Rome, Rome, Italy
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14
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Albera A, Canale A, Dagna F, Gervasio CF, Albera R. Hearing loss in Menière’s disease and sensorineural low-frequency fluctuating hearing loss without vertigo: are there any differences? HEARING, BALANCE AND COMMUNICATION 2018. [DOI: 10.1080/21695717.2018.1507578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Andrea Albera
- Otolaryngology Unit, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Andrea Canale
- Department of Surgical Sciences, Otolaryngology Unit, University of Turin, Turin, Italy
| | - Federico Dagna
- Department of Surgical Sciences, Otolaryngology Unit, University of Turin, Turin, Italy
| | | | - Roberto Albera
- Department of Surgical Sciences, Otolaryngology Unit, University of Turin, Turin, Italy
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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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16
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Mammarella F, Zelli M, Varakliotis T, Eibenstein A, Pianura CM, Bellocchi G. Is Electrocochleography Still Helpful in Early Diagnosis of Meniere Disease? J Audiol Otol 2017; 21:72-76. [PMID: 28704892 PMCID: PMC5516694 DOI: 10.7874/jao.2017.21.2.72] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/05/2017] [Accepted: 03/30/2017] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Despite the extensive research for the Meniere’s disease (MD), it’s pathophysiology still remains uncertain and questionable among scientists. Clinical symptoms and audiometric tests form the basis for the diagnosis. Nevertheless the differential diagnosis can be extremely challenging, due to subjective and not specific results. Incorrect diagnosis is most likely and for this reason there is a great demand for objective and reliable tests. Subjects and Methods The presence of endolymphatic hydrops is necessary condition but non enough for the diagnosis. In this study we analyze retrospectively the summating potentials (SP)/action protentials (AP) ratio from peritympanic electrocochleography in 34 patients,divided in two groups (13 patients classified as defined MD and 21 patients classified as probable MD). The purpose was to identify the utility of the exam so to be able to achieve an early defined diagnosis. Furthermore our intention was to obtain an objective test, besides the clinical criteria currently in use for the diagnosis and the classification of the MD. Results The analysis of the SP/AP results shows high predictability for the MD (positive in six out of seven cases with a sensitivity greater than 80%). Conclusions Our study demonstrates a satisfactory sensibility percentage in recurrent defined MD presentation (>80%). Early identification of MD can lead to an early treatment and control of the progression of the disease. Furthermore it could be a valuable instrument for the follow up and evaluation of the patients classified as probable MD in accordance with the criteria of the American Academy of Otolaryngology-Head and Neck Surgery (1995).
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Affiliation(s)
| | - Melissa Zelli
- ENT Department, San Camillo Forlanini Hospital, Rome, Italy
| | - Theodoros Varakliotis
- ENT Department, San Camillo Forlanini Hospital, Rome, Italy.,Department of Applied Clinical Sciences and Biotechnology (DISCAB), L'Aquila University, L'Aquila, Italy
| | - Alberto Eibenstein
- Department of Applied Clinical Sciences and Biotechnology (DISCAB), L'Aquila University, L'Aquila, Italy
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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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18
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Bruno A, Napolitano M, Califano L, Attanasio G, Giugliano V, Cavazzuti PP, Viccaro M, Masci E, Mastrangelo D, Salafia F, Mazzone S, Bernardo B, Cagnoni L, Filipo R, De Vincentis M, Greco A. The Prevalence of Chronic Cerebrospinal Venous Insufficiency in Meniere Disease: 24-Month Follow-up after Angioplasty. J Vasc Interv Radiol 2016; 28:388-391. [PMID: 28034701 DOI: 10.1016/j.jvir.2016.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/17/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate relationship between Meniere disease (MD) and chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound, magnetic resonance (MR) imaging, and venography and to evaluate the effectiveness of angioplasty of the internal jugular vein (IJV) and azygos vein (AV) in reducing symptoms of MD. MATERIALS AND METHODS Patients with a confirmed diagnosis of MD unresponsive to standard treatment underwent duplex ultrasound and MR imaging to diagnose CCSVI. Healthy volunteers were also studied to evaluate CCSVI in asymptomatic subjects. Patients with CCSVI and MD underwent venography and percutaneous transluminal angioplasty (PTA) of IJV and AV. RESULTS There were 182 patients with no clinical benefit from standard treatments evaluated. CCSVI was diagnosed in 175 (87.5%) patients with MD. Venography was performed in 69 patients to confirm the diagnosis of CCSVI. In 80% of these patients, PTA of the IJV and/or AV was effective for treating signs and symptoms of MD. In the healthy cohort, CCSVI was observed in only 12% of subjects. CONCLUSIONS These results suggest a possible etiologic relationship between CCSVI and MD that warrants further investigation.
