Research

CATEGORY:
Research

SCREENSHOT:

TITLE:
Evaluation of Industry Relationships Among Authors of Systematic Reviews and Meta-analyses Regarding Menieres Disease

CONTENT:
Ann Otol Rhinol Laryngol. 2021 Oct 12:34894211051822. doi: 10.1177/00034894211051822. Online ahead of print.

ABSTRACT

OBJECTIVES: To quantify the presence of conflicts of interest (COI) in SRs and MAs of Ménières disease treatment and identify any related secondary characteristics of these articles.

METHODS: A search was conducted on May 28, 2020 to search MEDLINE and Embase databases for SRs or MAs pertaining to Ménières disease published between September 1, 2016 and June 2, 2020. A risk of bias assessment was performed using the Cochrane Collaboration risk of bias assessment criteria.

RESULTS: A total of 13 systematic reviews conducted by 49 authors met the inclusion criteria. Of the 49 authors, 7 (14.3%) were found to have some form of COI. Of these 7 authors, 1 (14.3%) completely disclosed all COI within the SR, 1 (14.3%) disclosed one or more COI but were found to have an additional undisclosed COI, and 5 (71.4%) were found to have only undisclosed COI. One of 2 industry funded SRs (50%) had a high risk of bias, and 1 (50%) of the non-industry sponsored SRs were found to have a high risk of bias.

CONCLUSIONS: Overall authors of SRs pertaining to Ménières disease appear to be properly disclosing COI at higher rates than other fields of medicine; however, further room for improvement has been noted.

PMID:34636251 | DOI:10.1177/00034894211051822

SOURCE:
The Annals of otology, rhinology, and laryngology

PUBLISHER:

PMID:
pubmed:34636251

ID:
5dfa010a544eb3c21dde51db84c2481bpubmed:34636251

DOI:
10.1177/00034894211051822

DATE – PUBLISHED:
Tue, 12 Oct 2021 06:00:00 -0400

DATE – DOI:
2021-10-12T21:53:46Z

DATE – ADDED:
10/17/21 03:08AM

LINK – PUBMED:
https://pubmed.ncbi.nlm.nih.gov/34636251/

LINK – DOI:
https://doi.org/10.1177/00034894211051822

LINK – PUBLISHER:
http://journals.sagepub.com/doi/10.1177/00034894211051822?utm_source=menierestreatmentreport.com

IMAGE:

REFERENCE:
Meniere’s Treatment Report, Urgent Research, 2021-10-17T07:08:43+00:00, https://www.meniereslosstreatmentreport.com.

https://www.ncbi.nlm.nih.gov/pubmed/33457323?dopt=Abstract

Pharmacological, Surgical and Diagnostic Innovations in Meniere’s Disease: A Review.

Related Articles

Pharmacological, Surgical and Diagnostic Innovations in Meniere’s Disease: A Review.

Transl Med UniSa. 2020 Dec;23:48-52

Authors: Scarpa A, Ralli M, De Bonis E, Troisi D, Montanino A, Viola P, Chiarella G, Gioacchini FM, Cavaliere M, Cassandro E, Cassandro C

Abstract

Purpose: To investigate literature about pharmacological, surgical, and diagnostic innovations for Meniere’s Disease (MD).

Summary: Meniere’s disease is an inner ear disorder characterized by the presence of endolymphatic hydrops in the inner ear and symptomatology of recurrent and debilitating vertigo attacks, tinnitus, aural fullness, and fluctuating sensorineural hearing loss. Although many therapeutic options for MD have been proposed during years, no consensus has been reached by the scientific community. In the last decade, many therapeutic options have been proposed, as intratympanic steroid, intratympanic gentamicin, and intravenous glycerol. Recently, the role of the antisecretory factor in the diet of MD patients have been investigated. Surgery is recommended for intractable MD; some authors proposed new approaches including transcanal endoscopic infracochlear vestibular neurectomy, new marsupiliazation technique in sac surgery, and tenotomy of the stapedius and tensor tympani muscles.

PMID: 33457323 [PubMed]

PubMed:33457323

https://www.tandfonline.com/doi/abs/10.1080/00016489.2020.1843071?journalCode=ioto20

https://www.ncbi.nlm.nih.gov/pubmed/33176531?dopt=Abstract

The value of 3D-real IR MRI with intravenous gadolinium injection in the diagnosis of suspected Meniere’s disease in children.

Related Articles

The value of 3D-real IR MRI with intravenous gadolinium injection in the diagnosis of suspected Meniere’s disease in children.

Acta Otolaryngol. 2020 Nov 12;:1-5

Authors: Chen W, Chen Y, Geng Y, Lin N, Luo S, Wang Z, Yu S, Sha Y

Abstract

BACKGROUND: Intravenous gadolinium injection (IV-method) can be used to visualize endolymphatic hydrops.

AIMS/OBJECTIVES: This study was designed to use a three-dimensional inversion-recovery sequence with real reconstruction (3 D-real IR) sequence 4 h after the IV-method, images of the perilymph space were scored for endolymphatic hydrops in cases of suspected Meniere’s disease (MD) in children to investigate its diagnostic value of MD in children.

MATERIALS AND METHODS: We collected 28 suspected MD children aged ≤17 years old, all of whom underwent the IV-method. After 4 h, inner ear 3 D-real IR magnetic resonance imaging (MRI) was performed and results were analyzed.

RESULTS: Gadolinium contrast agent was seen distributed in the perilymphatic space with perilymphatic enhancement on 3 D-real IR MRI, allowing differentiation between the perilymphatic and endolymphatic spaces. Based on perilymph MRI diagnostic scoring, 64.3% (18/28) of the patients were categorized as having endolymphatic hydrops, who were followed and eventually diagnosed with confirmed MDs.

CONCLUSIONS AND SIGNIFICANCE: Suspected MD children should undergo gadolinium-enhanced examinations of the inner ear while taking dynamic audiology examinations for the confirmed diagnosis.

PMID: 33176531 [PubMed – as supplied by publisher]

PubMed:33176531

https://www.ncbi.nlm.nih.gov/pubmed/33044205?dopt=Abstract

https://content.iospress.com/articles/journal-of-vestibular-research/ves200716

Menière’s disease caused by CGRP – A new hypothesis explaining etiology and pathophysiology. Redirecting Menière’s syndrome to Menière’s disease.

Menière’s disease caused by CGRP – A new hypothesis explaining etiology and pathophysiology. Redirecting Menière’s syndrome to Menière’s disease.

J Vestib Res. 2020 Oct 05;:

Authors: Hegemann SCA

Abstract

This paper provides a new hypothetical explanation for the etiopathology and pathophysiology of Menière’s Disease (MD), which to date remain unexplained, or incompletely understood. The suggested hypothesis will explain the close connection of MD and Migraine, the coexistence of endolymphatic hydrops (ELH) and Menière attacks and the signs of inflammation detected in the inner ears of MD patients. Although as yet unproven, the explanations provided appear highly plausible and could pave the way for the generation of the first animal model of MD – an invaluable asset for developing new treatment strategies. Furthermore, if proven correct, this hypothesis could redefine and also reset the actual name of Menière’s Syndrome to Menière’s Disease.

PMID: 33044205 [PubMed – as supplied by publisher]

PubMed:33044205

https://www.ncbi.nlm.nih.gov/pubmed/33169953?dopt=Abstract

Effectiveness of Intratympanic Administration of Gentamicin in Unilateral MeniÈre’s Disease.

Related Articles

Effectiveness of Intratympanic Administration of Gentamicin in Unilateral MeniÈre’s Disease.

Otol Neurotol. 2020 Sep;41(8):e1066-e1067

Authors: De Luca P, Ralli M, Scarpa A, Cavaliere M, Gioacchini FM, Cassandro E, Cassandro C

PMID: 33169953 [PubMed – as supplied by publisher]

PubMed:33169953

https://www.tandfonline.com/doi/full/10.1080/14992027.2020.1799252

https://www.ncbi.nlm.nih.gov/pubmed/32731785?dopt=Abstract

Nystagmus during an acute Ménière’s attack: from prodrome to recovery.

Related Articles

Nystagmus during an acute Ménière’s attack: from prodrome to recovery.

Int J Audiol. 2020 Jul 31;:1-5

Authors: Phillips JS, Newman JL, Cox SJ, FitzGerald J

Abstract

OBJECTIVE: We are currently undertaking a clinical investigation to evaluate the diagnostic capability of a system for detecting periods of pathological dizziness. This article presents an analysis of the data captured during an acute attack of Ménière’s disease.

DESIGN: The Continuous Ambulatory Vestibular Assessment (CAVA) device is worn by patients in the community, and continuously records eye and head movement data (vestibular telemetry).

STUDY SAMPLE: A 53-year-old lady with a fifteen-year history of left-sided unilateral Ménière’s disease.

