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Christopher LH, Wilkinson EP. Meniere's disease: Medical management, rationale for vestibular preservation and suggested protocol in medical failure. Am J Otolaryngol 2021; 42:102817. [PMID: 33202330 DOI: 10.1016/j.amjoto.2020.102817] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023]
Abstract
Meniere's disease is a peripheral audiovestibular disorder characterized by vertigo, hearing loss, tinnitus, and aural fullness. Management of these symptoms includes medical and surgical treatment. Many patients with Meniere's disease can be managed using nonablative therapy, such as intratympanic steroids and endolymphatic shunt surgery, prior to ablative techniques such as intratympanic gentamicin. Recognition of concurrent migraine symptoms may aid in medical therapy and also underscore the importance of preserving vestibular function where possible. The goal of this review is to explain the importance of nonablative therapy options and discuss treatment protocols after medical failure.
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Affiliation(s)
| | - Eric P Wilkinson
- House Ear Clinic, House Institute Foundation, United States of America.
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Zhou R, Leng Y, Liu B. Vestibulo-ocular reflex tests may reflect unilateral Ménière disease progression: A cross-sectional study. Medicine (Baltimore) 2020; 99:e23706. [PMID: 33350750 PMCID: PMC7769311 DOI: 10.1097/md.0000000000023706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/17/2020] [Indexed: 01/08/2023] Open
Abstract
Vestibular disorders can manifest several patterns of horizontal vestibulo-ocular reflex (VOR) impairment, which can be detected by caloric test and video head impulse test (vHIT). Several studies have examined the patterns of caloric-vHIT response in Ménière disease (MD). The purpose of this study was to investigate the diversity of caloric-vHIT response and its related factors in unilateral MD patients. We also explore the possibility of assessing the progression of unilateral MD by using the horizontal VOR tests.Ninety-eight patients with unilateral MD were enrolled and underwent a battery of audio-vestibular evaluations, including the pure tone audiogram, caloric test, and horizontal vHIT. Some patients received the electrocochleography and glycerol test. The combined results of caloric test and horizontal vHIT were categorized qualitatively into 4 patterns: Pattern I: normal caloric and vHIT responses; Pattern II: abnormal caloric and normal vHIT responses; Pattern III: normal caloric and abnormal vHIT response; and Pattern IV: abnormal caloric and vHIT responses. The abnormal caloric results were semi-quantitatively subdivided into sub-patterns as mild, moderate, and severe abnormality. The associations between these patterns/sub-patterns and related factors were analyzed.Pattern I was found in 35 cases (35.7%), Pattern II in 57 (58.2%), and Pattern IV in 6 (6.1%). No patient had Pattern III. No significant differences were found between the patterns/sub-pattern distribution and age, electrocochleography, and glycerol test results. Disease duration was not associated with the pattern distribution, while remained a relation with sub-pattern distribution. The pattern/sub-pattern distribution varied significantly across MD stages. The proportion of pattern II or pattern IV increased with the stage of unilateral MD.MD can manifest several patterns of horizontal VOR impairment, of which the impaired caloric response with normal vHIT is the most common pattern. With the progression of unilateral MD, the caloric-vHIT pattern tends to shift, which may reflect the deterioration of endolymphatic hydrops and vestibular hair cells impairments.
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Viola P, Pisani D, Scarpa A, Cassandro C, Laria C, Aragona T, Ciriolo M, Spadera L, Ralli M, Cavaliere M, Iengo M, Chiarella G. The role of endogenous Antisecretory Factor (AF) in the treatment of Ménière's Disease: A two-year follow-up study. Preliminary results. Am J Otolaryngol 2020; 41:102673. [PMID: 32829060 DOI: 10.1016/j.amjoto.2020.102673] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/15/2020] [Accepted: 08/09/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the effects of increased endogenous Antisecretory Factor (AF) synthesis using specially processed cereals (SPC) in a sample of patients with defined unilateral Meniere's disease (MD), compared to the results of a treatment protocol of intravenous glycerol and dexamethasone. MATERIALS AND METHODS Twenty-six patients with unilateral MD were divided in 2 groups and treated with SPC and with intravenous glycerol and dexamethasone for 24 months. Audio-vestibular evaluation was performed before (T0) and every six months. The number of vertigo spells were evaluated before and after therapy and the Efficacy Index (EI) was calculated. Questionnaires for hearing loss, tinnitus and quality of life were administered. RESULTS EI decreased in the SPC group after 18 (T18) (p = .0017) and 24 (T24) months of therapy (p = .0111). There was a significant reduction for tinnitus score in the SPC group at T24 (p = .0131). No significant differences were found between the two groups at T0 (p = .4723), while a significant difference was found at T24 (p = .0027). Quality of life showed a significant improvement in daily activities in the SPC group (p = .0033) compared to the infusion therapy group. No statistically significant changes in PTA thresholds were found in both groups between T0 and T24. CONCLUSION The preliminary results of our study show a significant reduction of vertigo spells and a positive effect on tinnitus severity and on quality of life in patients with unilateral MD treated with SPC and when compared to patients treated with intravenous glycerol and dexamethasone. No effects on hearing thresholds were noted in both groups.
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Affiliation(s)
- Pasquale Viola
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Davide Pisani
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
| | | | - Carla Laria
- Department of Neurosciences, Reproductives and Odontostomatologic Sciences, Unit of Audiology, University of Naples "Federico II", Naples, Italy
| | | | - Marco Ciriolo
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Lucrezia Spadera
- Otolaryngology, San Leonardo Hospital, Castellammare di Stabia, Napoli, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Michele Cavaliere
- Department of Neurosciences, Reproductives and Odontostomatologic Sciences, Unit Ear, Nose and Throat Section, University of Naples "Federico II", Naples, Italy
| | - Maurizio Iengo
- Department of Neurosciences, Reproductives and Odontostomatologic Sciences, Unit Ear, Nose and Throat Section, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
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Peng A, Hu J, Wang Q, Jiang W, Liu W, Zhang Z, Huang C, Chen Y. Modulation of hearing function following the downgrading or upgrading of endolymphatic hydrops in Meniere's disease patients with endolymphatic duct blockage. PLoS One 2020; 15:e0240315. [PMID: 33125386 PMCID: PMC7598453 DOI: 10.1371/journal.pone.0240315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/23/2020] [Indexed: 12/16/2022] Open
Abstract
The present study was to investigate the dynamics of endolymphatic hydrops (EH) and hearing function, and explore whether the hearing loss is caused by EH alone and whether the hearing function can be modulated by changes in the EH. The extent of EH visualized by gadolinium (Gd)-enhanced inner ear magnetic resonance imaging, hearing thresholds and the summating potential/action potential ratio (-SP/AP ratio) of electrocochleography (ECochG) were recorded prior to and following surgery in 22 patients with intractable Meniere's disease (MD) who underwent endolymphatic duct blockage (EDB). The difference value of the hearing threshold and -SP/AP ratio was significantly positively correlated with the difference value of the endolymph to vestibule-volume ratio (EVVR) and grading of cochlear hydrops between prior to and following surgery. Among patients with a decreased EVVR, the average hearing threshold and -SP/AP ratio was significantly decreased following surgery, as compared to that prior to surgery. Six out of seven patients with a hearing improvement (≥10-dB decline) and 4/5 patients with a negative conversion of EcochG showed downgrading of their hydrops in the cochlea and/or vestibule. By contrast, among patients with an increased EVVR, the average hearing threshold and -SP/AP ratio tended to increase following EDB, as compared with that prior to surgery. One out of two patients with a hearing deterioration (≥10-dB elevation) showed upgrading of her hydrops in both cochlea and vestibule. The present results showed the downgrading of cochlear and/or vestibular hydrops accompanied by the downregulation of the hearing threshold and -SP/AP ratio of EcochG, as well as the upgrading of cochlear and/or vestibular hydrops that tended to upregulate the hearing threshold and -SP/AP ratio of EcochG; this suggested that hearing loss is likely to be caused by hydrops and that the impaired hearing function be modulated by changes in the hydrops.
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Affiliation(s)
- Anquan Peng
- Department of Otolaryngology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Junjiao Hu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qin Wang
- Department of Otolaryngology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenqi Jiang
- Department of Otolaryngology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Liu
- Department of Otolaryngology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiwen Zhang
- Department of Otolaryngology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chao Huang
- Department of Otolaryngology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yichao Chen
- Department of Otolaryngology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Abstract
Ménière's disease (MD) is a complex, multifactorial disorder of the inner ear that is the most common cause of the syndrome of episodic vertigo combined with fluctuating hearing loss. In spite of a century of investigation, the etiology and pathophysiology of MD remain controversial and incompletely understood. Among the factors that have contributed to these controversies are the absence of (1) a validated clinical test, (2) an appropriate animal model, and (3) a specific treatment. Nonetheless, physicians are able to assist MD patients with a variety of tailored, symptom-specific medications and therapies. Given that the vertigo induced by MD, in general, is self-limited, the long-term outlook for balance function is good. The same cannot be said for the hearing dysfunction of MD.
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Affiliation(s)
- George A Gates
- Department of Otolaryngology and Head and Neck Surgery, University of Washington, Seattle, WA 98195, USA.
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Abstract
Fitting amplification to a patient with Ménière's disease (MD) can present several challenges to the dispensing audiologist. These challenges include the presence of fluctuating hearing loss, a rising audiometric configuration, unilateral or asymmetrical hearing loss, reduced dynamic range, and reduced word-recognition scores. The presence of any one of these characteristics could create obstacles for a successful hearing aid fit. The presence of most if not all of these characteristics in a single patient can readily challenge the skills of even the most experienced dispensing audiologist. In addition to the audiometric challenges, this patient population has the added psychological problems associated with feeling ill due to the nausea secondary to vertiginous attacks and the anxiety associated with the unpredictable nature of the course of these attacks. This paper summarizes numerous strategies and technologies that could be implemented by the audiologist to address these unique challenges and provide a greater opportunity for a successful hearing aid fit. These suggestions include (1) advantages offered by digital signal processing; (2) using directional microphones and assistive listening devices to improve speech recognition in noise; (3) using wireless hearing aids as well as the bone anchored hearing aid; (4) counseling patients on the realistic expectations from amplification in noisy listening situations and for those with poor speech recognition; (5) using multiple programs for patients with fluctuating hearing loss; and (6) offering suggestions on programming the frequency-gain/output response for a rising configuration.