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Affiliation(s)
- Aldo Bruno
- Vascular Surgery Division, Gepos Clinic Telese Terme, Benevento, Italy.
| | | | - Luigi Califano
- Departmental Unit of Audiology and Phoniatrics, A.O. G. Rummo [G. Rummo Hospital Group], Benevento, Italy
| | | | | | | | - Marika Viccaro
- Sense Organs Department, Sapienza University, Rome, Italy
| | - Eleonora Masci
- Sense Organs Department, Sapienza University, Rome, Italy
| | - Diego Mastrangelo
- Vascular Surgery Division, Gepos Clinic Telese Terme, Benevento, Italy
| | - Francesca Salafia
- Departmental Unit of Audiology and Phoniatrics, A.O. G. Rummo [G. Rummo Hospital Group], Benevento, Italy
| | - Salvatore Mazzone
- Departmental Unit of Audiology and Phoniatrics, A.O. G. Rummo [G. Rummo Hospital Group], Benevento, Italy
| | | | - Laura Cagnoni
- Sense Organs Department, Sapienza University, Rome, Italy
| | - Roberto Filipo
- Head and Neck Department, Umberto I Polyclinic, Rome, Italy
| | | | - Antonio Greco
- Sense Organs Department, Sapienza University, Rome, Italy
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19
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Frejo L, Soto-Varela A, Santos-Perez S, Aran I, Batuecas-Caletrio A, Perez-Guillen V, Perez-Garrigues H, Fraile J, Martin-Sanz E, Tapia MC, Trinidad G, García-Arumi AM, González-Aguado R, Espinosa-Sanchez JM, Marques P, Perez P, Benitez J, Lopez-Escamez JA. Clinical Subgroups in Bilateral Meniere Disease. Front Neurol 2016; 7:182. [PMID: 27822199 PMCID: PMC5075646 DOI: 10.3389/fneur.2016.00182] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/07/2016] [Indexed: 11/25/2022] Open
Abstract
Meniere disease (MD) is a heterogeneous clinical condition characterized by sensorineural hearing loss, episodic vestibular symptoms, and tinnitus associated with several comorbidities, such as migraine or autoimmune disorders (AD). The frequency of bilateral involvement may range from 5 to 50%, and it depends on the duration of the disease. We have performed a two-step cluster analysis in 398 patients with bilateral MD (BMD) to identify the best predictors to define clinical subgroups with a potential different etiology to improve the phenotyping of BMD and to develop new treatments. We have defined five clinical variants in BMD. Group 1 is the most frequently found, includes 46% of patients, and is defined by metachronic hearing loss without migraine and without AD. Group 2 is found in 17% of patients, and it is defined by synchronic hearing loss without migraine or AD. Group 3, with 13% of patients, is characterized by familial MD, while group 4, that includes 12% of patients, is associated by the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by AD. This approach can be helpful in selecting patients for genetic and clinical research. However, further studies will be required to improve the phenotyping in these clinical variants for a better understanding of the diverse etiological factors contributing to BMD.