RESULTS: The patient wore the device nearly continuously for thirty days. The data revealed a three-hour long attack of vertigo consisting of four separate phases of nystagmus. The duration, beat-direction and slow phase velocity of the nystagmus evolved through time. The first phase contained isolated nystagmus beats which preceded the patient’s record of the vertigo attack onset but coincided with anticipation of an impending vertigo attack.

CONCLUSIONS: CAVA provides a unique insight into the physiological parameters present during episodes of dizziness. Here, it has provided the first full example of an acute Ménière’s attack, including a period of prodrome. These findings have implications for the prediction of vertigo attack onset, for the diagnosis of Ménière’s disease and other diseases resulting in dizziness.

PMID: 32731785 [PubMed – as supplied by publisher]

PubMed:32731785

https://www.nature.com/articles/s41598-020-68352-0

https://www.ncbi.nlm.nih.gov/pubmed/32704101?dopt=Abstract

Live imaging and functional changes of the inner ear in an animal model of Meniere’s disease.

Related Articles

Live imaging and functional changes of the inner ear in an animal model of Meniere’s disease.

Sci Rep. 2020 Jul 23;10(1):12271

Authors: Kakigi A, Egami N, Uehara N, Fujita T, Nibu KI, Yamashita S, Yamasoba T

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.

PMID: 32704101 [PubMed – in process]

PubMed:32704101

https://www.ncbi.nlm.nih.gov/pubmed/32539493?dopt=Abstract

https://www.tandfonline.com/doi/abs/10.1080/14656566.2020.1775812?journalCode=ieop20

The pharmacological management of vertigo in Meniere disease.

The pharmacological management of vertigo in Meniere disease.

Expert Opin Pharmacother. 2020 Jun 15;:1-11

Authors: Espinosa-Sanchez JM, Lopez-Escamez JA

Abstract

INTRODUCTION: The term Meniere disease (MD) gathers a set of rare diseases involving the inner ear characterized by episodic vertigo associated with fluctuating auditory symptoms. Five clinical subgroups of patients have been defined, including familial MD, autoimmune MD, and MD with migraine. The diagnosis is based on clinical criteria as no biomarker is available, but genetic factors have a significant contribution in familial and non-familial MD.

AREAS COVERED: In this review, the authors summarize the pharmacological treatment for vertigo in MD, providing evidence from preclinical and clinical studies. However, evidence supporting the efficacy for betahistine, diuretics, and intratympanic administration of corticosteroids or gentamicin is limited.

EXPERT OPINION: Randomized clinical trials should consider stratification by MD clinical subgroups. The treatment plan should be personalized according to the clinical subgroup, hearing stage, duration of the disease, vertigo attack profile, and comorbidities. The treatment should include therapeutic counseling, sodium-free diet, high-water intake, and a diary of vertigo attacks with symptoms during the episodes to improve phenotyping. Migraine or autoimmune comorbidities will also require pharmacotherapy. Genetic testing by exome/genome sequencing should be discussed with the patient for familial MD and individuals with an early onset for genetic counseling and future gene therapies.

PMID: 32539493 [PubMed – as supplied by publisher]

PubMed:32539493

https://journals.lww.com/otology-neurotology/Abstract/9000/Cochlear_Implantation_in_Patients_With_Meni_re_s.96043.aspx

https://www.ncbi.nlm.nih.gov/pubmed/32675729?dopt=Abstract

Cochlear Implantation in Patients With Menière’s Disease: Does Disease Activity Affect the Outcome?

Related Articles

Cochlear Implantation in Patients With Menière’s Disease: Does Disease Activity Affect the Outcome?

Otol Neurotol. 2020 Jul 14;:

Authors: Kocharyan A, Mark ME, Ascha MS, Murray GS, Manzoor NF, Megerian C, Mowry SE, Semaan MT

Abstract

OBJECTIVE: Menière’s disease (MD) is characterized by episodes of vertigo, tinnitus, and sensorineural hearing loss. In the setting of bilateral deafness due to MD alone or contralateral pathology, cochlear implantation (CI) improves hearing. Active MD is characterized by fluctuating auditory symptoms and vertigo; whereas remittance of vertiginous symptoms and severe, permanent sensorineural hearing loss characterizes the inactive disease state. This study evaluates outcomes for MD patients compared with the general CI population and assesses if disease activity affects implant outcomes.

STUDY DESIGN: Retrospective chart review.

SETTING: Tertiary referral center.

PATIENTS: Twenty-four patients with MD that received CI (7 active, 16 inactive, and 1 Probable Menière’s), and 24 age-matched controls.

INTERVENTIONS: Cochlear implantation.

MAIN OUTCOME MEASURES: Word Recognition Score, Sentence Recognition Score (SRS), and Speech Reception Threshold.

RESULTS: Best-aided preoperative and postoperative audiometric data were compared per ear between MD patients and controls and stratified by disease status using descriptive statistics with mixed-effects modeling. Patients with MD derived significantly more benefit from CI than controls when comparing differences between preoperative and postoperative levels for Word Recognition Score (12.2%, p = 0.0236), SRS (12.8%, p = 0.0375), and Speech Reception Threshold (-14.4 dB, p = 0.0188). Active disease status does not negatively impact CI outcomes and patients with active MD may benefit from greater gains in SRS (23.5%, p = 0.0107).

CONCLUSIONS: CI provides greater gains in functional hearing for patients with MD compared with age-matched controls. Patients with active MD seem to perform better with respect to SRS following CI than patients with inactive status.

PMID: 32675729 [PubMed – as supplied by publisher]

PubMed:32675729

https://journals.sagepub.com/doi/10.1177/0194599820940649

https://www.ncbi.nlm.nih.gov/pubmed/32663060?dopt=Abstract

MicroRNA Profiling as a Methodology to Diagnose Ménière’s Disease: Potential Application of Machine Learning.

Related Articles

MicroRNA Profiling as a Methodology to Diagnose Ménière’s Disease: Potential Application of Machine Learning.

Otolaryngol Head Neck Surg. 2020 Jul 14;:194599820940649

Authors: Shew M, Wichova H, Bur A, Koestler DC, St Peter M, Warnecke A, Staecker H

Abstract

OBJECTIVE: Diagnosis and treatment of Ménière’s disease remains a significant challenge because of our inability to understand what is occurring on a molecular level. MicroRNA (miRNA) perilymph profiling is a safe methodology and may serve as a “liquid biopsy” equivalent. We used machine learning (ML) to evaluate miRNA expression profiles of various inner ear pathologies to predict diagnosis of Ménière’s disease.

STUDY DESIGN: Prospective cohort study.

SETTING: Tertiary academic hospital.

SUBJECTS AND METHODS: Perilymph was collected during labyrinthectomy (Ménière’s disease, n = 5), stapedotomy (otosclerosis, n = 5), and cochlear implantation (sensorineural hearing loss [SNHL], n = 9). miRNA was isolated and analyzed with the Affymetrix miRNA 4.0 array. Various ML classification models were evaluated with an 80/20 train/test split and cross-validation. Permutation feature importance was performed to understand miRNAs that were critical to the classification models.

RESULTS: In terms of miRNA profiles for conductive hearing loss versus Ménière’s, 4 models were able to differentiate and identify the 2 disease classes with 100% accuracy. The top-performing models used the same miRNAs in their decision classification model but with different weighted values. All candidate models for SNHL versus Ménière’s performed significantly worse, with the best models achieving 66% accuracy. Ménière’s models showed unique features distinct from SNHL.

CONCLUSIONS: We can use ML to build Ménière’s-specific prediction models using miRNA profile alone. However, ML models were less accurate in predicting SNHL from Ménière’s, likely from overlap of miRNA biomarkers. The power of this technique is that it identifies biomarkers without knowledge of the pathophysiology, potentially leading to identification of novel biomarkers and diagnostic tests.

PMID: 32663060 [PubMed – as supplied by publisher]

PubMed:32663060

https://www.tandfonline.com/doi/full/10.1080/00016489.2020.1776385

https://www.ncbi.nlm.nih.gov/pubmed/32564698?dopt=Abstract

Current status on researches of Meniere’s disease: a review.

Related Articles

Current status on researches of Meniere’s disease: a review.

Acta Otolaryngol. 2020 Jun 21;:1-5

Authors: Liu Y, Yang J, Duan M

Abstract

Background: Meniere’s disease (MD) is a complex and multifactorial inner ear disease. The etiology of MD is unclear. Significant progress had been made in diagnosis and treatment. Complete cure for this disease is still impossible.Objectives: This review covers the updated research results in MD in the past decades.Material and methods: Recent publications were critically reviewed.Results: The relationship between Endolymphatic hydrops and Meniere symptoms requires further study. Direct visualization of EH is achieved by special sequences of inner ear MRI. Appearance of EH could be observed in MD patients both in symptomatic and asymptomatic ears. Visualization of EH in vivo might make a great substantial improvement in diagnose of MD. The first goal of the management of MD is to reduce the attack frequency. Several safe and effective medical and surgical therapies are practiced to help patients to control vertigo and preserve hearing.Conclusions and significance: There has been no major breakthrough in the pathogenesis research of MD in recent years. Visualization of EH in vivo might make a great substantial improvement in diagnose of MD. Clinicians still have few effective ways to alleviate the progress of the disease.

