Metabolic management in Menière's disease

Cervical Vestibular-Evoked Myogenic Potentials in Individuals with Diabetes Mellitus: A Systematic Review and Meta-Analysis

Vestibular evoked myogenic potentials (VEMPs) in individuals with diabetes mellitus (DM) provide evidence as how diabetes can bring about changes in the peripheral nervous system. Cervical VEMP (cVEMP) evaluates the function and integrity of the sacullo- collic pathway and ocular VEMP (oVEMP) evaluates the utriculo-collic pathway. cVEMP is an ipsilateral inhibitory response of the sternocleidomastoid muscle. cVEMP is recorded at higher intensity above 80-85 dBnHL with biphasic waveforms having initial peak positivity P13 followed by a negativity N23. We performed a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to evaluate cVEMP in diabetes mellitus. The search was conducted in the databases: PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Cochrane library using the keywords "diabetes mellitus" and "vestibular evoked myogenic potential" or "cVEMP." A two-phase selection process was used for the final inclusion of studies, and the methodological quality of these studies was assessed using the Newcastle Ottawa scale (NCOS). Meta-analysis was performed using a random-effects model. For comparisons between DM and healthy controls, a significant difference was observed for cVEMP amplitude (P = 0.01). Our meta-analysis's results suggest peripheral vestibular dysfunction can be observed in DM. It appears that cVEMPs may be useful in the early detection of neuropathy in DM.

Prevalence of Ménière's Disease in Syrian Patients with hypothyroidism: Cross-sectional study

Background

Ménière's Disease, a long-term debilitating disorder has been increasingly found among patients with hypothyroidism. Our study aims to evaluate the prevalence of ménière's disease among hypothyroid patients and assess the interrelationship between patients' symptomology and ménière's disease.

Materials and methods

A cross-sectional study was performed at the endocrinology clinics at Damascus Hospital and Syrian Red Crescent Hospital, Damascus, Syria between September 2021 and January 2022. Patients with hypothyroidism were interviewed using a questionnaire. The questionnaire contained questions about socio-demographic information, hypothyroid history, diagnostic criteria of ménière's disease, chief complaint, medical history, and lab test results. Patients, who reported ménière's disease symptoms, were referred to the otorhinolaryngology clinic for confirmation or exclusion of ménière's disease. At the clinic, patients underwent an otoscopy and a pure tone audiometry, probable and definite ménière's disease was diagnosed accordingly.

Results

Of 217 hypothyroid patients included in the sample, 17 (7.8%) were diagnosed with definite ménière's disease and 31 (14.3%) were diagnosed with probable ménière's disease. Hypothyroid symptoms reported among patients diagnosed with definite ménière's disease compared to no diagnosis differed by feeling low (χ2 (1, 217) = 4.014, p = 0.045), and depressive appearance (χ2 (1, 217) = 8.887, p = 0.003). Patients diagnosed with definite ménière's disease, probable ménière's disease, and both definite and probable ménière's disease were more likely to report that their symptoms affected their lifestyle compared to those that reported no effect (χ2 (3, 217) = 62.565, p < 0.001), (χ2 (3, 217) = 31.380, p < 0.001), and (χ2 (3, 217) = 35.542, p < 0.001), respectively.

Conclusion

A high number of hypothyroid patients were diagnosed with MD. Clinicians should consider clinically screening for MD among hypothyroid patients presenting to clinics.

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This study shows a significant association between hypothyroidism and Ménière's disease.

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Rates of feeling low and depressive appearance increase in definite MD patients.

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Meniere's disease patients were predisposed to the disease's effect on their lifestyle.