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Affiliation(s)
- Lidia Frejo
- Otology and Neurotology Group CTS495, Department of Genomic Medicine - Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO) , Granada , Spain
| | - Andres Soto-Varela
- Department of Otorhinolaryngology, Division of Otoneurology, Complexo Hospitalario Universitario , Santiago de Compostela , Spain
| | - Sofía Santos-Perez
- Department of Otorhinolaryngology, Division of Otoneurology, Complexo Hospitalario Universitario , Santiago de Compostela , Spain
| | - Ismael Aran
- Department of Otolaryngology, Complexo Hospitalario de Pontevedra , Pontevedra , Spain
| | | | - Vanesa Perez-Guillen
- Department of Otorhinolaryngology, Hospital Universitario La Fe , Valencia , Spain
| | | | - Jesus Fraile
- Department of Otolaryngology, Hospital Miguel Servet , Zaragoza , Spain
| | - Eduardo Martin-Sanz
- Department of Otolaryngology, Hospital Universitario de Getafe , Getafe , Spain
| | - Maria C Tapia
- Department of Otorhinolaryngology, Instituto Antolí Candela , Madrid , Spain
| | - Gabriel Trinidad
- Department of Otorhinolaryngology, Division of Otoneurology, Complejo Hospitalario Badajoz , Badajoz , Spain
| | - Ana María García-Arumi
- Department of Otorhinolaryngology, Hospital Universitario Vall d'Hebron , Barcelona , Spain
| | - Rocío González-Aguado
- Department of Otorhinolaryngology, Hospital Universitario Marqués de Valdecilla , Santander, Cantabria , Spain
| | - Juan M Espinosa-Sanchez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine - Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain; Department of Otorhinolaryngology, Hospital San Agustin, Linares, Jaen, Spain
| | - Pedro Marques
- Department of Otorhinolaryngology, Centro Hospitalar de São João, EPE, University of Porto Medical School , Porto , Portugal
| | - Paz Perez
- Department of Otorhinolaryngology, Hospital Cabueñes , Gijón , Spain
| | - Jesus Benitez
- Department of Otolaryngology, Hospital Universitario de Gran Canaria Dr. Negrin , Las Palmas , Spain
| | - Jose A Lopez-Escamez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine - Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain; Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitalario Universidad de Granada (CHUGRA), Granada, Spain
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20
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Manzari L, Tomassoni R, Treglia E, Formisano D. Prevalence of Tinnitus in Early Stages of Ménière’s Disease. Health (London) 2016. [DOI: 10.4236/health.2016.85040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Menière's disease (MD) is a chronic multifactorial disorder of the inner ear characterized by episodic vestibular symptoms associated with sensorineural hearing loss, tinnitus, and aural pressure. Epidemiologic and genomic evidence supports a genetic susceptibility with multiple biochemical pathways involved, including the endocrine system, innate immune response, and autonomic nervous system. Allergens, infectious agents, vascular events, or genetic factors could modify inner-ear homeostasis and trigger MD. The diagnosis of MD is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing loss, tinnitus, and/or fullness) in the affected ear. Headache is also found during the attacks and bilateral involvement is found in 25-40% of cases. Audiologic and vestibular assessment is recommended to monitor the clinical course. The treatment of MD is symptomatic to obtain relief of vestibular episodes and preventive to limit hearing loss progression. Treatment options include sodium restriction, betahistine, intratympanic gentamicin, or steroids and eventually surgery, such as cochlear implantation.
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Affiliation(s)
- J M Espinosa-Sanchez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Junta de Andalucia, Granada, Spain; Department of Otolaryngology, Hospital San Agustin, Linares, Jaen, Spain
| | - J A Lopez-Escamez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Junta de Andalucia, Granada, Spain; Department of Otolaryngology, Complejo Hospitalario Universitario de Granada, Granada, Spain.
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22
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Liu Y, Jia H, Shi J, Zheng H, Li Y, Yang J, Wu H. Endolymphatic hydrops detected by 3-dimensional fluid-attenuated inversion recovery MRI following intratympanic injection of gadolinium in the asymptomatic contralateral ears of patients with unilateral Ménière's disease. Med Sci Monit 2015; 21:701-7. [PMID: 25742875 PMCID: PMC4360748 DOI: 10.12659/msm.892383] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to identify the incidence of endolymphatic hydrops using 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) in the contralateral ear in patients with unilateral Ménière’s disease (MD). Material/Methods This was a prospective study. 3D-FLAIR MRI was performed with a 3 Tesla (3 T) unit 24 h after the intratympanic administration of gadolinium (Gd) in 30 unilateral MD patients with an asymptomatic contralateral ear. The incidence of contralateral involvement in unilateral MD patients and the potential correlations between the affected and contralateral ears were analyzed. Results Endolymphatic hydrops was observed in 7 of the 30 (23.3%) asymptomatic ears. The mean PTA of the asymptomatic ears in the contralateral hydrops patients (33.0±6.1 dB) was significantly higher compared with the non-hydrops patients (17.8±5.7 dB). The patients with observed contralateral hydrops exhibited a significantly longer duration of the disease compared with the non-hydrops patients (6.7±6.3 vs. 2.9±3.1 years, respectively). Furthermore, the patients with contralateral hydrops had a worse hearing level in the affected ears compared with the non-hydrops patients (70.3±7.4 vs. 52.5±3.8 dB, respectively). Conclusions Endolymphatic hydrops is closely related to hearing loss but does not necessarily result in Ménière’s symptoms. Patients with a long history of MD and severe hearing loss in the affected ear are more likely to exhibit endolymphatic hydrops in the asymptomatic contralateral ear. Adequate attention should focus on unilateral MD patients with contralateral ear hydrops because of the potential to develop bilateral MD.