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Affiliation(s)
- Michael Valente
- Michael Valente, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Box 8115, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
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Abstract
Electrocochleography (ECochG) has evolved as an important tool in the diagnosis/assessment/monitoring of Ménière's disease/endolymphatic hydrops (MD/ELH). This manuscript provides an update on the use of ECochG for these purposes. The material presented includes descriptions of the components of the electrocochleogram; ECochG recording approaches and parameters; how to prepare for an exam, including subject/patient considerations; construction and placement of a tympanic membrane recording electrode; and interpretation the electrocochleogram. Various approaches aimed at improving ECochG's sensitivity and specificity to MD/ELH also are described. These approaches go beyond simple measurement of the now-conventional summating potential (SP)/action potential (AP) magnitude ratio to include the SP magnitude to tonebursts, the SP/AP area ratio, and the AP latency difference to clicks of opposing polarity.
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Affiliation(s)
- John A Ferraro
- Hearing and Speech Department, University of Kansas Medical Center, Kansas City, KS 66160-7605, USA.
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Kakigi A, Egami N, Uehara N, Fujita T, Nibu KI, Yamashita S, Yamasoba T. Live imaging and functional changes of the inner ear in an animal model of Meniere's disease. Sci Rep 2020; 10:12271. [PMID: 32704101 PMCID: PMC7378199 DOI: 10.1038/s41598-020-68352-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/23/2020] [Indexed: 11/20/2022] Open
Abstract
The symptoms of Meniere's disease (MD) are generally considered to be related to endolymphatic hydrops (EH). There are many recent reports supporting the possibility that vasopressin (VP) is closely linked to the formation of EH in Meniere's disease. Based on this, we developed a clinically relevant animal model of Meniere's disease in which a VP type 2 receptor agonist was administered after electrocauterization of the endolymphatic sac. We report live imaging of the internal structure, and functional changes of the inner ear after electrocauterization of the endolymphatic sac and administration of a VP type 2 receptor agonist. In this model, the development of EH was visualized in vivo using optical coherence tomography, there was no rupture of Reissner's membrane, and low-tone hearing loss and vertiginous attacks were observed. This study suggested that acute attacks are caused by the abrupt development of EH. This is the first report of live imaging of the development of EH induced by the administration of a VP type 2 receptor agonist.
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Affiliation(s)
- Akinobu Kakigi
- Department of Otolaryngology-Head and Neck Surgery, Kobe University, Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Naoya Egami
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Natsumi Uehara
- Department of Otolaryngology-Head and Neck Surgery, Kobe University, Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takeshi Fujita
- Department of Otolaryngology-Head and Neck Surgery, Kobe University, Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University, Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shinji Yamashita
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, 153-8904, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
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Neri G, Bondi D, Scordella A, Tartaro A, Neri L, Cazzato F, Pini N, Mariggiò MA. Menière's disease patients improve specific posturographic parameters following diagnostic intratympanic injection. Am J Otolaryngol 2020; 41:102468. [PMID: 32248954 DOI: 10.1016/j.amjoto.2020.102468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Evaluation of specific computerized posturographic parameters in patients with Menière's disease (MD) following the intratympanic injection of gadolinium, a contrast agent, used in radiological diagnosing. MATERIALS AND METHODS We have observed 12 adult patients with unilateral Menière's Disease subjected to inner ear magnetic resonance imaging (MRI) examination after intratympanic gadolinium injection (ITG). The diagnoses have been performed according to the guidelines of the American Academy of otolaryngology. Before and after 24 h the ITG, all patients were subjected to the clinical evaluation and computerized posturography (CP), in 4 conditions depending on open/closed eyes and with/without foam cushion under feet. RESULTS After ITG, in the affected ear the MRI confirmed the endolymphatic hydrops revealing a thin or even disappeared perilymphatic space. The statokinesigram showed improvement of stability only with closed eyes on a foam cushion. The CP performed 24 h after the contrast intratympanic injection showed a significant reduction of Path Length and Confidence Ellipse Area, due to an improvement of vestibular function on static balance. This improvement could be directly dependent to intratympanic pressure modification mediated by volume of contrast liquid, by "columella effect". CONCLUSIONS This study demonstrates the absence of vestibular damage in patients undergoing intratympanic gadolinium infiltration and confirms the relationship between intratympanic pressure and vestibular stability modifications providing positive evidences for an applicative use of CP as a functional assessment to better address diagnosis and follow-up in MD patients treated with intratympanic injections.
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Affiliation(s)
- Giampiero Neri
- Department of Neuroscience, Imaging e Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.
| | - Danilo Bondi
- Department of Neuroscience, Imaging e Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy; Laboratory of Functional Evaluation, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Andrea Scordella
- Laboratory of Functional Evaluation, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Armando Tartaro
- Department of Medical and Oral Sciences and Biotechnologies, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Letizia Neri
- Department of Medical and Oral Sciences and Biotechnologies, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Fiorella Cazzato
- Department of Medical and Oral Sciences and Biotechnologies, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Niccolò Pini
- Department of Neuroscience, Imaging e Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy; Laboratory of Functional Evaluation, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Maria Addolorata Mariggiò
- Department of Neuroscience, Imaging e Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
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Wu V, Sykes EA, Beyea MM, Simpson MTW, Beyea JA. Approach to Ménière disease management. Can Fam Physician 2019; 65:463-467. [PMID: 31300426 PMCID: PMC6738466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To provide family physicians with an updated approach to the diagnosis and management of Ménière disease (MD), detailing the natural course of MD and describing how to initiate medical therapy while awaiting consultation with otolaryngology-head and neck surgery. SOURCES OF INFORMATION The approach is based on the authors' clinical practices and review articles from 1989 to 2018. Most of the cited studies provided level II or III evidence. MAIN MESSAGE Ménière disease is an uncommon disorder of the inner ear causing vertigo attacks with associated unilateral hearing loss, tinnitus, and aural fullness. It has a degenerative course that often results in permanent sensorineural hearing loss. On average, MD stabilizes with no further vestibular attacks by about 8 years after the onset of symptoms; however, this is highly variable. Vertigo symptoms can be controlled through a combination of dietary salt restriction, stress reduction, and medical therapy (betahistine, diuretics, or both). These can be initiated by family physicians before consultation with otolaryngology-head and neck surgery. Symptoms refractory to such strategies can be treated using nonablative, and occasionally ablative, therapies. CONCLUSION A thorough history is key to the approach to and management of MD and permits differentiating MD from other vestibular and nonvestibular conditions.
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Affiliation(s)
- Vincent Wu
- First-year resident in the Department of Otolaryngology-Head and Neck Surgery at the University of Toronto in Ontario.
| | - Edward A Sykes
- Medical student in the Department of Otolaryngology at Queen's University in Kingston, Ont
| | - Michael M Beyea
- Fourth-year resident in the Department of Emergency Medicine at Western University in London, Ont
| | | | - Jason A Beyea
- Otologist, neurotologist, and cranial base surgeon, Clinician Scientist, and Assistant Professor in the Department of Otolaryngology at Queen's University, and Adjunct Scientist at ICES Queen's
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Pyykkö I, Manchaiah V, Zou J, Levo H, Kentala E. Association between Syncope and Tumarkin Attacks in Ménière's Disease. J Int Adv Otol 2019; 15:135-140. [PMID: 31058603 PMCID: PMC6483450 DOI: 10.5152/iao.2019.6094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/15/2019] [Accepted: 03/19/2019] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The aim of the current study was to further collect evidence that would confirm the hypothesis that vestibular drop attacks (VDAs) could cause syncope in patients with Ménière's disease (MD). MATERIALS AND METHODS A cross-sectional survey design was employed in the present study. An Internet-based survey was administered on 602 individuals with MD. The mean age of the participants was 56.7 (25-75) years, and the mean duration of the disease was 12.4 (0.5-35) years. RESULTS VDAs with varying severity were present among 307 (50.7%) patients and led to fall in 92 patients, and syncope occurred in 45 patients with VDA. The overall percentage of syncope due to MD was 4.7%. Factors, such as duration of disease, age, and gender of the patient, did not explain attacks of syncope. Migraine and headache were not associated with syncope. Syncope was witnessed in 23 and self-reported by 22 patients. Syncope was associated with frequent VDA, duration of VDA, and falls that occurred during VDA. Patients with syncope reported the experience as frightening, had reduced general health-related quality of life, had higher anxiousness scores, and suffered more from fatigue. They also experienced problems with work, employment, and social restrictions. CONCLUSION Approximately 5% of patients with MD suffer from syncope, and syncope occurs among patients with VDA. In vestibular syncope, the sympathetic tone is lost, and baroreflex feedback is inhibited leading to fall and syncope. The consequences of vestibular syncope are severe, and patients face injuries and a significantly reduced quality of life.
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Affiliation(s)
- Ilmari Pyykkö
- Department of Otolaryngology, University of Tampere, School of Medicine, Tampere, Finland
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, School of Medicine, Beaumont, USA
| | - Jing Zou
- Department of Otolaryngology, University of Tampere, School of Medicine, Tampere, Finland
| | - Hilla Levo
- Department of Otolaryngology, University of Helsinki, School of Medicine, Helsinki, Finland
| | - Erna Kentala
- Department of Otolaryngology, University of Helsinki, School of Medicine, Helsinki, Finland
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Abstract
This article reviews 3 aspects of Meniere's disease (MD), which have been recently revisited: namely, the pathologic mechanism causing the attacks of vertigo, the clinical diagnosis, and the medical and surgical treatments. The characteristic attacks of vertigo are unlikely to be due to membrane ruptures, so a hypothesis that the vertigo is caused by a volume of endolymph shifting suddenly from the cochlea into the pars superior is suggested. The definite diagnosis according to the American Academy of Otolaryngology HNS 1995 criteria [<citeref rid="ref13">13</citeref>] failed to exclude vestibular migraine sufficiently and a revision in 2015 [<citeref rid="ref14">14</citeref>] has partly addressed this problem but another method which stresses the interaction of the cochlear and vestibular symptoms is described. The treatment of MD has been updated, providing evidence for each popular therapy. Newer treatments using intratympanic medications including steroid solutions and gentamicin are discussed. Finally, the role of cochlear implants is mentioned.