Hypothyroidism is an independent risk factor for Menière's disease: A population-based cohort study

The relationship of hypothyroidism and Menière's disease (MD) has been discussed before, yet not well documented. Our study aims to investigate the correlation of both diseases.This is a retrospective cohort study based on data from the LHID2000 (Longitudinal Health Insurance Database 2000), a subset of the Taiwan National Research Health Insurance Database that contains claims data for the 2000 to 2011 period. A total of 27,050 patients were included in this study, 5410 of whom had received a hypothyroidism diagnosis. The prevalence of MD was high in patients with hypothyroidism (95% confidence interval [CI]: 1.14-1.51), especially in those older than 50 years old (P < .001). Although comorbidities such as hypertension or cirrhosis are significant risk factors for Menière's disease (P < .001, P < .05), the incidence rate of Menière's disease in patients with hypothyroidism differs significantly between groups without these comorbidities (95% CI: 1.14-1.95). Regarding the timing for the occurrence of Menière's disease in patients with hypothyroidism, there was a significant time interval of <5 years (P < .05). The risk of MD decreased after treatment with thyroxine and did not differ from that of the nonhypothyroidism cohort (adjusted HR [aHR] = 0.85, 95% CI: 0.66-1.11).The study demonstrates a significant association between hypothyroidism and Menière's disease, especially in elderly female patients. Physicians should consider verifying the thyroid function when encountering these patients.

Metabolic disorders of the vestibular system

This article reviews the impact of metabolic disorders on vestibular function. Diabetes mellitus is a disorder of glucose metabolism that can be associated with vestibular dysfunction. Vertigo can be alleviated by diet management in many cases. Elevated levels of blood lipids have been implicated in cochleovestibular disorders. Treatment with a lipid-lowering drug has resulted in improved auditory and vestibular function in a placebo-controlled trial. Hypothyroidism may affect different parts of the vestibular system depending on the severity and duration of thyroid deficiency. Severe congenital hypothyroidism can cause central vestibular disorders affecting the cerebellum, whereas mild hypothyroidism may result in peripheral vestibulopathy. Endogenous alterations in concentrations of estrogen and progesterone in the premenstrual syndrome or with the use of exogenous hormones such as oral contraceptives may trigger vertigo. Metabolic evaluations for unexplained vertigo should include a lipoprotein profile, with cholesterol and triglyceride levels, glucose tolerance test, and thyroid hormone measurements. Nutritional and drug therapy may be useful to reverse the vestibular dysfunction.

Etiology and Treatment of Fluid Retention (Hydrops) in Ménière's Syndrome

For years low sodium diets have been recommended in the treatment of Ménière's syndrome. Elevated levels of insulin play an important role in sodium retention in renal tubules. Insulin production is stimulated by high carbohydrate diets. Adrenaline, cortisone, and glucagon levels may he increased by stress or food or inhalant allergies, further elevating insulin levels. The end result of prolonged hyperinsulinemia includes vasoconstriction and eventually arterial smooth muscle hypertrophy. Individual susceptibility to Ménière's syndrome may occur as a reult of inflammatory changes in the endolymphatic sac or cochlear aqueduct secondary to primary or latent viral infections, thus predisposing to fluid retention. Long term medical treatment of Ménière's should be directed towards preventing sodium retention through sodium restriciton and carbohydrate management. Other factors including stress and allergy should also be considered.

Plasma insulin response to oral glucose load in Menière's disease

Oral glucose tolerance tests and plasma insulin measurements were carried out in 74 patients with Menière's disease and 74 control subjects. No statistically significant differences were observed in fasting, one-hour, and two-hour blood glucose levels or in fasting, one-hour, and two-hour plasma insulin levels between patients with Menière's disease and control subjects. The results do not confirm the hypothesis that disturbances in glucose metabolism or plasma insulin response are etiologic factors in Menière's disease.

Lack of utility of metabolic screening in Ménière's disease

The incidence of disturbances of carbohydrate and lipid metabolism were studied in two groups of patients; one group with Ménière's disease, the other with otosclerosis. Our observations do not support the notion that metabolic disturbances are the principal causes of the symptom complex in Ménière's disease. Results of thyroid function tests were also normal in all Ménière's patients tested.