PMID: 32564698 [PubMed – as supplied by publisher]

PubMed:32564698

https://www.tandfonline.com/doi/abs/10.1080/00016489.2020.1766700?journalCode=ioto20

https://www.ncbi.nlm.nih.gov/pubmed/32437211?dopt=Abstract

Comparison of the video head impulse test results with caloric test in patients with Meniere’s disease and other vestibular disorders.

Comparison of the video head impulse test results with caloric test in patients with Meniere’s disease and other vestibular disorders.

Acta Otolaryngol. 2020 May 21;:1-8

Authors: Shugyo M, Ito T, Shiozaki T, Nishikawa D, Ohyama H, Fujita H, Yamanaka T, Kitahara T

Abstract

Background: The caloric test has been used to evaluate the semi-circular canal function for decades. In 2009, the video head impulse test (vHIT) was introduced, which can be used to evaluate the semi-circular canal function within a short time. Although both tests examine the semi-circular canal, the stimulation methods differ and it is unclear whether the vHIT is equivocal to the caloric test.Aims/objectives: This study aimed to discern the differences between the vHIT and caloric test.Material and methods: This study comprised 112 patients with vertigo who visited the vertigo/dizziness centre at our university hospital. Each of these patients underwent a caloric test and vHIT within the same day, and their results were compared. Additionally, an electrocochleography (EcoG) examination, glycerol test (G test), and MRI (performed 4 h after an intravenous gadolinium injection) were conducted to evaluate the influence of endolymphatic hydrops (EH) on the caloric test and vHIT results.Results: Differences in the caloric test and vHIT results, among those with and without EH, were observed in 66.7 and 35.3% of patients, respectively.Conclusions and significance: EH resulted in a difference in results between the caloric test and vHIT. Activated hair cell type may also be implicated.

PMID: 32437211 [PubMed – as supplied by publisher]

PubMed:32437211

https://www.karger.com/Article/Abstract/506921

https://www.ncbi.nlm.nih.gov/pubmed/32289780?dopt=Abstract

Epidemiology and Seasonal Variation of Ménière’s Disease: Data from a Population-Based Study.

Epidemiology and Seasonal Variation of Ménière’s Disease: Data from a Population-Based Study.

Audiol Neurootol. 2020 Apr 14;:1-7

Authors: Kim MH, Cheon C

Abstract

INTRODUCTION: Ménière’s disease (MD) is a disease of the inner ear. In Asian countries, there is one previous epidemiologic study that used a retrospective survey of a specific district. Previous studies have demonstrated that weather variables are strongly associated with symptom aggravation in MD. However, no study has reported on seasonal variation of MD.

METHODS: We conducted a retrospective population-based study using the Korean national health insurance claims database (NHICD). In the present study, the prevalence and incidence of MD from 2013 to 2017 were calculated. Prevalence and incidence of MD according to sex, age group, and monthly incidence are presented. Seasonal incidence was calculated for four seasons. The seasonal average humidity and atmospheric pressure were also calculated.

RESULTS: The incidence rate of MD showed a rapid yearly increase from 2013 to 2017 in Korea. The prevalence and incidence rate by age group continued to increase up to the 70 year olds. The female-to-male ratio was 2.17. The seasonal incidence of MD was relatively high in summer and autumn and relatively low in winter and spring; however, there were no significant differences.

DISCUSSION/CONCLUSIONS: The rapid progression to an aging society, increase in medical accessibility, and lifestyle changes could be the reasons for the elevation of the incidence rate in the Korean population. Consistent with a previous study, the incidence of MD was higher in seasons with high humidity and low atmospheric pressure; however, there were no significant differences. Further studies about the relationship between diet and MD, seasonality of MD with long-term analysis, and investigating the underlying mechanisms connecting weather and MD are needed.

PMID: 32289780 [PubMed – as supplied by publisher]

PubMed:32289780

https://www.tandfonline.com/doi/abs/10.1080/00016489.2020.1749299?journalCode=ioto20

https://www.ncbi.nlm.nih.gov/pubmed/32281461?dopt=Abstract

Phonophobia and migraine features in patients with definite meniere’s disease: Pentad or triad/tetrad?

Phonophobia and migraine features in patients with definite meniere’s disease: Pentad or triad/tetrad?

Acta Otolaryngol. 2020 Apr 11;:1-5

Authors: Saberi A, Nemati S, Amlashi TT, Tohidi S, Bakhshi F

Abstract

Background: Epidemiological studies have shown different association between migraine and Meniere’s disease (MD). Few studies investigated the frequency of phonophobia in MD.Objectives: This study aimed to determine the frequency of phonophobia and other features of migraine in definite MD.Material and Methods: Patients with definite MD and a group of healthy (non-MD, non-vertiginous) control subjects participated. Demographic data and other clinical features of the two diseases recorded. Data analyzed in SPSS software version 20, by qi square and independent T test and logistic regression model.Results: 69 MD patients (average age: 48.87 ± 12.15 years) and 60 control subjects (average age: 47.58 ± 12.05 years) enrolled. The frequency of migraine headache in MD cases was 16% (45% with aura) compared with 5% in control group (three cases; 2 without and 1 with aura) (p < .001). Family history of migraine was the only determinant of the presence of migraine in MD (p = .001, OR = 15.625, 95%CI: 2.94-88.33). The frequency of phonophobia in MD was very high (88.4%: 54.5% in migraine subgroup and 89.6% in non-migraine cases) and without significant relation to existence of migraine, in contrast to photophobia and osmophobia (p = .064).Conclusions: The frequency of migraine in MD is higher than normal subjects. Phonophobia may be an independent symptom in MD. PMID: 32281461 [PubMed - as supplied by publisher] PubMed:32281461

https://journals.sagepub.com/doi/10.1177/0194599820909439

https://www.ncbi.nlm.nih.gov/pubmed/32267820?dopt=Abstract

Clinical Practice Guideline: Ménière’s Disease Executive Summary.

Clinical Practice Guideline: Ménière’s Disease Executive Summary.

Otolaryngol Head Neck Surg. 2020 Apr;162(4):415-434

Authors: Basura GJ, Adams ME, Monfared A, Schwartz SR, Antonelli PJ, Burkard R, Bush ML, Bykowski J, Colandrea M, Derebery J, Kelly EA, Kerber KA, Koopman CF, Kuch AA, Marcolini E, McKinnon BJ, Ruckenstein MJ, Valenzuela CV, Vosooney A, Walsh SA, Nnacheta LC, Dhepyasuwan N, Buchanan EM

Abstract

OBJECTIVE: Ménière’s disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many, and approaches typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies.

PURPOSE: The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.

PMID: 32267820 [PubMed – as supplied by publisher]

PubMed:32267820

https://journals.lww.com/otology-neurotology/Abstract/9000/Predictive_Value_of_Vestibular_Evoked_Myogenic.96150.aspx

https://www.ncbi.nlm.nih.gov/pubmed/32271263?dopt=Abstract

Predictive Value of Vestibular Evoked Myogenic Potentials in the Diagnosis of Menière’s Disease and Vestibular Migraine.

Predictive Value of Vestibular Evoked Myogenic Potentials in the Diagnosis of Menière’s Disease and Vestibular Migraine.

Otol Neurotol. 2020 Apr 07;:

Authors: Rizk HG, Liu YF, Strange CC, Van Ausdal CH, English RC, McRackan TR, Meyer TA

Abstract

OBJECTIVE: To explore the usefulness of vestibular evoked myogenic potentials (VEMPs) in the diagnosis of Menière’s disease (MD) and vestibular migraine (VM).

STUDY DESIGN: Retrospective cohort.

SETTING: Multidisciplinary neurotology clinic.

PATIENTS: Definite MD and definite VM patients between January, 2015 and May, 2017, as well as healthy volunteers.

INTERVENTIONS: Cervical and ocular VEMP (cVEMP and oVEMP) testing.

MAIN OUTCOME MEASURES: VEMP response, amplitude, and latency.