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Affiliation(s)
- Yupeng Liu
- Department of Otolaryngology - Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Huan Jia
- Department of Otolaryngology - Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Jun Shi
- Department of Otolaryngology - Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Hui Zheng
- Department of Radiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Yuhua Li
- Department of Radiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Jun Yang
- Department of Otolaryngology - Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Hao Wu
- Department of Otolaryngology - Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
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Chiarella G, Petrolo C, Cassandro E. The genetics of Ménière's disease. APPLICATION OF CLINICAL GENETICS 2015; 8:9-17. [PMID: 25609993 PMCID: PMC4293923 DOI: 10.2147/tacg.s59024] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Our understanding of the genetic basis of Ménière’s disease (MD) is still limited. Although the familial clustering and the geographical and racial differences in incidence strongly suggest a certain role for genetic factors in the development of MD, no convincing evidence for an association with any gene exists, at present. In this review, starting from rational bases for a genetic approach to MD, we explored the numerous reports published in literature and summarize the recent advances in understanding of the genetic fundaments of the disease.
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Affiliation(s)
- Giuseppe Chiarella
- Department of experimental and Clinical Medicine, Audiology and Phoniatrics Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - C Petrolo
- Department of experimental and Clinical Medicine, Audiology and Phoniatrics Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - E Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Lütkenhöner B, Basel T. Reappraisal of the glycerol test in patients with suspected Menière's disease. BMC EAR, NOSE, AND THROAT DISORDERS 2014; 14:12. [PMID: 25866475 PMCID: PMC4392460 DOI: 10.1186/1472-6815-14-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/17/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recent advances in magnetic resonance imaging make it possible to visualize the presumed pathophysiologic correlate of Menière's disease: endolymphatic hydrops. As traditional diagnostic tests can provide only indirect evidence, they are hardly competitive in this respect and need to be rethought. This is done here for the glycerol test. METHODS The data of a previous retrospective analysis of the glycerol test in patients with suspected Menière's disease are reinterpreted using a simple model. The mean threshold reduction (MTR) in the frequency range from 125 to 1500 Hz (calculated from audiograms obtained immediately before and four hours after the glycerol intake) is used as the test statistic. The proposed model explains the frequency distribution of the observed MTR by the convolution of a Gaussian probability density function (representing measurement errors) with a template representing the frequency distribution of the true MTR. The latter is defined in terms of two adjustable parameters. After fitting the model to the data, the performance of the test is evaluated using receiver operating characteristic (ROC) analysis. RESULTS The cumulative frequency distribution of the observed MTR can be explained almost perfectly by the model. According to the ROC analysis performed, the capability of the currently used audiometric procedure to detect a glycerol-induced threshold reduction corresponds to a diagnostic test of rather high accuracy (area under the ROC curve greater than 0.9). Simulations show that methodological improvements could further enhance the performance. CONCLUSIONS Owing to their ability to reveal functional aspects without an obvious morphological correlate, traditional test for Menière's disease could be decisive for defining the stage of the disease. A distinctive feature of the glycerol test is that it is capable of determining, with high accuracy, whether the pathophysiologic condition of the inner ear is partially reversible. Prospectively, this could help to estimate the chances of specific therapies.