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Jian H, Yu G, Chen G, Lin N, Wang H. Correlation between auditory-vestibular functions and estrogen levels in postmenopausal patients with Meniere's disease. J Clin Lab Anal 2019; 33:e22626. [PMID: 30030864 PMCID: PMC6430344 DOI: 10.1002/jcla.22626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/30/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To investigate auditory and vestibular functions, estrogen levels, and its clinical correlation in postmenopausal females with Meniere's disease (MD). METHODS We retrospectively analyzed the serum estradiol (E2) levels and the auditory and vestibular functions measured by auditory brainstem response (ABR) to high click rate, pure-tone audiometry (PTA), and caloric test on postmenopausal women who suffered from MD or not at the Specialist Clinic of Vertigo, Shandong Provincial Hospital, during September 2010 to October 2014. RESULTS A total of 76 postmenopausal patients with MD and 50 healthy postmenopausal controls were included. The patients with MD had lower estrogen levels (22.50 ± 16.66 pg/mL vs 30.69 ± 18.59 pg/mL, P = 0.011), longer I-V interpeak latency of ABR (left 0.22 ± 0.16 mseconds vs 0.18 ± 0.10 mseconds, P = 0.118; right 0.24 ± 0.13 mseconds vs 0.17 ± 0.09 mseconds, P = 0.001), and higher unilateral weakness (UW) value (P < 0.001) in comparison with the controls. The mean pure-tone thresholds of at the speech frequency (500 Hz, 1 kHz, 2 kHz, and 3 kHz) were significantly elevated in patients with MD than those in the controls (left P < 0.001, right P < 0.01). The estradiol level of patients with MD was correlated with ABR latency (left r = -0.229, P < 0.05; right r = -0.220, P < 0.05) and UW value (r = -0.328, P < 0.05), but not with mean pure-tone threshold. CONCLUSIONS Estrogen levels correlated with auditory and vestibular function in postmenopausal patients with MD. Low estrogen may be involved in the microcirculatory disturbance of the inner ear, affecting the occurrence and development of MD.
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Affiliation(s)
- Huirong Jian
- Department of Otolaryngology‐Head and Neck SurgeryShandong Provincial Hospital Affiliated to Shandong UniversityJinanChina
| | - Gang Yu
- Department of Otolaryngology‐Head and Neck SurgeryShandong Provincial Hospital Affiliated to Shandong UniversityJinanChina
| | - Gang Chen
- Department of Otolaryngology‐Head and Neck SurgeryShandong Provincial Hospital Affiliated to Shandong UniversityJinanChina
| | - Naifen Lin
- Department of Otolaryngology‐Head and Neck SurgeryShandong Provincial Hospital Affiliated to Shandong UniversityJinanChina
| | - Haibo Wang
- Department of Otolaryngology‐Head and Neck SurgeryShandong Provincial Hospital Affiliated to Shandong UniversityJinanChina
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Tian YS, Zhang XJ, Ma R, Liu Y, Liu P, Zhang Y, Guo LR, Wang SZ, Wang D, Duan X, Yao Y. [Study on the shift of ocular vestibular evoked myogenic potentials frequency tuning of Meniere's disease]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 53:904-908. [PMID: 30585001 DOI: 10.3760/cma.j.issn.1673-0860.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective: To study the shift of oVEMP frequency tuning of unilateral Meniere's disease, by analyzing oVEMP of air-conducted tone bursts in various frequencies. Methods: From May 2016 to October 2017, 33 patients with unilateral Meniere's from Aerospace Center Hospital were tested for oVEMP in 500 Hz and 1 000 Hz air-conducted tone bursts respectively, and 20 healthy subjects(40 ears), matched for age and sex, were used as healthy control. The amplitudes of the N1-P1 wave and the frequency amplitude ratios of 500/1 000 Hz in affected ears, unaffected ears and normal ears were compared; and receiver operating characteristic curve was analyzed for frequency amplitude ratios of 500/1 000 Hz. Results: By the 500 Hz tone-burst stimulus, the provocation rates of the oVEMP were 84.9%(28/33), 93.9%(31/33) and 97.5%(39/40) in affected ears, contralateral ears and the ears of normal controls, respectively. By the stimulus of 1 000 Hz tone-burst, the provocation rates of the oVEMP were 81.8%(27/33), 87.9%(29/33) and 82.5% (33/40) in affected ears, contralateral ears and normal control ears, respectively. Amplitudes of N1-P1 waveforms in 500 Hz air-conducted tone bursts in affected ears were under normal control ears and contralateral ears. There was significant difference between affected ears and healthy control ears (P<0.05). Amplitudes of N1-P1 waveforms in contralateral ears were also significantly smaller than those in normal control ears (P<0.05). There were no significant differences in amplitudes of N1-P1 waveforms between affected ears, contralateral ears and normal control ears in 1 000 Hz tone bursts stimulus(P>0.05). Frequency amplitude ratios of 500/1 000 Hz in affected ears were significantly under contralateral and normal control ears (P<0.05). According to ROC, the frequency amplitude ratio critical value of frequency tuning was set as 1.17, the positive rate of frequency tuning shift in affected ears was 54.5%(18/33) and significantly higher than in contralateral ears(18.2%, 6/33, χ(2)=9.429, P=0.002) and normal control ears (7.5%, 3/40, χ(2)=19.530, P=0.000). In contrast, there was no significant difference in the incidence of frequency tuning shift between contralateral ears and normal ears(χ(2)=1.909, P=0.167). Conclusions: Frequency tuning oVEMP with Meniere's disease will be changed.Frequency tuning of oVEMP with Meniere's disease shifts from low frequency region to high frequency region in comparison with healthy people. Frequency amplitude ratio is helpful for diagnosis of Meniere's disease.
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Affiliation(s)
- Y S Tian
- Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China
| | - X J Zhang
- Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China
| | - R Ma
- Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China
| | - Y Liu
- Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China
| | - P Liu
- Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China
| | - Y Zhang
- Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China
| | - L R Guo
- Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China
| | - S Z Wang
- Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China
| | - D Wang
- Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China
| | - X Duan
- Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China
| | - Y Yao
- Department of Otorhinolaryngology, Aerospace Center Hospital, Beijing 100049, China
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Marques P, Duan M, Perez-Fernandez N, Spratley J. Gentamicin delivery to the inner ear: Does endolymphatic hydrops matter? PLoS One 2018; 13:e0207467. [PMID: 30440019 PMCID: PMC6237362 DOI: 10.1371/journal.pone.0207467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Middle ear application of gentamicin is a common medical treatment for uncontrolled Ménière’s disease. The objective of the study was to evaluate the impact of endolymphatic hydrops on inner ear delivery. Methods Perilymph gentamicin concentrations and correlation with endolymphatic hydrops in an animal model were assessed. A group of 24 guinea pigs was submitted to surgical obstruction of the endolymphatic sac and duct of the right ear. Gentamicin was applied either to the right ear’s round window niche or through a transtympanic injection. Perilymph specimens were collected at different times. Histologic morphometry was used to evaluate both turn-specific and overall hydrops degree. Results In animals with endolymphatic hydrops, lower concentrations of gentamicin were observed after 20 or 120 minutes of exposure and in both types of administration, when compared to controls. This difference reached statistical significance in the round window niche application group (Mann-Whitney, p = 0,007). A negative correlation between perilymphatic gentamicin concentration and hydrops degree could be observed in both groups, after 120 minutes of exposure (Spearman correlation, round window niche p<0,001; TT p = 0,005). Conclusions The study indicates that the endolymphatic hydrops degree has a negative interference on the delivery of gentamicin into the inner ear following middle ear application.
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Affiliation(s)
- Pedro Marques
- Department of Otorhinolaryngology, S.João Hospital Centre, Porto, Portugal
- Unit of Otorhinolaryngology, Department of Surgery and Physiology, University of Porto Medical School, Porto, Portugal
- * E-mail:
| | - Maoli Duan
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Otolaryngology, Head and Neck Surgery, Karolinska Universisty Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Jorge Spratley
- Department of Otorhinolaryngology, S.João Hospital Centre, Porto, Portugal
- Unit of Otorhinolaryngology, Department of Surgery and Physiology, University of Porto Medical School, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), University of Porto Medical School, Porto, Portugal
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Han L, Wang ZJ, Diao TX, Li XS, Wang L, Xia RM, Yu LS. [The correlation between the hearing frequency and staging of Meniere's disease]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 53:776-779. [PMID: 30347538 DOI: 10.3760/cma.j.issn.1673-0860.2018.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective: To study the relationship between the average hearing of different frequencies and the audiometry staging in patients with Meniere's disease. Methods: A total of 259 patients from 1996 to 2016 were collected .All patients underwent pure tone audiometry, of which 93 patients underwent 3 000 Hz audiometry. The patients were divided into five groups according to the frequencies of hearing(Ⅰ: 500, 1 000, 2 000, 3 000 Hz; Ⅱ: 250, 500, 1 000, 2 000, 3 000 Hz; Ⅲ: 250, 500, 1 000, 2 000; Ⅳ: 500, 1 000, 2 000, 4 000 Hz; Ⅴ: 500, 1 000, 2 000 Hz), then calculated the average audiometry and made the hearing staging. The obtained data were analyzed by chi-square test and Bonferroni correction was performed among the groups, P<0.05 was defined as a statistically significant criterion. Result: There were no significant difference between the five groups(P=0.441>0.05). Conclusions: The choice of different pure tone audiometry frequency has no significant effect on the hearing staging. It would be more likely upstaging when plus 250 Hz. There is no statistically significant difference in staging between the latest guidelines and the 1995 guidelines.500, 1 000 and 2 000 Hz are recommended when 3 000 Hz examine is not available.
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Affiliation(s)
- L Han
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing 100044, China
| | - Z J Wang
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing 100044, China
| | - T X Diao
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing 100044, China
| | - X S Li
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing 100044, China
| | - L Wang
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing 100044, China
| | - R M Xia
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing 100044, China
| | - L S Yu
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing 100044, China
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Marques PS, Dias CC, Perez-Fernandez N, Spratley J. Instrumental head impulse test changes after intratympanic gentamicin for unilateral definite Ménière's disease: A systematic review and meta-analysis. Auris Nasus Larynx 2018; 45:943-951. [PMID: 29402608 DOI: 10.1016/j.anl.2018.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 12/18/2017] [Accepted: 01/10/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate how much could intratympanic gentamicin (ITG) interfere with the vestibular-ocular reflex (VOR) parameters on instrumental head impulse test (HIT), either with scleral search coil or video head impulse test and, eventually, foresee the control of vertigo crisis in unilateral intractable Ménière's disease (MD). METHODS A literature search was conducted in PubMed, Scopus, Web of Science and Cochrane search engines. The search terms used were "vestibular ocular reflex", "head impulse test", "gentamicin," and "Meniere's disease". Limitations included text availability to be full text, species to be humans and language to be English. All study types were included. 89 articles were screened identifying four eligible studies were identified. Studies were included after consensus of the authors. Meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was analysed using Review Manager software. RESULTS Instrumental HIT, after ITG for MD, demonstrated, in the treated ear, a decreased gain in the horizontal, posterior and superior semicircular canals (SCC), of 0.36 (0.26; 0.47; 95% CI), 0.35 (0.22; 0.48; 95% CI) and 0.28 (0.21; 0.35; 95% CI), respectively. Gain asymmetry increases between the treated and non-treated ear of 23.78 (7.22; 40.35; 95% CI), 32.01 (12.27; 51.76; 95% CI) and 17.49 (9.99; 24.99; 95% CI), were similarly detected in the horizontal, posterior and superior SCC, respectively. Significantly smaller gain values after the first treatment were observed for a single injection group versus multiple injection group in the horizontal (p=0.002) and superior SCCs (p=0.016). CONCLUSIONS Instrumental HIT is effective in evaluating the SCC function after ITG for intractable unilateral MD. VOR gain changes in the direction of the treated ear in the three SCC have been clearly registered. An increased reduction of the VOR gain in the horizontal and anterior SCC also seemed to foresee the control of vertigo crisis. Still, after meta-analysis, the small number of patients' data available did not allow to define a treatment end-point value. This review also indicated that further and better-designed studies are warranted.