RESULTS: Twenty five definite MD, 34 definite VM, and 13 control subjects were analyzed. MD affected ears had significantly lower cVEMP (p = 0.007) and oVEMP (p < 0.001) amplitudes than control ears. VM ears had significantly lower oVEMP (p = 0.001), but not cVEMP (p = 0.198) amplitudes than control ears. MD affected ears, but not VM ears, had significantly more absent cVEMP (25.9% versus 0%, p = 0.005) and oVEMP responses (40.7% versus 0%, p < 0.001) than control ears. oVEMP latency was significantly shorter for both MD affected (p < 0.001) and VM ears (p < 0.001) than control ears. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated using a neurotology clinic MD prevalence of 7.9% in dizzy patients. A present cVEMP or oVEMP both have more than 93% chance of ruling MD out in the tested ear, while a cVEMP amplitude more than 54.9 μV or oVEMP amplitude more than 5.1 μV both have more than 94% of ruling out MD in the tested ear. CONCLUSIONS: Despite some overlap in VEMP results between MD and VM, when the diagnosis is uncertain between the two disorders due to symptomatic overlap and nonspecific audiometric data, VEMPs can be helpful in guiding treatment toward one disease entity or the other until more evidence points to a definitive diagnosis. PMID: 32271263 [PubMed - as supplied by publisher] PubMed:32271263

https://www.ejao.org/journal/view.php?doi=10.7874/jao.2020.00115

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141995/

https://www.ncbi.nlm.nih.gov/pubmed/32248670?dopt=Abstract

Experimental Animal Models for Meniere’s Disease: A Mini-Review.

Experimental Animal Models for Meniere’s Disease: A Mini-Review.

J Audiol Otol. 2020 Apr;24(2):53-60

Authors: Seo YJ, Brown D

Abstract

Several novel animal models that represent the pathophysiological process of endolymphatic hydrops (ELH) of Meniere’s disease (MD) have been developed. Animal models are important to identify and characterize the pathophysiology of ELH and to corroborate molecular and genetic findings in humans. This review of the current animal models will be useful in understanding the pathophysiology of and developing proper treatments for MD. Surgical animal models will be replaced by medication-induced animal models. Study models previously developed in guinea pigs will be developed in several smaller animals for ease of conducting molecular analysis. In this review, we provided updated resources including our previous studies regarding the current and desirable animal models for MD.

PMID: 32248670 [PubMed – as supplied by publisher]

PubMed:32248670

hhttps://pubmed.ncbi.nlm.nih.gov/32088708-bone-mineral-density-in-patients-suffering-from-menieres-disease/

ttps://www.ncbi.nlm.nih.gov/pubmed/32088708?dopt=Abstract

Bone Mineral Density in Patients Suffering from Ménière’s Disease.

Bone Mineral Density in Patients Suffering from Ménière’s Disease.

Audiol Neurootol. 2020 Feb 21;:1-6

Authors: Shupak A, Faranesh N

Abstract

INTRODUCTION: Previous studies have reported an association between reduced bone mineral density and the occurrence of benign paroxysmal positional vertigo, balance impairment, and saccular dysfunction. Furthermore, the results of recent animal studies have raised the possibility that vestibular dysfunction could affect bone remodeling and bone mass. The goal of the study was to compare bone mineral density of patients suffering from definite Ménière’s disease to that of a matched control group.

METHODS: We conducted a case-control cross-sectional study in a tertiary referral center. The study group included 23 patients suffering from definite Ménière’s disease, and the control group was comprised of 23 patients matched in their race, gender, and age parameters in whom no vestibular pathology could be found. Dual energy X-ray absorptiometry of the femoral head was used for the assessment of bone mineral density. The T and Z scores of the femoral heads’ bone mineral density were compared.

RESULTS: The average T scores were -1.53 ± 1.08 in the study and -0.39 ± 0.72 (p = 0.016) in the control groups, and the Z scores were -0.4 ± 0.63 and 0.33 ± 0.31 (p = 0.018), respectively. Seventeen patients (74%) of the study group and 9 (39%) of the control group had T scores less than -1.0, indicating osteopenia/osteoporosis (p = 0.036).

CONCLUSIONS: The results showed a significant association between Ménière’s disease and reduced bone mineral density of the femoral head. Bone mineral density studies of the weight-bearing bones are warranted in Ménière’s disease for the early diagnosis and treatment of osteopenia/osteoporosis on the one hand and possible benefit of this treatment for the evolution of Ménière’s disease on the other hand.

PMID: 32088708 [PubMed – as supplied by publisher]

PubMed:32088708

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225650

https://www.ncbi.nlm.nih.gov/pubmed/31756230?dopt=Abstract

Are viral-infections associated with Ménière’s Disease? A systematic review and meta-analysis of molecular-markers of viral-infection in case-controlled observational studies of MD.

Are viral-infections associated with Ménière’s Disease? A systematic review and meta-analysis of molecular-markers of viral-infection in case-controlled observational studies of MD.

PLoS One. 2019;14(11):e0225650

Authors: Dean NJ, Pastras C, Brown D, Camp A

Abstract

Despite considerable research, it remains controversial as to whether viral-infections are associated with Meniere’s Disease (MD), a clinically heterogeneous set of chronic inner-ear disorders strongly associated with endolymphatic hydrops. Here, we investigated whether viral-infections are associated with MD through a systematic review and meta-analysis of observational clinical studies using molecular-diagnostics. Eligible for inclusion were case-controlled studies which ascertained molecular-determinants of past or present viral-infection through either viral nucleic acids or host serological marker in MD cases and non-MD controls. Across online databases and grey literature, we identified 210 potentially relevant articles in the English language, from which a total of 14 articles fully satisfied our eligibility criteria such that meta-groups of 611 MD-cases and 373 controls resulted. The aggregate quality of the modest-sized (14 studies) body of evidence was limited and varied considerably with regards to participant selection, matching, and ascertainment(s) and determinant(s) of viral-infection. Most data identified concerned the human cytomegalovirus (CMV), and meta-analysis of eligible studies revealed that evidence of CMV-infection was associated approximately three-fold with MD compared to controls, however the timing of the infections was indeterminate as the pooled analyses combined antiviral serological markers with viral nucleic acid markers. No association was found for any of HSV-1, -2, VZV, or EBV. Associative analyses of any viral species not aforementioned were precluded by limited data, and thus potential associations between other viral species and MD, especially other than Herpesviridae, are yet to be characterised. Overall, we have found a small association between CMV-infection and MD, however it is to be determined for what sub-groups of MD this finding may be relevant, and ideally the reported association remains would be reproduced by a greater volume of higher quality evidence.

PMID: 31756230 [PubMed – in process]

PubMed:31756230

https://onlinelibrary.wiley.com/doi/10.1002/lary.28389

https://www.ncbi.nlm.nih.gov/pubmed/31710712?dopt=Abstract

Chronic cerebrospinal venous insufficiency and menière’s disease: Interventional versus medical therapy.

The results of the present study confirm the close relationship between vascular disorders and Menière’s disease. The encouraging responses to vascular interventional therapy on Meniére’s disease symptoms suggest that this may be a promising path for interpretation and treatment of this complex disease.

Chronic cerebrospinal venous insufficiency and menière’s disease: Interventional versus medical therapy.

Laryngoscope. 2019 Nov 11;:

Authors: Attanasio G, Califano L, Bruno A, Giugliano V, Ralli M, Martellucci S, Milella C, de Vincentiis M, Russo FY, Greco A

Abstract

OBJECTIVES/HYPOTHESIS: To evaluate the incidence of chronic cerebrospinal venous insufficiency in Menière’s disease patients and the effect of bilateral percutaneous transluminal angioplasty of the jugular/azygos veins compared to medical therapy.

STUDY DESIGN: Prospective case-control study.

METHODS: Five hundred fourteen subjects were included in the study, 412 affected by definite Menière’s disease, and 102 healthy controls. All patients underwent audiovestibular and vascular examination. Patients with Menière’s disease and concomitant cerebrospinal venous insufficiency were divided in two subgroups: patients who underwent vascular intervention with bilateral percutaneous transluminal angioplasty (PTA) of the jugular/azygos veins and patients treated with medical therapy.

RESULTS: Chronic cerebrospinal venous insufficiency was diagnosed in 330/412 (80.1%) Menière’s disease patients and in 12/102 healthy individuals (11.8%) (P < .001). In the two chronic cerebrospinal venous insufficiency subgroups, a significant difference in Dizziness Handicap Inventory scores was found between patients in the PTA group compared to patients treated with medical therapy (31 ± 8.6 vs. 48.1 ± 14.4; P < .001); no significant differences were found for the Tinnitus Handicap Inventory scores (50.8 ± 16.58 vs. 49.6 ± 17.5; P = .23). Subjective evaluation of aural fullness was significantly better in patients in the PTA group (P = .003) as well as pure-tone average, which was significantly different between groups (49.8 ± 16.5 dB in the PTA group vs. 55.8 ± 13 in the medical therapy group; P = .035). CONCLUSIONS: The results of the present study confirm the close relationship between vascular disorders and Menière's disease. The encouraging responses to vascular interventional therapy on Meniére's disease symptoms suggest that this may be a promising path for interpretation and treatment of this complex disease. LEVEL OF EVIDENCE: 2b Laryngoscope, 2019. PMID: 31710712 [PubMed - as supplied by publisher] PubMed:31710712

https://www.sciencedirect.com/science/article/pii/S030698771931028X?via%3Dihub

https://www.ncbi.nlm.nih.gov/pubmed/31629154?dopt=Abstract

A hypothetical proposal for association between migraine and Meniere’s disease.

