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Mohseni-Dargah M, Falahati Z, Pastras C, Khajeh K, Mukherjee P, Razmjou A, Stefani S, Asadnia M. Meniere's disease: Pathogenesis, treatments, and emerging approaches for an idiopathic bioenvironmental disorder. ENVIRONMENTAL RESEARCH 2023; 238:116972. [PMID: 37648189 DOI: 10.1016/j.envres.2023.116972] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
Meniere's disease (MD) is a severe inner ear condition known by debilitating symptoms, including spontaneous vertigo, fluctuating and progressive hearing loss, tinnitus, and aural fullness or pressure within the affected ear. Prosper Meniere first described the origins of MD in the 1860s, but its underlying mechanisms remain largely elusive today. Nevertheless, researchers have identified a key histopathological feature called Endolymphatic Hydrops (ELH), which refers to the excessive buildup of endolymph fluid in the membranous labyrinth of the inner ear. The exact root of ELH is not fully understood. Still, it is believed to involve several biological and bioenvironmental etiological factors such as genetics, autoimmunity, infection, trauma, allergy, and new theories, such as saccular otoconia blocking the endolymphatic duct and sac. Regarding treatment, there are no reliable and definitive cures for MD. Most therapies focus on managing symptoms and improving the overall quality of patients' life. To make significant advancements in addressing MD, it is crucial to gain a fundamental understanding of the disease process, laying the groundwork for more effective therapeutic approaches. This paper provides a comprehensive review of the pathophysiology of MD with a focus on old and recent theories. Current treatment strategies and future translational approaches (with low-level evidence but promising results) related to MD are also discussed, including patents, drug delivery, and nanotechnology, that may provide future benefits to patients suffering from MD.
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Affiliation(s)
- Masoud Mohseni-Dargah
- School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109, Australia; Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zahra Falahati
- Department of Biological Sciences, Institute for Advanced Studies in Basic Sciences (IASBS), Zanjan, Iran
| | - Christopher Pastras
- School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109, Australia; The Meniere's Laboratory, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Khosro Khajeh
- Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Payal Mukherjee
- RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Amir Razmjou
- Centre for Technology in Water and Wastewater, University of Technology Sydney, New South Wales 2007, Australia
| | - Sebastian Stefani
- School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109, Australia
| | - Mohsen Asadnia
- School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109, Australia.
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Zou J, Zhang G, Li H, Zhao Z, Zhang Q, Pyykkö I, Mäkitie A. Multiple genetic variants involved in both autoimmunity and autoinflammation detected in Chinese patients with sporadic Meniere's disease: a preliminary study. Front Neurol 2023; 14:1159658. [PMID: 37273692 PMCID: PMC10232973 DOI: 10.3389/fneur.2023.1159658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/20/2023] [Indexed: 06/06/2023] Open
Abstract
Background The mechanisms of Meniere's disease (MD) remain largely unknown. The purpose of this study was to identify possible genetic variants associated with immune regulation in MD. Methods The whole immune genome of 16 Chinese patients diagnosed with sporadic MD was sequenced using next-generation sequencing. Results Definite pathological variants of MEFV (c.1223G>A, c.1105C>T), COL7A1 (c.5287C>T), and ADA (c.445C>T) contributing to the clinical phenotype were found in three patients. Limited and likely pathological variants of TLR3 (c.2228G>A) and RAB27A (c.560G>A) were detected in one patient each. The following definite pathological variants impairing the structure and function of translated proteins were detected in 10 patients, and multigene variants occurred in five patients: PRF1 (c.710C>A), UNC13D (c.1228A>C), COLEC11 (c.169C>T), RAG2 (c.200G>C), BLM (c.1937G>T), RNF31 (c.2533G>A), FAT4 (c.11498A>G), PEPD (c.788A>G), TNFSF12 (c.470G>A), VPS13B (c.11972A>T), TNFRSF13B (c.226G>A), ERCC6L2 (c.4613A>G), TLR3 (c.2228G>A), ADA (c.445C>T), PEPD (c.151G>A), and MOGS (c.2470G>A). The following limited pathological variants impairing the structure and function of translated proteins were detected in five patients, with double gene variants identified in one patient: EXTL3 (c.1396G>A), MTHFD1 (c.2057G>A), FANCA (c.2039T>C), LPIN2 (c.1814C>T), NBAS (c.4049T>C), and FCN3 (c.734G>A). Conclusion Patients with sporadic MD carry multiple genetic variants involved in multiple steps of immune regulation, which might render patients susceptible to developing inflammation via both autoimmune and autoinflammation mechanisms upon internal stress.