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Affiliation(s)
- Pedro Santos Marques
- Department of Otorhinolaryngology, S. João Hospital Centre, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Department of Surgery and Physiology/Otorhinolaryngology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal.
| | - Claudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Nicolas Perez-Fernandez
- Department of Otorhinolaryngology, Clinica Universidad Navarra, University of Navarra, Pamplona, Spain
| | - Jorge Spratley
- Department of Otorhinolaryngology, S. João Hospital Centre, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Department of Surgery and Physiology/Otorhinolaryngology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
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Yazdani N, Nejadian F, Rezazadeh N, Hoseinabadi R, Karimi E, Gharibi R, Dabiri S. The Follow-Up Role of the Vestibular Evoked Myogenic Potential Test in Meniere's Disease. Acta Med Iran 2018; 56:43-48. [PMID: 29436794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 06/08/2023] Open
Abstract
Despite some proposed roles for the diagnostic impact of the cervical vestibular evoked myogenic potential test in the patients with Meniere's disease, the role of this test as an objective instrument in following up the patients with Meniere's disease who underwent. Intratympanic steroid injection is not cleared. In a prospective study, thirty-one adult patients with definite one-sided Meniere's disease with vertigo as main complaint refractory to medical treatments for three months, were selected. Patients underwent three times of intratympanic dexamethasone injection with one-week intervals. We performed cervical vestibular evoked myogenic potential test at first and four weeks after the last injection for all participants. We followed the patients for one year. The study results were analyzed with the chi-square test. Cervical vestibular evoked myogenic potential test could not be recorded in 26 patients (83.9%), and the test results were abnormal in the remaining 5 patients. The results were abnormal in the healthy ear of 32.3% of the patients. Despite the clinical improvement of the symptoms after intratympanic injection, the test results were not changed. Cervical vestibular evoked myogenic potential test could not be recorded in the majority of the patients with Meniere's disease; while it is usually recorded in normal ears. On the other hand, results of the cervical vestibular evoked myogenic potential test do not change during the early phase after treatment and could not be a good option for follow up and evaluating the response in this situation.
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Affiliation(s)
- Nasrin Yazdani
- Department of Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Nejadian
- Department of Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezazadeh
- Department of Audiology, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Reza Hoseinabadi
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Karimi
- Department of Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Gharibi
- Department of Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Dabiri
- Department of Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Young P, Castillo-Bustamante M, Almirón CJ, Bruetman JE, Finn BC, Ricardo MA, Binetti AC. [Approach to patients with vertigo]. Medicina (B Aires) 2018; 78:410-416. [PMID: 30504108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Vertigo is defined as an abnormal sensation of body motion or of its surrounding objects. It is a common chief complaint in emergency departments comprising 2 to 3% of these consultations worldwide. Vertigo is classified as peripheral or central, according to its origin, and can also be occasionally mixed, the most common cause of peripheral involvement being benign paroxysmal positional vertigo. The initial findings on clinical evaluation of patients are the clues for making a correct diagnosis. The differentiation between central and peripheral vertigo can be optimized by analysing nystagmus, by using the skew test and the head impulse test (HINTS), as also by performing the appropriate tests to evaluate the integrity of the vestibular-cerebellar pathway. In addition, tonal threshold audiometry could raise the diagnostic sensibility from 71 to 89% on initial approach. Appropriate diagnosis is the principal key for managing this clinical condition.
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Affiliation(s)
- Pablo Young
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina. E-mail:
| | | | - Carlos J Almirón
- Servicio de Rehabilitación, Hospital Británico de Buenos Aires, Argentina
| | - Julio E Bruetman
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina
| | - Bárbara C Finn
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina
| | - María A Ricardo
- Servicio de Otorrinolaringología, Hospital Británico de Buenos Aires, Argentina
| | - Ana C Binetti
- Servicio de Otorrinolaringología, Hospital Británico de Buenos Aires, Argentina
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Choi JE, Kim YK, Cho YS, Lee K, Park HW, Yoon SH, Kim HJ, Chung WH. Morphological correlation between caloric tests and vestibular hydrops in Ménière's disease using intravenous Gd enhanced inner ear MRI. PLoS One 2017; 12:e0188301. [PMID: 29190293 PMCID: PMC5708622 DOI: 10.1371/journal.pone.0188301] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/08/2017] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to prove the hypothesis that caloric response in Ménière's disease (MD) is reduced by hydropic expansion of the vestibular labyrinth, not by vestibular hypofunction, by evaluating the correlation morphologically using an intravenous Gadolinium (IV-Gd) inner ear MRI. In study I, the prevalence of abnormal video Head Impulse Test (vHIT) results among the patients with definite unilateral MD (n = 24) and vestibular neuritis (VN) (n = 22) were investigated. All patients showed abnormal canal paresis (CP) (> 26%) on caloric tests. The prevalence of abnormal vHIT in patients with abnormal CP was significantly lower in MD patients (12.5%) than that in VN patients (81.8%) (p < 0.001). In study II, morphological correlation between caloric tests and vestibular hydrops level was evaluated in unilateral MD patients (n = 16) who had normal vHIT results. Eleven patients (61%) had abnormal CP. After taking the images of IV-Gd inner ear MRI, the vestibular hydrops ratio (endolymph volume/total lymph volume = %VH) was measured. In addition, the relative vestibular hydrops ratio (%RVH = (%VHaffected ear-%VHunaffected ear) / (%VHaffected ear + %VHunaffected ear)) was calculated. Each ratio (%VH and %RVH) was compared with average peak slow phase velocity (PSPV) and CP, respectively. In the MD patients, %VH of the affected ear correlated significantly with mean PSPV on the same side (rs = -0.569, p = 0.024), while %RVH correlated significantly with CP (rs = 0.602, p = 0.014). In most MD patients (87.5%) compared to VN patients, vHIT results were normal even though the caloric function was reduced. In addition, the reduced caloric function with normal vHIT was related to the severity of the vestibular hydrops measured by the IV-Gd inner ear MRI. These findings concluded that the abnormal caloric tests with normal vHIT in MD indicated severe endolymphatic hydrops rather than vestibular hypofunction.
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Affiliation(s)
- Ji Eun Choi
- Department of Otorhinolaryngology—Head and Neck Surgery, Dankook University Hospital, Cheonan, Republic of Korea
| | - Yi-Kyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Sang Cho
- Department of Otorhinolaryngology—Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kieun Lee
- Department of Otorhinolaryngology—Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Woo Park
- Department of Otorhinolaryngology—Head and Neck Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sung Hoon Yoon
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyung-Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Ho Chung
- Department of Otorhinolaryngology—Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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Petri M, Chirilă M, Bolboacă SD, Cosgarea M. Health-related quality of life and disability in patients with acute unilateral peripheral vestibular disorders. Braz J Otorhinolaryngol 2017; 83:611-618. [PMID: 27595924 PMCID: PMC9449007 DOI: 10.1016/j.bjorl.2016.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/12/2016] [Accepted: 08/07/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Health-related quality of life is used to denote that portion of the quality of life that is influenced by the person's health. Objectives To compare the health-related quality of life of individuals with vestibular disorders of peripheral origin by analyzing functional, emotional and physical disabilities before and after vestibular treatment. Methods A prospective, non randomized case-controlled study was conduced in the ENT Department, between January 2015 and December 2015. All patients were submitted to customize a 36 item of health survey on quality of life, short form 36 health survey questionnaire (SF-36) and the Dizziness Handicap Inventory for assessing the disability. Individuals were diagnosed with acute unilateral vestibular peripheral disorders classified in 5 groups: vestibular neuritis, Ménière Disease, Benign Paroxysmal Positional Vertigo, cochlear-vestibular dysfunction (other than Ménière Disease), or other type of acute peripheral vertigo (as vestibular migraine). Results There was a statistical significant difference for each parameter of Dizziness Handicap Inventory score (the emotional, functional and physical) between the baseline and one month both in men and women, but with any statistical significant difference between 7 days and 14 days. It was found a statistical significant difference for all eight parameters of SF-36 score between the baseline and one month later both in men and women; the exception was the men mental health perception. The correlation between the Dizziness Handicap Inventory and the SF-36 scores according to diagnostics type pointed out that the Spearman's correlation coefficient was moderate correlated with the total scores of these instruments. Conclusion The Dizziness Handicap Inventory and the SF-36 are useful, proved practical and valid instruments for assessing the impact of dizziness on the quality of life of patients with unilateral peripheral vestibular disorders.
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Affiliation(s)
- Maria Petri
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Otorhinolaryngology, Cluj-Napoca, Romania
| | - Magdalena Chirilă
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Otorhinolaryngology, Cluj-Napoca, Romania.
| | - Sorana D Bolboacă
- Iuliu Haţieganu University of Medicine and Pharmacy, Department of Medical Informatics and Biostatistic, Cluj-Napoca, Romania
| | - Marcel Cosgarea
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Otorhinolaryngology, Cluj-Napoca, Romania
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Affiliation(s)
- Richard L Pullen
- Richard L. Pullen, Jr., is a professor of nursing at Texas Tech University Health Sciences Center School of Nursing in Lubbock, Tex
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Dabiri S, Yazdani N, Esfahani M, Tari N, Adil S, Mahvi Z, Rezazadeh N. Analysis of Saccular Function With Vestibular Evoked Myogenic Potential Test in Meniere's Disease. Acta Med Iran 2017; 55:123-127. [PMID: 28282709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 06/06/2023] Open
Abstract
Meniere's disease is the disorder of inner ear characterized by vertigo, tinnitus and sensorineural hearing loss. The vestibular evoked myogenic potential (VEMP) test could be useful in the analysis of saccular function, and diagnosis of Meniere's disease. In this study, we've analyzed the saccular function, using VEMP test in different groups of Meniere's disease. Patients were categorized as possible, probable or definite Meniere's disease groups according to the guideline of American Academy of Otolaryngology-Head and Neck Surgery. The exclusion criteria were neuromuscular system diseases, diseases of central nervous system, inner ear disorders, conductive hearing loss, a history of ototoxic drug consumption, being a drug abuser and a positive history of inner ear surgery or manipulations. The VEMP test is the recording of positive and negative waves from sternocleidomastoid muscle that is made by an auditory click to the ear. From the total of 100 patients, the waves of VEMP test was seen in 59 patients which 19 patients had abnormal amplitude, and latency and 40 patients were with normally recorded waves. There was a significant relationship between the severity of hearing loss and a VEMP test without any recorded waves. Most of the cases with 'no wave recorded' VEMP test, were patients with severe hearing loss. However, there wasn't any relation between the pattern of hearing loss and 'no wave recorded' VEMP test. VEMP test could be a valuable diagnostic clue especially in patients with definite Meniere's disease.