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Affiliation(s)
| | - Türker Basel
- ENT Clinic, Münster University Hospital, Münster, Germany
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25
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Oh KH, Kim KW, Chang J, Jun HS, Kwon EH, Choi JY, Im GJ, Chae SW, Jung HH, Choi J. Can we use electrocochleography as a clinical tool in the diagnosis of Meniere's disease during the early symptomatic period? Acta Otolaryngol 2014; 134:771-5. [PMID: 24865301 DOI: 10.3109/00016489.2014.907500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONCLUSION Our results indicate that electrocochleography (ECoG) has limited value in diagnosing Meniere's disease during the early symptomatic period. OBJECTIVE We hypothesized that if endolymphatic hydrops is a cause of Meniere's disease, ECoG results obtained in normal subjects would differ from those obtained during the early symptomatic period of Meniere's disease. We aimed to investigate the usefulness of ECoG in the diagnosis of Meniere's disease during the early symptomatic period. METHODS Extratympanic ECoG was used to evaluate 60 patients in a Meniere's group (17 men, 43 women; mean age 43.6 years, range 19-62 years) and 30 controls (11 men, 19 women; mean age 43.5 years, range 21-63 years). The summating potential/action potential (SP/AP) amplitude ratio and SP/AP area ratio were compared between the groups. RESULTS Statistically significant differences were not demonstrated in the SP/AP amplitude ratio between the definite Meniere's, probable Meniere's, overall Meniere's, or control groups (0.35 ± 0.02, 0.30 ± 0.03, 0.33 ± 0.02, and 0.30 ± 0.01, respectively). Additionally, statistically significant differences were not indicated in the mean SP/AP area ratio between the definite Meniere's, probable Meniere's, overall Meniere's, or control groups (5.18 ± 0.98, 4.78 ± 0.21, 4.01 ± 0.78, and 3.72 ± 0.66, respectively).
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Affiliation(s)
- Kyoung Ho Oh
- Department of Otorhinolaryngology-Head and Neck Surgery
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26
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Outcomes after cochlear implantation for patients with single-sided deafness, including those with recalcitrant Ménière's disease. Otol Neurotol 2014; 34:1681-7. [PMID: 24232066 DOI: 10.1097/mao.0000000000000102] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Compare preoperative and postoperative performance in patients undergoing cochlear implantation (CI) for unilateral severe-to-profound sensorineural hearing loss (single-sided deafness, SSD). STUDY DESIGN IRB-approved, prospective SETTING Tertiary center PATIENTS Twenty-nine patients have undergone CI for SSD. SSD was due to Ménière's disease (MD) in 10 subjects; these also suffered from recalcitrant vertigo spells and in these 10 patients along with 2 others the CI was placed simultaneous with a labyrinthectomy. INTERVENTION(S) CI with or without labyrinthectomy. MAIN OUTCOME MEASURE(S) CNC word and AzBio sentences in quiet were administered to the implanted ear. A multiple-loudspeaker sound localization test was administered in the bilateral listening condition. All data were collected preoperatively and 3, 6, and 12 months postoperatively with postoperative data available for 19 subjects. Additionally, a tinnitus handicap questionnaire is administered pre- and 12-months post-operatively. RESULTS CNC word and AzBio sentence scores showed improvement in the implanted ear. Sound localization appeared to improve in an experience-dependent fashion in some patients. Most patients reported diminished tinnitus after cochlear implantation. All patients undergoing labyrinthectomy experienced resolution of vertigo attacks. CONCLUSION CI restores auditory function to the deafened ear. Additionally, the binaural input appears to improve sound localization for most patients. In patients with severe hearing loss and recalcitrant vertigo attacks because of MD, simultaneous labyrinthectomy and CI effectively relieves vertigo attacks and improves auditory function.