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Affiliation(s)
- Jing Zou
- Department of Otolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
- Research Program in Systems Oncology, Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Guoping Zhang
- Department of Otolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hongbin Li
- Department of Otolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zikai Zhao
- Department of Otolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qing Zhang
- Department of Otolaryngology-Head and Neck Surgery, 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
| | - Antti Mäkitie
- Research Program in Systems Oncology, Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Risk of Sensorineural Hearing Loss in Patulous Eustachian Tube. Otol Neurotol 2021; 42:e521-e529. [PMID: 33629826 DOI: 10.1097/mao.0000000000003059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate whether the long-term presence of a patulous Eustachian tube (PET) is associated with sensorineural hearing loss (SNHL). STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Ears (n = 100) were classified into two groups based on duration of PET symptom(s), i.e., Short (≤3 mo; n = 47 ears) and Long (≥48 mo; n = 53 ears). Contralateral ears without PET (n = 28 ears) were classified as the Contralateral group. MAIN OUTCOME MEASURES We used ISO 7029 to calculate the hearing thresholds of an age- and sex-matched population at a given frequency. Hearing loss was defined as >25% of these calculated values. RESULTS At 4 kHz, the Long PET group showed a higher prevalence of hearing loss (47%) at 4 kHz than did the Contralateral (21%) and Short PET (19%) groups (p = 0.0280 and 0.0043, respectively). Ears with breathing autophony or a sonotubometric low probe tone level showed a higher prevalence of hearing loss at 4 kHz than those without this symptom or with a high probe tone level (p = 0.0329 or 0.0103, respectively). At low frequencies, ≥89% of the ears in all groups showed mild hearing loss. CONCLUSION Chronic PET was associated with SNHL at 4 kHz. PET patients showed low-frequency hearing loss regardless of disease duration. Further studies are needed to better understand the pathophysiology of SNHL in patients with PET.
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Iwasaki S, Shojaku H, Murofushi T, Seo T, Kitahara T, Origasa H, Watanabe Y, Suzuki M, Takeda N. Diagnostic and therapeutic strategies for Meniere's disease of the Japan Society for Equilibrium Research. Auris Nasus Larynx 2020; 48:15-22. [PMID: 33131962 DOI: 10.1016/j.anl.2020.10.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We provided diagnostic and therapeutic strategies for Meniere's disease in accordance with Japanese Clinical Practice Guideline of Meniere's disease and delayed endolymphatic hydrops 2nd ed. Tokyo: Kanehara Shuppan; 2020 edited by the Japan Society for Equilibrium Research. METHODS The Committee for Clinical Practice Guidelines was entrusted with a review of the scientific literature on the above topic. Clinical Questions (CQs) concerning the treatment for Meniere's disease were produced, and the literature according to each of them including CQ was searched. The recommendations are based on the literature review and the expert opinion of a subcommittee. RESULTS Diagnosis criteria of Meniere's disease are classified into Meniere's disease with typical cochlear and vestibular symptoms, and atypical Meniere's disease with either cochlear symptoms or vestibular symptoms. Treatment of Meniere's disease was composed of lifestyle changes, medications such as anti-vertigo drugs and diuretics, middle ear positive pressure treatment, and selective destruction of the vestibule. CONCLUSION Meniere's disease is diagnosed based on clinical histories and examination findings after processes of differential diagnosis. Treatment option of the disease should be selected in order of invasiveness, according to the severity of the disease and the response to each treatment.