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Affiliation(s)
- Sasan Dabiri
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Yazdani
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdis Esfahani
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloufar Tari
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Susan Adil
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Mahvi
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezazadeh
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Fabry's disease corresponds to an inherited disorder transmitted by an X-linked recessive gene. It generates a dysfunction of glycosphingolipid metabolism due to an enzymatic deficiency of α-galactosidase activity, resulting in glycosphingolipid deposits in all areas of the body. The clinical (heart, kidney, and central nervous system) manifestations are more severe in hemizygous boys than in heterozygous girls. They appear during childhood or adolescence: acroparesthesia, joint pain, angiokeratoma, corneal dystrophy, hypohydrosis or anhydrosis, and renal failure. The otoneurologic symptoms consist of hearing fluctuation, progressive unilateral or bilateral hearing loss, and episodes of vertigo or dizziness. Otoneurologic findings in 12 of 26 members of the same family are presented: the mother and 9 of her 12 children, as well as 2 of her 14 grandchildren: 4 healthy persons, 4 heterozygous female carriers, and 4 hemizygous male patients. Three of the male patients had fluctuation of hearing, sudden hearing loss, and episodes of vertigo and dizziness. The otoneurologic examinations showed a bilateral cochleovestibular deficit (n = 1), a right cochleovestibular deficit (n = 1), and a bilateral hearing loss combined with a right vestibular deficit (n = 1). Histopathologic evidence of glycosphingolipid accumulation in vascular endothelial and ganglion cells, as well as atrophy of the stria and spiral ligament, might explain the otoneurologic symptoms and findings.
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Affiliation(s)
- Dominique Vibert
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University of Berne, Berne, Switzerland
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Abstract
Objectives: The aim of this study was to apply videonystagmography (VNG) and vestibular evoked myogenic potential (VEMP) tests to patients with Meniere attacks, to explore the mechanics of where saccular disorders may affect the semicircular canals. Methods: From January 2001 to December 2003, 12 consecutive patients with unilateral definite Meniere's disease with vertiginous attacks underwent VNG for recording spontaneous nystagmus, as well as VEMP tests. Results: At the very beginning of the Meniere attack, the spontaneous nystagmus beat toward the lesion side in 5 patients (42%) and toward the healthy side in 7 patients (58%). Twenty-four hours later, only 6 patients (50%) showed spontaneous nystagmus beating toward the healthy side. Nevertheless, spontaneous nystagmus subsided in all patients within 48 hours. The VEMP test was performed within 24 hours of a Meniere attack; the VEMPs were normal in 4 patients and abnormal in 8 patients (67%). After 48 hours, 4 patients with initially abnormal VEMPs had resolution and return to normal VEMPs, and the other 4 patients still had absent VEMPs. Conclusions: Most patients (67%) with Meniere attacks revealed abnormal VEMPs, indicating that the saccule participates in a Meniere attack. This is an important idea that stimulates consideration of the mechanism of Meniere attacks.
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Affiliation(s)
- Shih-Wei Kuo
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taiwan
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Lamounier P, de Souza TSA, Gobbo DA, Bahmad F. Evaluation of vestibular evoked myogenic potentials (VEMP) and electrocochleography for the diagnosis of Ménière's disease. Braz J Otorhinolaryngol 2016; 83:394-403. [PMID: 27397722 PMCID: PMC9442737 DOI: 10.1016/j.bjorl.2016.04.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/03/2016] [Accepted: 04/14/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Ménière's disease (MD) is an inner ear disorder characterized by episodic vertigo, tinnitus, ear fullness, and fluctuating hearing. Its diagnosis can be especially difficult in cases where vestibular symptoms are present in isolation (vestibular MD). The definitive diagnosis is made histologically and can only be performed post-mortem, after analysis of the temporal bone. Endolymphatic hydrops is a histopathological finding of the disease and occurs more often in the cochlea and saccule, followed by the utricle and semicircular canals. Vestibular evoked myogenic potentials (VEMP) emerged as the method of assessment of vestibular function in 1994. Until then, there was no unique way of assessing saccular function and the inferior vestibular nerve. Given that the saccule is responsible for most cases of severe hydrops, VEMP appears as a new tool to assist in the diagnosis of MD. Objective To evaluate the sensitivity and specificity of VEMP and electrocochleography (EcochG) in the diagnosis of definite MD compared with clinical diagnosis. Methods The study includes 12 patients (24 ears) diagnosed with definite MD defined according to the clinical criteria proposed by the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) in 1995, as well as 12 healthy volunteers allocated to the control group (24 ears). A clinical diagnosis by the AAO-HNS criteria was considered as the gold standard. All patients underwent an otoneurological examination, including pure tone and speech audiometry, VEMP, and extratympanic EcochG. The sensitivity and specificity to detect the presence or absence of disease were calculated, as well as their 95% confidence intervals. The reliability of VEMP and EcochG in both ears was assessed using the kappa index. Results In both tests and in both ears, the ability to diagnose healthy cases was high, with specificity ranging from 84.6% to 100%. Moreover, the ability of the tests to diagnose the disease varied from low to moderate sensitivity, with values ranging from 37.5% to 63.6%. The agreement of both tests in the right ear, measured by the kappa coefficient, was equal to 0.54 (95% CI: 0.20–0.89), indicating a moderate agreement. In the left ear, that agreement was equal to 0.07 (95% CI: −0.33 to 0.46), indicating a weak correlation between the tests. The sensitivity of the VEMP for the right ear was 63.6% and for the left ear, 62.5%. The sensitivity of EcochG for the right ear was 63.6% and 37.5% for the left ear. Conclusion The specificity of both tests was high, and the sensitivity of VEMP was higher than that of EcochG.
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Affiliation(s)
- Pauliana Lamounier
- Universidade de Brasília (UNB), Ciências da Saúde, Brasília, DF, Brazil; Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER-GO), Goiânia, GO, Brazil
| | | | - Debora Aparecida Gobbo
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER-GO), Goiânia, GO, Brazil
| | - Fayez Bahmad
- Universidade de Brasília (UNB), Ciências da Saúde, Brasília, DF, Brazil; Instituto Brasiliense de Otorrinolaringologia, Brasília, DF, Brazil.
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Casani A, Nuti D, Franceschini SS, Gaudini E, Dallan I. Transtympanic Gentamicin and Fibrin Tissue Adhesive for Treatment of Unilateral Menière's Disease: Effects on Vestibular Function. Otolaryngol Head Neck Surg 2016; 133:929-35. [PMID: 16360516 DOI: 10.1016/j.otohns.2005.07.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: To determine the effects of transtympanic injections, with a mixture composed of gentamicin and fibrin tissue adhesive (FTA), on vestibular function of patients with intractable unilateral Menière's disease. STUDY DESIGN: This was an open, prospective study. SETTING AND PATIENTS: The study was performed at 2 tertiary referral centers. Twenty-six patients affected by “definite” unilateral Menière's disease, unresponsive to medical therapy for at least 6 months, were enrolled. INTERVENTION: A buffered gentamicin solution mixed with FTA was injected in the middle ear until the development of bedside vestibular hypofunction signs and/or caloric weakness in the treated ear. MAIN OUTCOME MEASURE: Vestibular function was evaluated by 3 bedside vestibular tests (observation of spontaneous nystagmus, head shaking test, and head thrust test) and by a caloric test. Tests were performed on days 10 and 30 after completion of treatment. Tests were also performed 3, 6, and 12 months from completion of the gentamicin-FTA protocol. The effects of treatment were also assessed in terms of hearing levels, control of vertigo, and disability status. RESULTS: In 22 of the 26 patients, only 1 gentamicin-FTA injection was necessary to obtain 1 or more signs indicating a reduction of the vestibular function in the treated ear. Four patients needed another treatment because of the persistence of their incapacitating symptoms during the follow-up. Four patients needed more than 1 injection to obtain a vestibular hypofunction. None of the patients who received 1 or 2 injections presented hearing loss in direct temporal relationship to the treatment. CONCLUSIONS: A mixture of gentamicin and fibrin glue makes it possible to considerably reduce the number of administrations in patients with intractable unilateral Menière's disease. Spontaneous nystagmus, post head shaking nystagmus, and a head thrust sign are the clinical signs that indicate onset or progression of unilateral vestibular hypofunction. These signs were obtained with only 1 injection in 81% of patients. EBM RATING: C
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Affiliation(s)
- Augusto Casani
- Department of Otorhinolaryngology, University of Pisa, Italy.
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Abstract
OBJECTIVE For many years, surgery was the mainstay of therapy for medically refractory patients, but recently, transtympanic gentamicin perfusion has attracted increasing interest and is a method frequently used for treating Meniere's disease. Many otologists question the relevance of surgical treatments, and traditional options are rarely discussed or offered to patients. The purpose of this study is to describe results of labyrinthectomy, vestibular nerve section, and endolymphatic mastoid shunt surgery for patients with Meniere's disease and to compare them with published results for gentamicin perfusion. STUDY DESIGN AND SETTING Retrospective chart review. Two hundred twenty-nine patients underwent surgery for management of Meniere's disease between January 1, 1995 and December 31, 2001. One hundred eighty-nine patients' charts had sufficient data for review. Thirty-two patients had translabyrinthine labyrinthectomies, 83 underwent suboccipital vestibular nerve sections, and 74 elected for an endolymphatic mastoid shunt. Hearing results, dizziness classification, and functional level score were determined from patient charts and telephone conversations. All results were in accordance with the guidelines of the AAO-HNS Committee on Hearing and Equilibrium for evaluation of Meniere's disease therapy. RESULTS Audiologic results, functional level score, and dizziness classification are reported for the preoperative period and for the 18- to 24-month postoperative period for all surgical patients. These data are also reported individually for each of the 3 surgical procedures. Early postoperative data and most recent follow-up data are presented if available. CONCLUSIONS Surgical management of Meniere's disease is a safe and viable option for patients with medically refractory disease. EBM RATING C.