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Toktas H, Okur E, Dundar U, Dikici A, Kahveci OK. Infliximab has no apparent effect in the inner ear hearing function of patients with rheumatoid arthritis and ankylosing spondylitis. Clin Rheumatol 2014; 33:1481-7. [PMID: 24770796 DOI: 10.1007/s10067-014-2625-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/07/2014] [Accepted: 04/10/2014] [Indexed: 12/01/2022]
Abstract
Animal studies suggest that tumor necrosis factor (TNF) alpha blockers may pass to the inner ear in adequate concentration. In this prospective study, we aimed to evaluate the effect of infliximab on the inner ear hearing function in patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). The patients with high disease activity, who were planned to begin infliximab for therapy by physical medicine and rehabilitation department, were referred to ear-nose-throat clinic for consultation. After physical and otoscopic examination, audiological tests were performed. Air conduction thresholds between 250 and 8,000 Hz, bone conduction thresholds between 500 and 4,000 Hz, pure tone average, speech discrimination scores, distortion product otoacoustic emission (DPOAE) were used to evaluate the hearing function. The tests were repeated 2 and 6 months after the initiation of the drug "infliximab." A total of 44 ears of 22 patients (17 males and 5 females) were evaluated. Fifteen patients had a diagnosis of AS, and seven patients had RA. After initiation of infliximab therapy, statistically significant improvement was observed in disease activity scores [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for AS, Disease Activity Score 28 (DAS-28) for RA] after 2 and 6 months (p < 0.05). We did not find any statistically significant difference between the air conduction thresholds, bone conduction thresholds, pure tone average, speech discrimination scores, and measurements of DPOAE before the initiation of treatment and after 2 and 6 months (p > 0.05). Any problem about the balance, vertigo, or dizziness was not reported from the patients during the treatment period. As a result, our study showed that there was no notable change or deterioration in the hearing function of the patients with AS and RA who were treated with infliximab. Further studies with higher number of patients with AS and RA and also with different TNF alpha inhibitors are needed to make more valid conclusion.
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Affiliation(s)
- H Toktas
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Afyon Kocatepe University, 03200, Afyonkarahisar, Turkey
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Requena T, Espinosa‐Sanchez J, Cabrera S, Trinidad G, Soto‐Varela A, Santos‐Perez S, Teggi R, Perez P, Batuecas‐Caletrio A, Fraile J, Aran I, Martin E, Benitez J, Pérez‐Fernández N, Lopez‐Escamez J. Familial clustering and genetic heterogeneity in Meniere's disease. Clin Genet 2013; 85:245-52. [DOI: 10.1111/cge.12150] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 01/31/2023]
Affiliation(s)
- T. Requena
- Otology & Neurotology Group CTS495, Human DNA Variability Department ‐ Centro de Genómica e Investigación OncológicaPfizer/Universidad de Granada/ Junta de Andalucía (GENYO) Granada Spain
| | - J.M. Espinosa‐Sanchez
- Otology & Neurotology Group CTS495, Human DNA Variability Department ‐ Centro de Genómica e Investigación OncológicaPfizer/Universidad de Granada/ Junta de Andalucía (GENYO) Granada Spain
- Department of OtorhinolaryngologyHospital San Agustin Linares Spain
| | - S. Cabrera
- Otology & Neurotology Group CTS495, Human DNA Variability Department ‐ Centro de Genómica e Investigación OncológicaPfizer/Universidad de Granada/ Junta de Andalucía (GENYO) Granada Spain
| | - G. Trinidad
- Division of Otoneurology, Department of OtorhinolaryngologyComplejo Hospitalario Badajoz Badajoz Spain
| | - A. Soto‐Varela
- Division of Otoneurology, Department of OtorhinolaryngologyComplexo Hospitalario Universitario Santiago de Compostela Spain
| | - S. Santos‐Perez
- Division of Otoneurology, Department of OtorhinolaryngologyComplexo Hospitalario Universitario Santiago de Compostela Spain
| | - R. Teggi
- Department of OtolaryngologySan Raffaelle Scientific Institute Milan Italy
| | - P. Perez
- Department of OtorhinolaryngologyHospital Cabueñes Gijón Spain
| | | | - J. Fraile
- Department of OtolaryngologyHospital Miguel Servet Zaragoza Spain
| | - I. Aran
- Department of OtolaryngologyComplexo Hospitalario de Pontevedra Pontevedra Spain
| | - E. Martin
- Department of OtolaryngologyHospital Universitario de Getafe Madrid Spain
| | - J. Benitez
- Department of OtolaryngologyHospital Universitario de Gran Canaria Dr Negrin Las Palmas Spain
| | - N. Pérez‐Fernández
- Department of OtolaryngologyClinica Universidad de Navarra Pamplona Spain
| | - J.A. Lopez‐Escamez
- Otology & Neurotology Group CTS495, Human DNA Variability Department ‐ Centro de Genómica e Investigación OncológicaPfizer/Universidad de Granada/ Junta de Andalucía (GENYO) Granada Spain
- Department of OtolaryngologyHospital de Poniente Almería Spain
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