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Affiliation(s)
- Shinichi Iwasaki
- Department of Otolaryngology & Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hideo Shojaku
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
| | - Toshihisa Murofushi
- Department of Otolaryngology, Teikyo University Hospital Mizonokuchi, Kawasaki, Japan
| | - Toru Seo
- Department of Otolaryngology, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology- Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Hideki Origasa
- Department of Biostatistics and Clinical Epidemiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yukio Watanabe
- Ohsawano Rehabilitation Facility for the Elderly Kagayaki, Toyama, Japan
| | - Mamoru Suzuki
- Department of Otolaryngology, Tokyo Medical University, Tokyo, Japan
| | - Noriaki Takeda
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
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Naganuma H, Kawahara K, Tokumasu K, Satoh R, Okamoto M. Effects of arginine vasopressin on auditory brainstem response and cochlear morphology in rats. Auris Nasus Larynx 2014; 41:249-54. [DOI: 10.1016/j.anl.2013.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 12/01/2013] [Accepted: 12/09/2013] [Indexed: 11/27/2022]
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Zapata C, López-Escámez JA. Estudio piloto de la salud sexual en pacientes con enfermedad de Ménière. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 62:119-25. [DOI: 10.1016/j.otorri.2010.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 09/06/2010] [Accepted: 09/08/2010] [Indexed: 01/09/2023]
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Zapata C, López-Escámez JA. A pilot study of sexual health in patients with Ménière's disease. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/s2173-5735(11)70021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Goto F, Nakai K, Kunihiro T, Ogawa K. Case report: a case of intractable Meniere's disease treated with autogenic training. Biopsychosoc Med 2008; 2:3. [PMID: 18221543 PMCID: PMC2265298 DOI: 10.1186/1751-0759-2-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 01/25/2008] [Indexed: 11/16/2022] Open
Abstract
Background Psychological stress plays an important role in the onset and course of Meniere's disease. Surgical therapy and intratympanic gentamicin treatment are options for cases that are intractable to conventional medical therapy. Psychotherapy, however, including autogenic training (AT), which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of AT in a subject suffering from intractable Meniere's disease. Case presentation A 51-year-old male patient has suffered from fluctuating right sensorineural hearing loss with vertigo since 1994. In May 2002, he was first admitted to our hospital due to a severe vertigo attack accompanied by right sensorineural hearing loss. Spontaneous nystagmus toward the right side was observed. Since April 2004, he has experienced vertigo spells with right-sided tinnitus a few times per month that are intractable to conventional medical therapy. After four months, tympanic tube insertion was preformed in the right tympanic membrane. Intratympanic injection of dexamethasone was ineffective. He refused Meniett therapy and intratympanic gentamicin injection. In addition to his vertigo spells, he suffered from insomnia, tinnitus, and anxiety. Tranquilizers such as benzodiazepines and antidepressants such as serotonin selective re-uptake inhibitors (SSRIs) failed to stop the vertigo and only slightly improved his insomnia. In December 2006, the patient began psychological counseling with a psychotherapist. After brief psychological counseling along with cognitive behavior therapy (CBT), he began AT. He diligently and regularly continued his AT training in his home according to a written timetable. His insomnia, tinnitus, and vertigo spells disappeared within a few weeks after only four psychotherapy sessions. In order to master the six standard formulas of AT, he underwent two more sessions. Thereafter, he underwent follow-up for 9 months with no additional treatment. He is now free from drugs, including tranquilizers, and has continued AT. No additional treatment was performed. When we examined him six and nine months later for follow-up, he was free of vertigo and insomnia. Conclusion AT together with CBT can be a viable and palatable treatment option for Meniere's disease patients who are not responsive to other therapies.