A hypothetical proposal for association between migraine and Meniere’s disease.

Med Hypotheses. 2019 Oct 12;134:109430

Authors: Sarna B, Abouzari M, Lin HW, Djalilian HR

Abstract

Meniere’s disease (MD) is a chronic condition affecting the inner ear whose precise etiology is currently unknown. We propose the hypothesis that MD is a migraine-related phenomenon which may have implications for future treatment options for both diseases. The association between MD and migraine is both an epidemiological and a mechanistic one, with up to 51% of individuals with MD experiencing migraine compared to 12% in the general population. The presence of endolymphatic hydrops in those with MD may be the factor that unites the two conditions, as hydropic inner ears have an impaired ability to maintain homeostasis. Migraine headaches are theorized to cause aura and symptoms via spreading cortical depression that ultimately results in substance P release, alterations in blood flow, and neurogenic inflammation. Chronically hydropic inner ears are less able to auto-regulate against the changes induced by active migraine attacks and may ultimately manifest as MD. This same vulnerability to derangements in homeostasis may also explain the common triggering factors of both MD attacks and migraine headaches, including stress, weather, and diet. Similarly, it may explain the efficacy of common treatments for both diseases: current migraine treatments such as anti-hypertensives and anti-convulsants have shown promise in managing MD. Though the etiology of both MD and migraine is likely multifactorial, further exploration of the association between the two conditions may illuminate how to best manage them in the future. MD is likely a manifestation of cochleovestibular migraine, which occurs as a result of migraine related changes in both the cochlea and vestibule.

PMID: 31629154 [PubMed – as supplied by publisher]

PubMed:31629154

https://www.biorxiv.org/content/10.1101/771527v1.full

Rare Variants in the OTOG Gene Are a Frequent Cause of Familial Meniere’s Disease

https://www.karger.com/Article/Abstract/502275

https://www.ncbi.nlm.nih.gov/pubmed/31522181?dopt=Abstract

Rat Model of Ménière’s Attack: Intratympanic Injection of Potassium Chloride Produces Direction-Changing Spontaneous Nystagmus and Hearing Fluctuations.

Rat Model of Ménière’s Attack: Intratympanic Injection of Potassium Chloride Produces Direction-Changing Spontaneous Nystagmus and Hearing Fluctuations.

Audiol Neurootol. 2019 Sep 13;:1-7

Authors: Kamakura T, Kitahara T, Kondo M, Horii A, Hanada Y, Takimoto Y, Ishida Y, Nakamura Y, Imai T, Inohara H, Shimada S

Abstract

The major symptoms of Ménière’s disease are episodic vertigo, fluctuating hearing loss, and tinnitus. Direction-changing spontaneous nystagmus is a characteristic vestibular finding in Ménière’s disease. In the acute stage, spontaneous nystagmus beating to the affected side (irritative nystagmus) is often observed, while paralytic nystagmus beating to the healthy side is found in the chronic stage. This direction-changing nystagmus can be reproduced in guinea pigs by increasing the potassium ion concentration in the perilymph. The objectives of the present study were to examine the effects of increasing the potassium ion concentration of the rat perilymph on hearing and nystagmus. Under isoflurane anesthesia, 22 rats received intratympanic injection of different concentrations of potassium chloride (KCl) solution or distilled water: groups 1, 2, 3, and 4 received saturated (3.4 M) KCl solution, 2 M KCl, 1 M KCl, and distilled water, respectively. The nystagmus direction and number per 15 s were monitored for 150 min. In the other 8 rats, hearing was monitored 30 min and 20 h after intratympanic injection of 2 M KCl (group 5) or distilled water (group 6) using the auditory brainstem responses. Rats in groups 1 and 2 showed spontaneous irritative nystagmus beating to the affected ear followed by paralytic nystagmus beating to the contralateral side. In group 3, irritative nystagmus occurred but paralytic nystagmus was rarely observed. Rats in group 4 showed no nystagmus. Rats in group 5 showed significant hearing impairment 30 min after KCl injection that recovered 20 h later. Control animals in group 6 showed no significant changes in hearing. The reversible hearing impairment with direction-changing spontaneous nystagmus induced by potassium injection into the tympanic cavity in rats was quite similar to that observed in acute Ménière’s attacks. This rat model could be used for basic research investigating the pathophysiological mechanisms underlying Ménière’s attacks.

PMID: 31522181 [PubMed – as supplied by publisher]

PubMed:31522181

https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2019.0099

https://www.ncbi.nlm.nih.gov/labs/pubmed/31508988-menieres-disease-treated-by-grommet-insertion/

Menière’s disease treated by grommet insertion

https://www.tandfonline.com/doi/full/10.1080/00016489.2019.1658898

https://www.ncbi.nlm.nih.gov/pubmed/31498001?dopt=Abstract

Intratympanically administered steroid for progressive sensorineural hearing loss in Ménière’s disease.

Intratympanically administered steroid for progressive sensorineural hearing loss in Ménière’s disease.

Acta Otolaryngol. 2019 Sep 09;:1-5

Authors: Molnár A, Maihoub S, Tamás L, Szirmai Á

Abstract

Background: Ménière’s disease is characterised by episodic rotational vertigo, sensorineural hearing loss, tinnitus, and vegetative symptoms. Objectives: The aim of our study is to follow-up the effects of the intratympanic steroid treatment of hearing loss in MD. Material and methods: A group of 105 clinically diagnosed MD patients were enrolled in this investigation. Long-term follow-up was carried out, and pure tone speech audiometry results of the subjects before and after application of steroid were contrasted. Statistical analysis was carried out using the IBM SPSS V24 software. Results: Based on the audiograms in this population, all stages of hearing loss were presented (from slight to profound). In most of the cases (68.6%), after intratympanic dexamethasone treatment, stagnation in the hearing profile was achieved. Moreover, there was a smaller group demonstrating hearing improvement after the treatment (12.4%). According to logistic regression [p = .001; Odds ratio: 2.75 (95% CI 1.068-4.442,)], there was a strong correlation between hearing improvement and dexamethasone treatment (all patients were treated with intratympanic dexamethasone, while improvement without steroid treatment could never be attained). Conclusions and significance: Intratympanically administered dexamethasone is a potent agent to prevent the progression of hearing loss in MD.

PMID: 31498001 [PubMed – as supplied by publisher]

PubMed:31498001

https://www.karger.com/Article/Abstract/496088

https://www.ncbi.nlm.nih.gov/pubmed/31390639?dopt=Abstract

Correlation between Vestibular Evoked Myogenic Potentials and Disease Progression in Ménière’s Disease.

Correlation between Vestibular Evoked Myogenic Potentials and Disease Progression in Ménière’s Disease.

ORL J Otorhinolaryngol Relat Spec. 2019 Aug 07;:1-9

Authors: Kharkheli E, Japaridze S, Kevanishvili Z, Oz I, Ozluoglu LN

Abstract

OBJECTIVE: To assess the relationship between ocular (oVEMPs) and cervical (cVEMPs) vestibular evoked myogenic potentials and audiometrically determined clinical stage in Ménière’s disease (MD).

METHODS: Thirty-four unilateral MD patients and 30 healthy volunteers were included in the study. Pure-tone hearing levels, oVEMPs, cVEMPs, and videonystagmography results were analyzed and compared between the groups.

RESULTS: Both oVEMPs and cVEMPs were highly reproducible in the control group. At the early stages of MD, cVEMPs were particularly disturbed, while at the advanced stages both oVEMPs and cVEMPs were altered pathologically. In the study group, oVEMP and cVEMP amplitudes and interaural amplitude difference (IAD) statistically differed from those in the control sample. oVEMPs were absent in 7.7% of stage III and in 44.5% of stage IV MD patients, while cVEMPs were absent in 15.4% of stage III and in 54.5% of stage IV MD patients, respectively. In stage III and IV MD patients in whom oVEMPs and cVEMPs were obtained, IADs were increased. Caloric asymmetry was found in 64.7% of MD patients. Caloric weakness was more prominent in cases with advanced MD.

CONCLUSION: VEMPs can be used for objective validation of the stage of MD.