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Li F, Zhuang J, Chen Y, Gao B, Gu H, Zhou X. [Difference of cervical vestibular evoked myogenic potentials in different audition stage of Ménière disease]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:9-12. [PMID: 27197445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Our goal was to find whether inreversible function damage of saccule was exist and correlated in Meniere's patients with different audition. METHOD Senenty-nine patients with unilateral Meniere's disease, who visited the Dizziness Diagnosis and Treatment Centre of the Second Military Medical University from January to July in 2015 were included. They were grouped as slightly audition damage group (41 cases), mildly-severely audition damage group(38 cases). Meanwhile 20 normal controls underwent the research. The cervical vestibular evoked myogenic potentials were conducted in symptom free period. RESULT There was no significant difference of the C-VEMP inducing rate between slightly audition damage group and normal control group. While a statistically difference showed between mildly-severely audition damage group and normal control group or slightly audition damage group. P1, N1 latency had no statistically difference between three groups. The P1-N1 amplitude and asymmetric ratio had no difference between slightly audition damage group and normal control group, but had a statistically difference between mildly-severely audition damage group and slightly audition damage group, normal control group. CONCLUSION The function of saccule in Meniere's patients decreased with the aggravation of audition damage.
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Yang Y, Zhuang J, Zhou L, Tong B, Zhou X, Gao B. [Comparison of caloric responses between vestibular migraine and Ménière disease patients]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:15-18. [PMID: 27197447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare the features of caloric tests in vestibular migraine (VM) and Menière's disease (MD) patients, and provide objective evidence for differentiating the 2 groups of patients. METHOD This case-control study included 11 MD patients with left ear involved and mild to moderate impaired hearing, and 18 matched cases with VM. All participants received caloric tests. Maximum slow phase velocities (SPVmax) were used to describe horizontal and vertical nystagmus respectively and were compared between the 2 groups. Horizontal and vertical canal parasis(CP) were calculated according to respective SPVmax. Unilateral (UW-VR) or bilateral (BW-VR) weakness of vestibular response, and positive unilateral (UVR) or bilateral (BVR) vertical response or negative bilateral vertical response (NBVR) were judged by the boundary point of SPVmax of 5°/s respectively. Total left (LV) or right (RV) Vertical reactions were calculated accoeding to vertical SPVmax,and inter ears difference of vertical responses (IED-VR) calculated from LV minus RV. RESULT There were no significant differences in age and gender between the 2 groups. Horizontal SPVmax of all of caloric tests of VM group,except the left cold (LC), were statistically larger than that of MD group (P < 0.05) and the maximum responses of right warm (RW) caloric test in VM group (34.50 ± 17.77) were significantly greater than that in MD group (12.82 ± 6.69) (P < 0.01). Only the vertical SPVmax of RW of all caloric tests has statistically difference between the 2 groups (P < 0.01), and the maximum responses of RW caloric test in VM group (6.00 ± 4.45) were significantly stronger than that of LC in MD group (1.27 ± 2.00) (P < 0.01). Horizontal CP ≥ 25% of the 2 groups(VM: 72.22%, MD: 54.55%) were not statistically different, while the proportions of UW-VR and BW-VR in VM group (5.56%, 0) were significantly lower than that in MD group (27.27%, 18.18%) (P < 0.05). Vertical CP ≥ 25% of the 2 groups (VM: 94.44%, MD: 27.27%) were significantly different (P < 0.01), and the proportions of positive UVR (left: 5.56%, right: 77.78%) and BVR (0) and NBVR (16.67%) in VM group were significantly different from that in MD group (UVR (left: 9.09%, right: 0), BVR (0), NBVR (90.91%)) (P < 0.01). There was statistically difference between LV and RV in VM group (P < 0.01, LV < RV), while no difference were showed in MD group. IED-VR in VM group (left intenser: 16.67%, right intenser: 83.33%) was statistically different from that in MD group (left intenser: 36.36%, right intenser: 9.09%, both no difference: 54.55%) (P < 0.01). CONCLUSION Vestibular responses of caloric test are more sensitive, and vertical reactions are more easily induced in VM patients than in MD. Caloric test can be used to differentiate the 2 groups of diseases.
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Gao Y, Wang D, Wang H, Guan J, Lan L, Wu Z, Xie L, Yu L, Zhang S, Shan X, Wang Q. [Cinical and genetic characteristics of familial Meniere's disease: three families report]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 50:915-924. [PMID: 26887996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the clinical and genetic characteristics of three Chinese Meniere's disease (MD) families and decipher the mechanism of MD further. METHODS Personal and family medical evidence of hearing loss, vestibular symptoms, and other clinical abnormalities of the participants were identified, clinical and genetic features were analyzed. Targeted 307 genes capture and high-throughput sequencing were performed on the two ascertained members of family 1007184. RESULTS Eight patients from these three families showed post-lingual sensorineural hearing loss, six women and two men were involved. Age of onset in these affected members concentrated in the middle age, with the average age of 39.3 years old. Among them, patients from 1407278 were accompanied by migraine. All of the three probands presented as recurrent vertigo firstly, and then fluctuated hearing loss showed up, accompanying by tinnitus and ear fullness feeling. The hearing loss manifested as late-onset, low frequency-involved pattern, with subsequent gradual progression from moderate to severe level. Some of the patients progressed to severe level involving all frequencies at higher ages. In addition, most of the cases showed revitalization. Four cases received vestibular function tests, three of which had varying dysfunction of vestibular function, while the other one had normal vestibular function. Patients who had abnormal vestibular function showed much more severe hearing impairment. The three-generation family 1007193 had an autosomal recessive genetic characteristics, family 1007184 showed autosomal dominant inheritance of characteristics, family 1407278 were either autosomal dominant or X-linked dominant pattern. Through target genes capture high-throughput sequencing technology, we identified two candidate variants in the two members of family 1007184, named c. 2057G>A in EGFLAM and c. 1961C>T in ITGA8. CONCLUSION Meniere's disease has some genetic and familial aggregation in Chinese population, but its complex genetic pathogenic mechanisms need further study.
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Affiliation(s)
- Yun Gao
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Otorhinolaryngology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | | | | | | | | | | | | | | | | | - Xizheng Shan
- , Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China
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Dastgheib ZA, Lithgow B, Blakely B, Moussavi Z. Application of Vestibular Spontaneous Response as a Diagnostic Aid for Meniere's Disease. Ann Biomed Eng 2015; 44:1672-84. [PMID: 26334355 DOI: 10.1007/s10439-015-1441-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/26/2015] [Indexed: 01/14/2023]
Abstract
In this paper, we report on a new method for assisting in Meniere's disease diagnosis. An accurate diagnosis of Meniere's is challenging, and requires an expert opinion after observing several clinical assessments and tests over a period of time. Our proposed method is based on the analysis of the spontaneous and driven ear evoked responses recorded using Electrovestibulography (EVestG). We used the EVestG signals of 35 individuals suspected of Meniere's and 26 age-matched healthy controls, out of which data of 14 patients with Meniere's and 16 healthy controls were used for developing the diagnostic algorithm (training set) and the rest for testing. While recording and analyzing the test dataset, the researchers were only aware the patients suffered some dizziness, and were kept blind to the exact diagnoses till the end of study. EVestG field potentials (FPs) and their firing pattern, in response to several whole body tilt stimuli from both left and right ears were extracted. We investigated several features of the extracted FPs in response to each of side, back/forward, rotation, up/down, supine rotation, and supine up/down tilt stimulations, and selected the top five features showing the most significant differences between of the groups of the training set for every tilt. An ad-hoc average voting classifier was designed based on building five single-feature classifiers (using Linear Discriminant analysis) and taking the average of the single-feature classifiers' votes. The results showed the side tilt data were best for the purpose of Meniere's diagnosis; it resulted in 78% and 90% sensitivity and specificity for test dataset, respectively. The second best accuracy was achieved using back/forward tilt. The results and their implications are discussed. Overall, the EVestG side tilt results encourage the use of vestibular response as a non-invasive, robust and quick screening for Meniere's and separating it from other types of dizziness.
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Affiliation(s)
- Z A Dastgheib
- Biomedical Engineering, Department of Electrical & Computer Engineering, University of Manitoba, Room E3-512 Eng. Bldg., 75A Chancellor's Circle, Winnipeg, MB, R3T 5V6, Canada
| | - B Lithgow
- Electrical & Computer Engineering and Biomedical Engineering Program, University of Manitoba, Winnipeg, Canada
- Monash-Alfred Psychiatry Research Centre, Alfred Hospital, Melbourne, Australia
- Riverview Health Centre, Room PE456, 1 Morley Avenue, Winnipeg, MB, R3L2P4, Canada
| | - B Blakely
- Department of Otolaryngology - Head and Neck Surgery, GB421 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
| | - Z Moussavi
- Biomedical Engineering, Department of Electrical & Computer Engineering, Room E3-513 Eng. Bldg., 75A Chancellor's Circle, Winnipeg, MB, R3T 5V6, Canada.
- Riverview Health Center, Winnipeg, Canada.
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Abstract
CONCLUSIONS Postural control is dependent on the visual system in normal conditions. Shift from visual to somatosensory dependence in dizzy patients suggests that utilizing the stable visual references is recommended for the rehabilitation of dizzy patients. OBJECTIVES To investigate which of the visual or somatosensory system is mainly used for substitution of the impaired spatial orientation in dizzy patients. METHODS We recruited 189 consecutive patients with or without dizziness and vestibular dysfunction. Dizzy patients were divided into three groups: acute, episodic, and chronic dizziness. Vestibular function was assessed by caloric test, traditional head impulse test, and head shaking nystagmus. Visual or somatosensory dependence of spatial orientation was assessed by posturography on a solid surface or on foam in eyes open or closed condition. The foam ratio (posturography with/without foam) when eyes were closed was indicative of somatosensory dependence of postural control, whereas the Romberg ratio on foam showed visual dependence. (Romberg ratio on foam)/(foam ratio with eyes closed) was calculated and used as an index of the visual/somatosensory dependence of postural control. RESULTS The visual/somatosensory ratio of postural control was significantly lower in dizzy patients as well as patients with vestibular dysfunction, however, no differences were found between acute, episodic, and chronic dizziness.