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Affiliation(s)
- Fumiyuki Goto
- Department of Otorhinolaryngology, Hino Municipal Hospital, Tamadaira 4-3-1, Hino-shi, Tokyo 191-0062, Japan.,Department of Otolaryngology, Keio School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8520, Japan
| | - Kimiko Nakai
- Department of Otorhinolaryngology, Hino Municipal Hospital, Tamadaira 4-3-1, Hino-shi, Tokyo 191-0062, Japan.,Department of Otolaryngology, Keio School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8520, Japan
| | - Takanobu Kunihiro
- Department of Otolaryngology, Keio School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8520, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology, Keio School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8520, Japan
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Ibekwe TS, Ijaduola GTA. Meniere’s disease: rare or underdiagnosed among Africans. Eur Arch Otorhinolaryngol 2007; 264:1399-403. [PMID: 17610076 DOI: 10.1007/s00405-007-0377-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 06/12/2007] [Indexed: 11/26/2022]
Abstract
Meniere's disease can easily be misdiagnosed because several otological disorders mimic the disease. Conflicting reports on the incidence of this disease among the Africans had been documented. The goal of our study was to verify the prevalence and clinical features of Meniere's disease in WA sub-region. A 10 year (1996-2005) retrospective study carried out in our hospital. The diagnostic criteria for the disease were outlined and Oyedeji's social classification instrument was adapted for socio-economic stratification of patients. The method of treatment and prognostic out-come were discussed. Out of 11,463 patients seen within the period, 25 (16 females and 9 males) met the diagnostic criteria for Meniere's disease. The age ranged from 27 to 75 years (mean=47.2 SD13.2) and the most predominant age group was 41-50 years. Sixty-eight percent were of low socio-economic class and the rest high. About 84% had unilateral and 16% bilateral Meniere's disease. All the patients presented with tinnitus, vertigo and audiologically confirmed sensorineural hearing loss. CT-scan and MRI were used to rule out some differentials, while caloric and recruitment tests were used to strengthen the diagnosis. Treatment regimen (conservative) outcome: 72% had good improvement, 8% fair, while 20% absconded from follow-up. The prevalence of Meniere's disease in West African sub-region is 0.22%. This prevalence among Africans may not differ from the Caucasians. Under- or over-diagnosis of the disease previously must have been responsible for the contrasting results. Appropriate diagnostic tools are necessary for accurate diagnosis of the disease.
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Affiliation(s)
- T S Ibekwe
- Department of Otorhinolaryngology, College of Medicine University of Ibadan, University College Hospital Ibadan, Ibadan, Nigeria.
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Takahashi M, Odagiri K, Sato R, Wada R, Onuki J. Personal factors involved in onset or progression of Ménière's disease and low-tone sensorineural hearing loss. ORL J Otorhinolaryngol Relat Spec 2005; 67:300-4. [PMID: 16374064 DOI: 10.1159/000089412] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To identify personal causative factors for Ménière's disease. PROCEDURES Patterns of hearing loss progression were studied in patients with Ménière's disease and low-tone sensorineural hearing loss, and the involvement of stress and the relation of stressors to the onset or progression of the disease were analyzed. RESULTS Low-tone loss recurred in 40% of patients even after hearing was restored, and low-tone loss progressed to high-tone loss after frequent repetitions of recovery and recurrence. High-tone loss tended to proceed to all-tone loss. Eighty percent of patients reported that stress was involved or deeply involved in the onset or progression of the disease. Common causative stressors were business-related pressure, insufficient sleep, and troubles at the workplace or at home. CONCLUSIONS The present findings indicate that recovery and recurrence may be influenced by the strength and duration of stress that is produced when patients do not feel rewarded for engrossment in their work or for self-inhibiting behaviors.
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Affiliation(s)
- Masahiro Takahashi
- Department of Otolaryngology, Tokai University School of Medicine, Iseharashi, Japan.
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