PMID: 31390639 [PubMed – as supplied by publisher]

PubMed:31390639

https://link.springer.com/article/10.1007%2Fs00441-019-03062-2

https://www.ncbi.nlm.nih.gov/pubmed/31338584?dopt=Abstract

Immunolocalization of calcium sensing and transport proteins in the murine endolymphatic sac indicates calciostatic functions within the inner ear.

Related Articles

Immunolocalization of calcium sensing and transport proteins in the murine endolymphatic sac indicates calciostatic functions within the inner ear.

Cell Tissue Res. 2019 Jul 23;:

Authors: Bächinger D, Egli H, Goosmann MM, Monge Naldi A, Eckhard AH

Abstract

An exceptionally low calcium (Ca2+) concentration in the inner ear endolymph ([Ca2+]endolymph) is crucial for proper auditory and vestibular function. The endolymphatic sac (ES) is believed to critically contribute to the maintenance of this low [Ca2+]endolymph. Here, we investigated the immunohistochemical localization of proteins that are presumably involved in the sensing and transport of extracellular Ca2+ in the murine ES epithelium. Light microscopic and fluorescence immunolabeling in paraffin-embedded murine ES tissue sections (male C57BL/6 mice, 6-8 weeks old) demonstrated the presence of the calcium-sensing receptor CaSR, transient receptor potential cation channel subtypes TRPV5 and TRPV6, sarco/endoplasmic reticulum Ca2+-ATPases SERCA1 and SERCA2, Na+/Ca2+ exchanger NCX2, and plasma membrane Ca2+ ATPases PMCA1 and PMCA4 in ES epithelial cells. These proteins exhibited (i) membranous (apical or basolateral) or cytoplasmic localization patterns, (ii) a proximal-to-distal labeling gradient within the ES, and (iii) different distribution patterns among ES epithelial cell types (mitochondria-rich cells (MRCs) and ribosome-rich cells (RRCs)). Notably, in the inner ear membranous labyrinth, CaSR was exclusively localized in MRCs, suggesting a unique role of the ES epithelium in CaSR-mediated sensing and control of [Ca2+]endolymph. Structural loss of the distal ES, which is consistently observed in Meniere’s disease, may therefore critically disturb [Ca2+]endolymph and contribute to the pathogenesis of Meniere’s disease.

PMID: 31338584 [PubMed – as supplied by publisher]

PubMed:31338584

https://www.ncbi.nlm.nih.gov/pubmed/31271345?dopt=Abstract

Evolution of Meniere’s Disease from MD 1.0, via MD 1.5, to MD 2.0.

Evolution of Meniere’s Disease from MD 1.0, via MD 1.5, to MD 2.0.

Acta Otolaryngol. 2019 Jul 04;:1-6

Authors: Lu TC, Young YH

Abstract

Background: Elder Meniere’s disease (MD) patients ultimately lose their vestibular function. Objective: This study utilized an inner ear test battery to investigate evolution of MD. Methods: Total 278 elder MD patients aged >65 years were divided into three groups. Ninety-four patients with bilateral MD (188 ears) were assigned to Group A. The remaining 184 patients with unilateral MD were further divided into two groups. Group B consisted of 20 affected ears with normal vestibular function on the opposite ears, while Group C indicated 184 unaffected ears. All patients underwent an inner ear test battery. Results: Inner ear deficits in Group B declined from the cochlea via the saccule, utricle to semicircular canals. In contrast, Groups A and C did not significantly differ in the abnormality rates of cervical vestibular-evoked myogenic potential (cVEMP), ocular VEMP and caloric tests, indicating that Group C (unaffected ears) may partly share the same mechanism like Group A (affected ears), namely aging and hydropic effects. Conclusion and significance: Evolution of MD may progress from unilateral MD (MD 1.0), via unilateral MD coupled with asymptomatic hydrops on opposite ear (MD 1.5), toward bilateral MD (MD 2.0), where the number 1.0-2.0 means the number of clinically affected ears.

PMID: 31271345 [PubMed – as supplied by publisher]

PubMed:31271345

https://www.ncbi.nlm.nih.gov/pubmed/31272843?dopt=Abstract

Results in caloric test, video head impulse test and inner ear MRI in patients with Ménière’s disease.

Related Articles

Results in caloric test, video head impulse test and inner ear MRI in patients with Ménière’s disease.

Auris Nasus Larynx. 2019 Jul 01;:

Authors: Kitano K, Kitahara T, Ito T, Shiozaki T, Wada Y, Yamanaka T

Abstract

OBJECTIVE: Our aim was to elucidate relationships between results from the caloric test (c-test), video Head Impulse Test (vHIT) and inner ear gadolinium-enhanced MRI (ieMRI) in patients with endolymphatic hydrops (EH), especially patients with Ménière’s disease (MD).

METHODS: We managed 1789 successive patients at the Vertigo/Dizziness Center in Nara Medical University from May 2014 to December 2018. After providing informed consent for vertigo/dizziness examinations, 281 patients were hospitalized to check their inner ear function for proper diagnosis and treatment. Then 76 participants underwent the c-test, vHIT and ieMRI. Among these 76 cases, 20 were diagnosed with MD (20/76; 26.3%) and 56 were non-MD (56/76; 73.7%) according to the 2015 diagnostic guideline of the International Classification of Vestibular Disorders. The MD group included 15 unilateral and 5 bilateral cases. The non-MD group included 22 benign paroxysmal positional vertigo, 10 vestibular neuritis, 8 sudden deafness with vertigo, 6 orthostatic dysregulation, 4 vestibular neuropathy and 6 others. Results in these examinations in the side of an active lesioned inner ear were representative in each peripheral case.

RESULTS: Twenty-nine of the 76 patients (38.1%) showed discrepant results between the c-test (outside of normal range) and vHIT (within normal range). Twenty-two of 76 patients (28.9%) had a positive EH sign on ieMRI. The c-test/vHIT discrepancy percentage in MD (14/20; 70.0%) was significantly higher than that in non-MD (15/56; 26.8%) (p=0.00179). The positive EH sign in ieMRI percentage in MD (15/20; 75.0%) was significantly higher than that in non-MD (7/56; 12.5%) (p=0.0015). There was a significant positive relationship between the c-test/vHIT discrepancy and the positive EH sign (p=0.00058) in all 76 cases combined. However, there was no significant relationship between c-test/vHIT discrepancy and positive EH sign (p=0.13) in the 20 MD cases. Considering the 15 unilateral and 5 bilateral MD cases, the c-test/vHIT discrepancy was observed in 14 of the 25 affected ears. Positive signs of vestibular EH herniation into the cupula in the lateral semicircular canal was seen in 14 of the 25 MD ears. There was significant relationship between the c-test/vHIT discrepancy and EH herniation (p=0.0012) in MD ears.

CONCLUSION: The present results suggest that patients with MD could have inner ear EH significantly more often than those with non-MD. In cases with MD, a positive EH sign on ieMRI did not always indicate a c-test/vHIT discrepancy; both findings may occur due to herniation of vestibular EH adjacent to the lateral semicircular canal.

PMID: 31272843 [PubMed – as supplied by publisher]

PubMed:31272843

https://www.ncbi.nlm.nih.gov/pubmed/31300426?dopt=Abstract

Approach to Ménière disease management.

Approach to Ménière disease management.

Can Fam Physician. 2019 Jul;65(7):463-467

Authors: Wu V, Sykes EA, Beyea MM, Simpson MTW, Beyea JA

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.

PMID: 31300426 [PubMed – in process]

PubMed:31300426

https://link.springer.com/article/10.1007%2Fs00415-019-09431-9

https://www.ncbi.nlm.nih.gov/pubmed/31222419?dopt=Abstract

Dissociation of caloric and head impulse tests: a marker of Meniere’s disease.

Related Articles

Dissociation of caloric and head impulse tests: a marker of Meniere’s disease.

J Neurol. 2019 Jun 20;:

Authors: Hannigan IP, Welgampola MS, Watson SRD

Abstract

A retrospective analysis of the horizontal video head impulse test (vHIT) results and caloric testing results was undertaken on 644 patients who attended a neuro-otology outpatient facility. Presenting symptoms included spontaneous vertigo, positional vertigo, imbalance or chronic subjective dizziness. For 570 patients, the results of vHIT and caloric testing were concordant. Both tests were normal in 500 subjects with an average vHIT gain = 0.92 ± 0.09 (L); 0.98 ± 0.10 (R) and canal paresis (CP) = 7.88 ± 6.12; (range 0-28%). 54 had concordant asymmetries, average ipsilesional vHIT gain = 0.56 ± 0.15, average contralesional vHIT gain = 0.88 ± 0.12. CP = 68.02 ± 24.38 (range 31-100%). 16 subjects had bilateral vestibular hypofunction with average vHIT gains of 0.42 ± 0.20 (L); 0.41 ± 0.19 (R), peak slow phase velocity (SPV) on warm caloric testing = 2.68 ± 2.08, range 0-6°/s (L) and 3.75 ± 3.43 range, 0-10°/s (R). 36 patients showed a dissociation of results between the two tests. In these subjects, the vHIT gain was normal (0.93 ± 0.06 left and 0.98 ± 0.07 right) and the caloric test showed a CP > 30% (48 ± 13.8%). Their final diagnoses included clinically definite Meniere’s disease (MD) (n = 27), vestibular schwannoma (VS) (n = 2) vestibular migraine (VM) (n = 1), vestibular neuritis (VN) (n = 5) and unknown (n = 1). No patient with abnormal HSCC gain on vHIT had a normal caloric result. The caloric test complements the vHIT in the assessment of vestibular disorders and is most useful in suspected endolymphatic hydrops. Asymmetric caloric function in the presence of normal horizontal head impulse tests is most commonly associated with Meniere’s disease and may function as a diagnostic marker.