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Affiliation(s)
- Tomoko Okumura
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine , Suita, Osaka , Japan
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McGarvie LA, Curthoys IS, MacDougall HG, Halmagyi GM. What does the dissociation between the results of video head impulse versus caloric testing reveal about the vestibular dysfunction in Ménière's disease? Acta Otolaryngol 2015; 135:859-65. [PMID: 26087818 DOI: 10.3109/00016489.2015.1015606] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION It is suggested that the different results of rotational (video head impulse - vHIT) and caloric tests in patients with Ménière's disease (MD) may be a consequence of the physical enlargement of the membranous duct in the hydropic labyrinths in MD, causing a reduced response to caloric stimulation. OBJECTIVES There have been reports that the results of two tests of semicircular canal function, the caloric response and the responses to vHIT do not agree. This retrospective study at a tertiary referral hospital examined this disagreement. METHODS This study reviewed the data of 22 patients who met the AAO-HNS criteria for MD and who had both caloric and vHIT testing. RESULTS There was a clear dissociation: patients with MD had a small or absent response to caloric stimulation of their affected ear, whilst their response to vHIT was in the normal range. DISCUSSION The accepted Gentine model of the mechanism of caloric stimulation could account for this dissociation: the increased diameter of the semicircular duct in hydropic labyrinths resulting in endolymph circulation within the duct itself and so a smaller thermally induced pressure across the cupula. The increased duct diameter will have little effect on responses to rotation.
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Affiliation(s)
- Leigh A McGarvie
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital , Camperdown NSW , Australia
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Chen Y, Zhao Z, Zhuang J, Xie X, Jin Z, Li F. [The features of high and low-frequency function of horizontal, semicircular canal in Meniere's disease]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:882-884. [PMID: 26595999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To analyze the feature of horizontal semicircular canal function at high and low-frequencies in Meniere's disease. METHOD Thirty patients suffering from unilateral Meniere's disease were included in the research from 2013 June to 2014 June. Caloric test and video head impulse test were performed to evaluate the high low-frequency function of horizontal semicircular canal. RESULT these patients were devided by the severity of unilateral weakness in caloric test. The gain value in video head impulse test, which reflects the high-frequency function of semicircular canal, were not different between the normal and mild abnormal group (P > 0.05), but were obviously different between the normal and mild-severe abnormal group, slight abnormal and mild-severe abnormal group (P < 0.05). Gain asymmetry, which reflects the high-frequency function of both side, has no difference between three groups (P > 0.05). CONCLUSION A part of Meniere's disease may have normal high, low-frequency function of horizontal semicircular canal. As patient suffering slight injury of low-frequency function, the high-frequency function keeps normal. As the injury of low-frequency function become mildly to severely, the damage of high-frequency function appears, but the symmetry still keeps balance.
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Mizukoshi K, Kobayashi H, Ohashi N, Watanabe Y. Visual modulatory influences of vestibulo-ocular reflex in patients with vertigo. Adv Otorhinolaryngol 2015; 41:63-70. [PMID: 3213712 DOI: 10.1159/000416033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- K Mizukoshi
- Department of Otolaryngology, Toyama Medical and Pharmaceutical University, Japan
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Ishizaki H, Umemura K, Mineta H, Nozue M, Matsuoka I, Iwasaki K, Nishida Y. The examination of body sway in normal subjects and patients with Ménière's disease or cerebellar dysfunction. Adv Otorhinolaryngol 2015; 41:166-72. [PMID: 3265001 DOI: 10.1159/000416051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- H Ishizaki
- Department of Otorhinolaryngology, Hamamatsu University School of Medicine, Japan
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Satta A, Soro G, Ginanni A, Faedda R, Giamila A, Melis F, Caria M, Bartoli E. Antidiuretic hormone secretion related to pressure into the inner ear. Contrib Nephrol 2015; 83:260-3. [PMID: 2100719 DOI: 10.1159/000418809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- A Satta
- Institute of Clinical Medicine, Sassari University, Italy
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Zilstorff K, Thomsen J, Laursen P, Hoffmann G, Kjoerby O, Paludan B, Theilgaard A. Meniere's disease: a neuropsychological study II. Adv Otorhinolaryngol 2015; 25:100-5. [PMID: 484341 DOI: 10.1159/000402924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
23 Meniere patients were examined with an extensive battery of neuropsychological tests. In a previous investigation the authors had demonstrated that patients with a long duration of Meniere's disease had psychological disturbances, presumably localized in the nondominant hemisphere. In the present investigation the patients had a short duration of the disease, and we were unable to reproduce the psychological disturbances. It is concluded that the central changes in the nondominant hemisphere function develop over a long period of time. It is hoped for that further neuropsychological investigations of Meniere patients can give more information of what is primary in Meniere's disease: peripheral sensory or central neurological changes.
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Futaki T, Takeda T, Kitahara M. Measurement of eye deviation under the nonfixative condition in patients with peripheral labyrinthine disorders, especially Meniere's disease. Adv Otorhinolaryngol 2015; 25:122-6. [PMID: 484344 DOI: 10.1159/000402928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Among 232 Japanese patients with peripheral disorders, 98 had a unilateral Meniere's disease. In these patients and 20 healthy adults, recordings of eye deviation were made utilizing DC-ENG under two conditions, i.e. eyes closed (EC) and eyes open in the absolute darkness (AD). (1) 90 % tolerance interval of AD. was significantly smaller than that of EC in controls. (2) Appearance of nystagmus in 5 groups with labyrinthine lesions was compared with the direction of deviation toward and against the affected side in both conditions. (3) Concerning unilateral Meniere's, the relationship among deviation, nystagmus and caloric response was analyzed statistically and the clinical application discussed.
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Wolfe JW, Engelken EJ, Olson JE. Low-frequency harmonic acceleration in the evaluation of surgical treatment of Meniere's disease. Adv Otorhinolaryngol 2015; 25:192-6. [PMID: 484351 DOI: 10.1159/000402941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
23 patients with classical findings of Meniere's disease and so diagnosed by a neurotologist were tested with harmonic acceleration. 7 of these patients were selected to receive endolymphatic-mastoid shunts for intractable vertigo and/or highly progressive fluctuant hearing loss. All 7 patients showed an increase in the impairment in their phase relationships at the lowest frequency (0.01Hz) following surgery which was considered to be secondary to the procedure. Later this phase lag returned to a level approaching normal. They also showed a definite decrease in the asymmetry (labyrinthine preponderance) of their nystagmic responses to acceleration.
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Abstract
CONCLUSION An inner ear test battery may suggest bilateral involvement and aid in 'grading' of potential disease in a patient with actively symptomatic Meniere's disease (MD). OBJECTIVES This study applied an inner ear test battery in patients with bilateral MD to map the inner ear deficits in each ear. METHODS From 2009 to 2012, 100 (20%) of 498 MD patients were diagnosed with bilateral involvement, which was defined as established MD in one ear, and the opposite ear had inner ear symptoms combined with documented hearing loss. Each patient underwent audiometry, and ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests. RESULTS Grading of inner ear deficits was based on the number of abnormal results in the inner ear test battery. Of 100 patients with bilateral MD, 54% had the same grade and 46% had different grades in their 2 ears. On the other hand, based on four-tone average, 79% had the same Meniere stage and 21% had different stages in their two ears. The difference between ears with asymmetric grades (46%) and ears with asymmetric stages (21%) accounts for 25% of bilateral MD patients, which may be caused by the saccular hydrops in the opposite ear.
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Affiliation(s)
- Chi-Hsuan Huang
- Department of Otolaryngology, Catholic Cardinal Tien Hospital, Fu-Jen Catholic University , New Taipei
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Blakley B, Dastgheib ZA, Lithgow B, Moussavi Z. Preliminary report: neural firing patterns specific for Meniere's disease. J Otolaryngol Head Neck Surg 2014; 43:52. [PMID: 25526745 PMCID: PMC4279806 DOI: 10.1186/s40463-014-0052-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe the application of a new, objective diagnostic test for Meniere's disease. INTRODUCTION Electrovestibulography (EVestG) is a complex, newly-developed test paradigm that searches for neural firing patterns that may be diagnostic for particular neural disorders. EVestG system was previously "trained" to distinguish Meniere's disease from other patients on a set of training data. In this paper we illustrate its diagnostic application in a new group of unknown subjects. SETTING Collaborative Academic Bioengineering Research Centre. STUDY DESIGN Prospective, blinded human Clinical Trial. METHODS In an attempt to understand the specific neural firing patterns that may objectively characterize latent Meniere's disease, two hundred fifty-six consecutive patients who presented for electronystagmography testing were asked to undergo EVestG testing. Ten subjects actually completed testing but data were too noisy to permit analysis for one patient. Complete data were available for nine patients with either a clinical diagnosis of either Meniere's disease (4 patients) or some other vestibular disorder (2 vestibular neuritis, 2 benign positional vertigo and 1 non-specific dizziness). None of the patients were experiencing attacks of vertigo within a week of EVestG testing. Ten normal control subjects with no history or symptoms of ear disease were also tested. EVestG was performed in a separate engineering research facility by investigators who were unaware of their clinical diagnosis. If EVestG suggested that the probability of Meniere's disease was 0.5 or greater Meniere's disease was considered present by the objective testing. The objective and clinical diagnoses were compared. RESULTS EVestG testing correctly identified three of four Meniere's disease patients and rejected the diagnosis in 9 of the 10 controls. Two of the 5 dizzy, non-Meniere's patients were incorrectly identified as Meniere's disease. The sensitivity and specificity of EvestG testing were 75% and 80%, respectively. EVestG results were statistically significantly different for Meniere's patients versus the other dizzy patients and controls (Univariate ANOVA difference contrasts p = 0.0340) even in this small sample. CONCLUSION The EVestG protocol appeared to show promise as an objective, diagnostic test for Meniere's disease, but our sample size is too small to generalize widely. LEVEL OF EVIDENCE N.A. Prospective Human clinical trial.
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Affiliation(s)
- Brian Blakley
- />Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, GB421 - 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9 Canada
| | - Zeinab A Dastgheib
- />University of Manitoba, Room E3-512 Eng. Bldg., Biomedical Engineering, 75A Chancellor’s Circle, Winnipeg, MB R3T 5 V6 Canada
| | - Brian Lithgow
- />Monash Alfred Psychiatry Research Centre, University of Manitoba, and Research Affiliate of Riverview Health Center, EVestG Research Lab, Riverview Health Centre, Room PE446, 1 Morley Avenue, Winnipeg, MB R3L2P4 Canada
| | - Zahra Moussavi
- />Biomedical Engineering, University of Manitoba, and Research Affiliate of Riverview Health Center, Room E3-513 Eng. Bldg., Biomedical Engineering, 75A Chancellor’s Circle, Winnipeg, MB R3T 5V6 Canada
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Blödow A, Heinze M, Bloching MB, von Brevern M, Radtke A, Lempert T. Caloric stimulation and video-head impulse testing in Ménière's disease and vestibular migraine. Acta Otolaryngol 2014; 134:1239-44. [PMID: 25399882 DOI: 10.3109/00016489.2014.939300] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Both the bithermal caloric test and the video-head impulse test (vHIT) were more often abnormal in Ménière's disease (MD) than in vestibular migraine (VM). Horizontal vestibulo-ocular reflex (hVOR) evaluation with caloric test (low-frequency test) was significantly more often abnormal than vHIT (high-frequency test). Therefore, both tests can be used in a complementary way for frequency-selective testing of peripheral vestibular function. OBJECTIVES To compare the results of caloric testing and vHIT in MD and VM and to determine which test is more sensitive to uncover peripheral vestibular hypofunction. METHODS Patients with MD (n=30) or VM (n=23) were examined with the caloric test and vHIT. The parameters analyzed were the canal paresis factor for the caloric test and the hVOR gain on both sides in vHIT. RESULTS The caloric test was abnormal in 67% of patients with MD and in 22% with VM (p=0.002), while the vHIT showed an hVOR deficit in 37% in MD and 9% in VM (p=0.025). In all, 28% of patients with an abnormal caloric test had a normal vHIT, whereas 6% of those with an abnormal vHIT had a normal caloric test. The sensitivity of vHIT compared with caloric testing was 55% for MD and 40% for VM. Neither the caloric test nor vHIT could detect significant differences between early (<5 years) or advanced stages (>5 years) of MD or VM.
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Affiliation(s)
- Alexander Blödow
- Department of Otorhinolaryngology, Head and Neck Surgery and Communication Disorders , HELIOS-Klinikum Berlin-Buch , Germany
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Zulueta-Santos C, Lujan B, Manrique-Huarte R, Perez-Fernandez N. The vestibulo-ocular reflex assessment in patients with Ménière's disease: examining all semicircular canals. Acta Otolaryngol 2014; 134:1128-33. [PMID: 25315912 DOI: 10.3109/00016489.2014.919405] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Abstract Conclusion: The distribution of abnormal results is not uniform between different canals in each patient; the most frequent gain reduction is obtained for the posterior canal. Gain reduction reflects the disease duration and amount of hearing loss. OBJECTIVE To test the hypothesis that the vestibulo-ocular reflex (VOR) evoked after stimulation of each semicircular canal behaves in a different manner in patients with unilateral definite Ménière's disease. METHODS We studied the VOR evoked by rapid head-impulses in the plane of the 6 semicircular canals in 36 patients. It was evaluated with a video system that analyzes the head and eye velocity and the gain was the objective measure. RESULTS In 12 (33.3%) patients the examination of both ears was normal for all the semicircular canals, in 12 patients the results from the affected ear were abnormal in at least 1 of the semicircular canals, in 11 (30.5%) patients the results were abnormal in at least 1 of the semicircular canals in both the affected and unaffected ears, and in 1 (2.9%) patient the results were abnormal only in the unaffected ear. The most frequent abnormal result was obtained from the posterior canal of the affected ear and from the coupled superior canal of the unaffected ear. The distribution of abnormal findings was dependent on the disease duration and hearing loss.
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Affiliation(s)
- Cristina Zulueta-Santos
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, University Hospital and Medical School, University of Navarra , Pamplona, Navarra , Spain
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Kim SH, Kim JY, Lee HJ, Gi M, Kim BG, Choi JY. Autoimmunity as a candidate for the etiopathogenesis of Meniere's disease: detection of autoimmune reactions and diagnostic biomarker candidate. PLoS One 2014; 9:e111039. [PMID: 25330336 PMCID: PMC4201580 DOI: 10.1371/journal.pone.0111039] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 09/23/2014] [Indexed: 11/23/2022] Open
Abstract
Meniere's disease is an inner ear disorder that can manifest as fluctuating vertigo, sensorineural hearing loss, tinnitus, and aural fullness. However, the pathologic mechanism of Meniere's disease is still unclear. In this study, we evaluated autoimmunity as a potential cause of Meniere's disease. In addition we tried to find useful biomarker candidates for diagnosis. We investigated the protein composition of human inner ear fluid using liquid column mass spectrometry, the autoimmune reaction between circulating autoantibodies in patient serum and multiple antigens using the Protoarray system, the immune reaction between patient serum and mouse inner ear tissues using western blot analysis. Nine proteins, including immunoglobulin and its variants and interferon regulatory factor 7, were found only in the inner ear fluid of patients with Meniere's disease. Enhanced immune reactions with 18 candidate antigens were detected in patients with Meniere's disease in Protoarray analysis; levels of 8 of these antigens were more than 10-fold higher in patients than in controls. Antigen-antibody reactions between mouse inner ear proteins with molecular weights of 23–48 kDa and 63–75 kDa and patient sera were detected in 8 patients. These findings suggest that autoimmunity could be one of the pathologic mechanisms behind Meniere's disease. Multiple autoantibodies and antigens may be involved in the autoimmune reaction. Specific antigens that caused immune reactions with patient's serum in Protoarray analysis can be candidates for the diagnostic biomarkers of Meniere's disease.
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Affiliation(s)
- Sung Huhn Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kim
- Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jin Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Mia Gi
- Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Gyung Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
- Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Louza J, Krause E, Gürkov R. Audiologic evaluation of Menière's disease patients one day and one week after intratympanic application of gadolinium contrast agent: our experience in sixty-five patients. Clin Otolaryngol 2014; 38:262-6. [PMID: 23360133 DOI: 10.1111/coa.12087] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2013] [Indexed: 11/27/2022]
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Borel L, Redon-Zouiteni C, Cauvin P, Dumitrescu M, Devèze A, Magnan J, Péruch P. Unilateral vestibular loss impairs external space representation. PLoS One 2014; 9:e88576. [PMID: 24523916 PMCID: PMC3921214 DOI: 10.1371/journal.pone.0088576] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022] Open
Abstract
The vestibular system is responsible for a wide range of postural and oculomotor functions and maintains an internal, updated representation of the position and movement of the head in space. In this study, we assessed whether unilateral vestibular loss affects external space representation. Patients with Menière's disease and healthy participants were instructed to point to memorized targets in near (peripersonal) and far (extrapersonal) spaces in the absence or presence of a visual background. These individuals were also required to estimate their body pointing direction. Menière's disease patients were tested before unilateral vestibular neurotomy and during the recovery period (one week and one month after the operation), and healthy participants were tested at similar times. Unilateral vestibular loss impaired the representation of both the external space and the body pointing direction: in the dark, the configuration of perceived targets was shifted toward the lesioned side and compressed toward the contralesioned hemifield, with higher pointing error in the near space. Performance varied according to the time elapsed after neurotomy: deficits were stronger during the early stages, while gradual compensation occurred subsequently. These findings provide the first demonstration of the critical role of vestibular signals in the representation of external space and of body pointing direction in the early stages after unilateral vestibular loss.
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Affiliation(s)
- Liliane Borel
- Aix-Marseille Université, Marseille, France
- CNRS, UMR 7260 Laboratoire de Neurosciences Intégratives et Adaptatives, Marseille, France
| | | | | | - Michel Dumitrescu
- Aix-Marseille Université, Marseille, France
- CNRS, UMR 7260 Laboratoire de Neurosciences Intégratives et Adaptatives, Marseille, France
| | - Arnaud Devèze
- Aix-Marseille Université, Marseille, France
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Nord, Marseille, France
| | - Jacques Magnan
- Aix-Marseille Université, Marseille, France
- CNRS, UMR 7260 Laboratoire de Neurosciences Intégratives et Adaptatives, Marseille, France
| | - Patrick Péruch
- Aix-Marseille Université, Marseille, France
- INSERM, UMR_S 1106 Institut de Neurosciences des Systèmes, Marseille, France
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Nagai N, Ogawa Y, Hagiwara A, Otsuka K, Inagaki T, Shimizu S, Suzuki M. Ocular vestibular evoked myogenic potentials induced by bone-conducted vibration in patients with unilateral inner ear disease. Acta Otolaryngol 2014; 134:151-8. [PMID: 24215219 PMCID: PMC3913081 DOI: 10.3109/00016489.2013.844361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/01/2013] [Indexed: 12/02/2022]
Abstract
CONCLUSION Patients with vestibular neuritis (VN) with complete canal paresis (CP) showed a higher rate of abnormal ocular vestibular evoked myogenic potential (oVEMP) than those with partial CP. From these results, it is speculated that the superior vestibular nerve function mainly affects oVEMP. Significant correlation was found between the grades of the hearing outcome and oVEMP in sudden sensorineural hearing loss (SSHL). OBJECTIVE We attempted to correlate the results of oVEMP with the results of cervical VEMP (cVEMP), results of subjective visual vertical (SVV), and clinical course in patients with various vestibular disorders. METHODS Twenty-two patients with VN, 65 with SSHL, and 22 with Meniere's disease (MD), were enrolled in this study. We compared the results of oVEMP with those of cVEMP, SVV, and the caloric test. Furthermore, the oVEMP results were compared with the initial hearing threshold, presence of vertigo, and hearing recovery in the patients with SSHL. RESULTS The patients with VN with complete CP showed a higher rate of abnormal oVEMP than those with partial CP. In the patients with SSHL, the hearing recovery rate was lower in the patients with abnormal oVEMP than in those with normal oVEMP.
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Affiliation(s)
- Noriko Nagai
- Department of Otorhinolaryngology, Tokyo Medical University, Tokyo, Japan
| | - Yasuo Ogawa
- Department of Otorhinolaryngology, Tokyo Medical University, Tokyo, Japan
| | - Akira Hagiwara
- Department of Otorhinolaryngology, Tokyo Medical University, Tokyo, Japan
| | - Koji Otsuka
- Department of Otorhinolaryngology, Tokyo Medical University, Tokyo, Japan
| | - Taro Inagaki
- Department of Otorhinolaryngology, Tokyo Medical University, Tokyo, Japan
| | - Shigetaka Shimizu
- Department of Otorhinolaryngology, Tokyo Medical University, Tokyo, Japan
| | - Mamoru Suzuki
- Department of Otorhinolaryngology, Tokyo Medical University, Tokyo, Japan
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