PMID: 31222419 [PubMed – as supplied by publisher]

PubMed:31222419

https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/aural-fullness-and-transtympanic-ventilation-tubes-in-menieres-disease-a-scoping-review/D2A49DF91D7BC223D6FAD9A77B008FEA

https://www.ncbi.nlm.nih.gov/pubmed/31172892?dopt=Abstract

Aural fullness and transtympanic ventilation tubes in Ménière’s disease: a scoping review.

Aural fullness and transtympanic ventilation tubes in Ménière’s disease: a scoping review.

J Laryngol Otol. 2019 Jun 07;:1-7

Authors: Sevilla C, Goody J, Baguley DM, Kasbekar AV

Abstract

BACKGROUND: Ménière’s disease often presents with aural fullness, for reasons that are currently not well understood. Transtympanic ventilation tube insertion has been historically used for the management of this symptom, though the nature and mechanism of effectiveness is unclear.

OBJECTIVE: To give an overview of the data available on the effects of ventilation tube insertion on aural fullness in Ménière’s disease.

METHODS: The databases PubMed, Embase, Medline, Scopus, Web of Science, Central and Google Scholar were searched to identify relevant records. Records were subsequently analysed and data extracted.

RESULTS: Only two studies directly measured the effect of ventilation tube insertion on aural fullness, while three others measured it as a placebo to assess another treatment. Considerable heterogeneity was found amongst the studies, including conflicting conclusions.

CONCLUSION: There is a paucity of evidence investigating the effect of grommet insertion on aural fullness in Ménière’s disease. This work directs future research into this topic.

PMID: 31172892 [PubMed – as supplied by publisher]

PubMed:31172892

https://link.springer.com/article/10.1007%2Fs00415-019-09399-6

https://www.ncbi.nlm.nih.gov/pubmed/31165925?dopt=Abstract

The role of ion channels and transporters in the pathophysiology of Ménière’s disease

Endolymphatic hydrops and ionic transporters: genetic and biohumoral aspects.

Endolymphatic hydrops and ionic transporters: genetic and biohumoral aspects.

J Neurol. 2019 Jun 05;:

Authors: Teggi R, Carpini SD, Zagato L

Abstract

Ménière’s disease (MD) is an inner ear disorder, characterized by a burden of symptoms, probably arising from the interplay of genetic and environmental factors. In this brief review, we consider the role of ion channels and transporters in the pathophysiology of MD, focusing on genetic and biohumoral aspects. Pathophysiological mechanisms related to altered concentrations of ions in the endolymph include altered osmotic pressure leading to hydrops and/or immunomodulatory effects of K+ and Endogenous Ouabain (EO) concentrations in the inner ear. Aquaporins 1-5 (AQPs) have been found in the inner ear; AQP2 is the only isoform controlled by a hormone, namely, vasopressin (antidiuretic hormone, ADH). Genetic studies on AQPs have provided inconclusive results. Recently, two genetic polymorphisms have been associated with MD: rs3746951, a missense variant (Gly180Ser) in the Salt-Inducible Kinase-1 (SIK1) gene and rs487119, an intronic variant of gene SLC8A1 coding for a Na+,Ca++ exchanger (NCX-1). EO is a hormone released by the midbrain and adrenal glands. It controls the constitutive capacity of modulating Na+,K+-ATPase activity. Higher plasma levels of EO have been found in MD subjects compared to a control group.

PMID: 31165925 [PubMed – as supplied by publisher]

PubMed:31165925

https://www.frontiersin.org/articles/10.3389/fimmu.2019.01229/full

https://www.ncbi.nlm.nih.gov/pubmed/31214186?dopt=Abstract

Differential Proinflammatory Signature in Vestibular Migraine and Meniere Disease.

Related Articles

Differential Proinflammatory Signature in Vestibular Migraine and Meniere Disease.

Front Immunol. 2019;10:1229

Authors: Flook M, Frejo L, Gallego-Martinez A, Martin-Sanz E, Rossi-Izquierdo M, Amor-Dorado JC, Soto-Varela A, Santos-Perez S, Batuecas-Caletrio A, Espinosa-Sanchez JM, Pérez-Carpena P, Martinez-Martinez M, Aran I, Lopez-Escamez JA

Abstract

Vestibular Migraine (VM) and Meniere’s Disease (MD) are episodic vestibular syndromes defined by a set of associated symptoms such as tinnitus, hearing loss or migraine features during the attacks. Both conditions may show symptom overlap and there is no biological marker to distinguish them. Two subgroups of MD patients have been reported, according to their IL-1β profile. Therefore, considering the clinical similarity between VM and MD, we aimed to investigate the cytokine profile of MD and VM as a means to distinguish these patients. We have also carried out gene expression microarrays and measured the levels of 14 cytokines and 11 chemokines in 129 MD patients, 82 VM patients, and 66 healthy controls. Gene expression profile in peripheral blood mononuclear cells (PBMC) showed significant differences in MD patients with high and low basal levels of IL- 1β and VM patients. MD patients with high basal levels of IL- 1β (MDH) had overall higher levels of cytokines/chemokines when compared to the other subsets. CCL4 levels were significantly different between MDH, MD with low basal levels of IL- 1β (MDL), VM and controls. Logistic regression identified IL- 1β, CCL3, CCL22, and CXCL1 levels as capable of differentiating VM patients from MD patients (area under the curve = 0.995), suggesting a high diagnostic value in patients with symptoms overlap.

PMID: 31214186 [PubMed – in process]

PubMed:31214186

https://www.ncbi.nlm.nih.gov/pubmed/31025490?dopt=Abstract

Different medications for the treatment of Ménière’s disease by intratympanic injection: a systematic review and network meta-analysis.

Related Articles

Different medications for the treatment of Ménière’s disease by intratympanic injection: a systematic review and network meta-analysis.

Clin Otolaryngol. 2019 Apr 26;:

Authors: Cao Z, Yue F, Huang W, Rajenderkumar D, Zhao F

Abstract

BACKGROUND: It is generally accepted that intratympanic injection provides an effective approach to manage severe vertigo in Ménière’s disease. Although there are several medications available, that which is the most effective is still subject to debate.

OBJECTIVE: To assess the effectiveness and safety of the different medications used in treatment of Ménière’s disease by intratympanic injection using a network meta-analysis.

METHODS: PubMed, EMBASE, CINAHL and CENTRAL were searched. Only randomized controlled trials that compared the effectiveness of medications used for intratympanic injection to treat Ménière’s disease with each other or a placebo were included. The primary outcome assessed was the effectiveness of medication in the management of vertigo symptoms. The effectiveness was expressed in terms of risk ratio (RR) with a 95% credible interval (CrI) for individual studies analyzed. Network meta-analyses was performed by Stata version 15.0 using the network package.

RESULTS: Nine studies involving 314 patients treated with 5 different medications were included in the present analysis. Number of injections given varied from 1 to 10 and follow-up time from 3 to 28 months. When compared to each other or to a placebo, Gentamicin was found to be the most efficacious medication, followed by Methylprednisolone, Latanoprost, Dexamethasone and Ganciclovir in order of effectiveness. However, no significant difference in efficacy was found between Gentamicin and Methylprednisolone when outcomes from studies with a follow-up time equal to or more than 24 months were analyzed. It was not possible to conduct subgroup and sensitivity analysis because of the limited number of studies that were included.

CONCLUSION: All medications are more effective than a placebo in the treatment of Ménière’s disease by intratympanic injection. According to the SUCRA, Gentamicin ranked the most effective, with Gentamicin and Methylprednisolone equally effective in the long-term. When the potential risk of hearing loss induced by Gentamicin is taken into consideration, Methylprednisolone may be the best choice for treatment of Ménière’s disease by intratympanic injection. This article is protected by copyright. All rights reserved.

PMID: 31025490 [PubMed – as supplied by publisher]

PubMed:31025490

https://www.ncbi.nlm.nih.gov/pubmed/31058601?dopt=Abstract

The Clinical Benefit of Device Therapy for Meniere’s Disease in Adults: Systematic Review and Meta-Analysis.

The Clinical Benefit of Device Therapy for Meniere’s Disease in Adults: Systematic Review and Meta-Analysis.

J Int Adv Otol. 2019 Apr;15(1):121-129

Authors: Wang SJ, Yang H, Yao YY, Gu HY, Lin LL, Zhang C, Luo J

Abstract

OBJECTIVES: This study aimed to assess the clinical benefit of device therapy on controlling the symptoms of Meniere’s disease (MD).

MATERIALS AND METHODS: We searched PubMed, Embase, the Cochrane Library, China National Knowledge Internet, and Wanfang Data before January 13, 2018. We selected randomized controlled clinical trials, case-controlled studies, and cohort studies that dealt with outcomes of device therapy for the treatment of MD.

RESULTS: Sixteen trials met our inclusion criteria. The use of device therapy resulted in improved vertigo control, which was described as a reduction in the number of vertigo days by month (weighted mean difference [WMD]: 3.15, 95% confidence interval [CI]: 2.00-4.31), in the number of vertigo episodes by month (WMD: 7.37, 95% CI: 2.40-12.35), and in the vertigo visual analog score (WMD: 41.51, 95% CI: 34.68-48.34). In addition, the overall complete vertigo control (class A) rate was 50% (95% CI: 37%-64%). The device therapy also reduced the number of sick days by month (WMD: 4.56, 95% CI: 2.15-6.97), and the functional level improved (WMD: 2.66, 95% CI: 2.15-3.17). The electrocochleographic parameters decreased. The device therapy proved beneficial for hearing changes (WMD: 3.19, 95% CI: 0.66-5.71). No publication bias was found in the funnel plot and the results of Egger’s test.

CONCLUSION: This study showed that the device therapy might reduce vertigo attacks and sick days in patients with MD. Additionally, the function level and hearing level may improve after the device therapy. In addition, the decrease in electrocochleographic parameters showed that inner ear electrophysiology improved after device therapy.

PMID: 31058601 [PubMed – in process]

PubMed:31058601

https://www.tandfonline.com/doi/abs/10.1080/00016489.2019.1575525?journalCode=ioto20

https://www.ncbi.nlm.nih.gov/pubmed/30907242?dopt=Abstract

CASP9 genotype confers gentamicin susceptibility in intratympanic treatment of intractable vertigo caused by Ménière’s disease.

CASP9 genotype confers gentamicin susceptibility in intratympanic treatment of intractable vertigo caused by Ménière’s disease.

Acta Otolaryngol. 2019 Mar 25;:1-4

Authors: Huang CJ, Wan TK, Fang TY, Wang PC

Abstract

BACKGROUND: Ménière’s disease (MD) is a disorder of the inner ear, causing episodes of vertigo. Although surgery is reserved for intractable MD, intratympanic gentamicin (ITG) injection has become an alternative for controlling vertigo.

AIMS/OBJECTIVES: To investigate the genetic basis of ITG efficacy.

MATERIAL AND METHODS: We hypothesized that single nucleotide polymorphisms (SNPs) affect outcomes in patients with MD who receive ITG injections. Whole-exome sequencing was used to determine variations in coding regions.

RESULTS: Multivariate analysis revealed two SNPs, rs1052571 in caspase 9 (CASP9; p = .017) and rs3745274 in cytochrome P450 2B6 (p = .053), which were associated with susceptibility to ITG injections. Only the C-allele in the rs1052571 SNP was significantly associated with susceptibility (p = .027; odds ratio: 5.95; 95% confidence interval: 1.26-28.57, by Fisher’s exact test).

CONCLUSIONS AND SIGNIFICANCE: Our results elucidated the role of the rs1052571 SNP and provide a genetic perspective on gentamicin efficacy (susceptibility) in treating intractable MD.

PMID: 30907242 [PubMed – as supplied by publisher]

PubMed:30907242

https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0038-1673698
https://www.ncbi.nlm.nih.gov/pubmed/30956708?dopt=Abstract

Menière’s Disease and Disorders of the Carbohydrate Metabolism Involving the Inner Ear.

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Menière’s Disease and Disorders of the Carbohydrate Metabolism Involving the Inner Ear.

Int Arch Otorhinolaryngol. 2019 Apr;23(2):218-220

Authors: Albernaz PLM

Abstract

Introduction  Menière’s disease was described in 1861, but there are still uncertainties regarding its pathophysiology and treatment. Endolymphatic hydrops is recognized as a fundamental pathological characteristic of the disease, as a result of an inadequate absorption of the endolymph. A milder type of endolymphatic hydrops results from an altered chemical composition of the endolymph, due to disorders of the carbohydrate metabolism. Objective  To describe the association of both types of hydrops in patients with Menière disease. Methods  This was a retrospective study of 98 patients with Menière’s disease, 62 of whom also presented disorders of the carbohydrate metabolism, and 5 patients with delayed endolymphatic hydrops, 2 of whom also presented disorders of the carbohydrate metabolism. Results  The follow-up of these patients showed that the correction of the metabolic disorders may help in the clinical treatment of Menière’s disease and of delayed endolymphatic hydrops, but this does not happen in the more severe types of the diseases. Conclusion  Patients with Menière’s disease may present simultaneous disorders of the carbohydrate metabolism, affecting the inner ear. The correction of these disorders helps the clinical treatment but does not preclude the progression of the more severe cases of Menière disease.

PMID: 30956708 [PubMed]

PubMed:30956708

https://journals.lww.com/otology-neurotology/Abstract/publishahead/Long_Term_Follow_Up_of_Intratympanic.96542.aspx

https://insights.ovid.com/crossref?an=00019052-201902000-00026

Peripheral vestibular disorders: an update

https://www.sciencedirect.com/science/article/pii/S1672293018301028?via%3Dihub

https://www.ncbi.nlm.nih.gov/pubmed/31223301?dopt=Abstract

The cardiovascular aspects of a Ménière’s disease population – A pilot study.

The cardiovascular aspects of a Ménière’s disease population – A pilot study.

J Otol. 2019 Jun;14(2):51-56

Authors: Rego ÂR, Dias D, Pinto A, E Castro SS, Feliciano T, E Sousa CA

Abstract

Introduction: MD is considered a rare disease. An adequate model that explains MD’s pathophysiology is not well established. Recently, the vascular theory of the disease has been revived.

Objectives: To characterize a MD population according to its cardiovascular risk and correlate it to the MD clinical course.

Methods: In this retrospective chart study the data of 31 MD patients observed between January 2017 and April 2018 in a tertiary university hospital were reviewed. Patients included in the study were diagnosed according to the Bárány Society criteria. Lost follow-ups, patients with autoimmune disease, atopy or allergy, major psychiatric disease and migraine were excluded. Age, gender, cardiovascular risk factors, audiometric and vestibular parameters, occurrence of MD attacks in the previous 6 months, vestibular medication in course and time course of MD were recorded and compared between groups (with and without cardiovascular risk factors).

Results: 31 patients (61.3% females) mean aged 60.3 years (±9.7) were studied. 74% of the population had at least one risk factor and 51.6% of patients had attacks in the last 6 months. There was a statistically significant difference in the occurrence of MD attacks in the last 6 months (p = 0.014) between MD patients with and without risk factors. Mean PTA thresholds were higher and speech discrimination was lower in individuals with more cardiovascular risk factors.

Conclusions: Treatment of MD focusing on vascular risk factors may allow a better control of symptoms and result in a decreased need for ablative procedures in this disorder.

PMID: 31223301 [PubMed]

PubMed:31223301

https://www.karger.com/Article/Abstract/490274

https://www.ncbi.nlm.nih.gov/pubmed/30947172?dopt=Abstract

Meniere’s Disease.

Meniere’s Disease.

Adv Otorhinolaryngol. 2019;82:77-86

Authors: Gibson WPR

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 [13] failed to exclude vestibular migraine sufficiently and a revision in 2015 [14] 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.

PMID: 30947172 [PubMed – in process]

PubMed:30947172

https://www.ncbi.nlm.nih.gov/pubmed/30289103?dopt=Abstract

Ménière’s disease: ‘a riddle wrapped in a mystery inside an enigma’. Has the key been found?

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Ménière’s disease: ‘a riddle wrapped in a mystery inside an enigma’. Has the key been found?

J Laryngol Otol. 2018 Sep;132(9):763

Authors: Fishman J, Fisher E, Hussain M

PMID: 30289103 [PubMed – indexed for MEDLINE]

PubMed:30289103

https://www.mdpi.com/1420-3049/23/10/2507

Gene Delivery into the Inner Ear and Its Clinical Implications for Hearing and Balance