https://www.sciencedirect.com/science/article/pii/S0013935123017760?via%3Dihub
Research
Radiological feature heterogeneity supports etiological diversity among patient groups in Meniere’s disease
Comparison of clinical characteristics and vestibular function test results in patients with vestibular migraine and Menière’s disease
Evaluation of Industry Relationships Among Authors of Systematic Reviews and Meta-analyses Regarding Menieres Disease
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.
On the Nature of Hearing Loss in Méniere’s Disease: a dramatic recovery of hearing in patients with MD using antiviral (AV) drugs
https://www.ncbi.nlm.nih.gov/pubmed/33596586?dopt=Abstract
On the Nature of Hearing Loss in Méniere’s Disease.
On the Nature of Hearing Loss in Méniere’s Disease.
ORL J Otorhinolaryngol Relat Spec. 2021 Feb 17;:1-7
Authors: Gacek RR
Abstract
OBJECTIVE: To explain the pathophysiology of the hearing loss in Ménière’s disease (MD).
BACKGROUND: In a previous report, we described a dramatic recovery of hearing in 12/31 patients with MD using antiviral (AV) drugs. The hearing loss in the remaining 19 patients with a longer history of MD remained unchanged or else worsened. Vertigo control was complete in the group with improved hearing but poorer in the group with greater hearing loss (and a longer MD history). Since achieving the recovery of hearing and control of the vertigo using AV drugs in these patients with a shorter history (≤2 years) of MD, we have continued to record dramatic hearing recovery in MD when patients have a shorter history of symptoms. We describe this here in 5 representative MD patients. We feel that the most likely explanation for the outcome is the removal of viral nucleic acids (NA) from the organ of Corti.
SUMMARY: A likely explanation for the sensorineural hearing loss in MD is paralysis of the cochlear amplifier function of the outer hair cells due to the toxicity ofNA. These NA are released from neurotropic viruses located in the vestibular nerve ganglion. Key Messages: (1) Viruses (Herpes family) are the cause of the symptoms in MD. (2) Hearing loss is the result of viral NA in the organ of Corti. (3) A short history of MD symptoms (<2 years) favors hearing recovery. PMID: 33596586 [PubMed - as supplied by publisher] PubMed:33596586
Could ionic regulation disorders explain the overlap between meniere’s disease and migraine?
https://www.ncbi.nlm.nih.gov/pubmed/33579883?dopt=Abstract
https://content.iospress.com/articles/journal-of-vestibular-research/ves200788
Could ionic regulation disorders explain the overlap between meniere’s disease and migraine?
Related Articles
Could ionic regulation disorders explain the overlap between meniere’s disease and migraine?
J Vestib Res. 2021 Feb 10;:
Authors: Teggi R, Colombo B, Zagato L, Filippi M
Abstract
Ménière’s disease (MD) is an inner ear disorder characterized by a burden of symptoms and comorbidities, including migraine. In both disorders, ionic dysregulation may play a role as a predisposing factor. In recent years. aquaporins have been widely investigated, but the results are far from conclusive. We recently studied the genetics of ionic transporters and the hormone endogenous ouabain as predisposing factors for development of MD. In particular, we found two genetic polymorphisms associated with MD: 1) rs3746951, a missense variant (Gly180Ser) in the salt-inducible kinase-1 (SIK1) gene encoding a Na +, K+ ATPase; 2) rs487119, an intronic variant of gene SLC8A1 coding for a Na +, Ca ++ exchanger (NCX-1).Ionic concentration in the brain also plays a role in the pathophysiology of migraine. In this brief review we summarize what has been published on MD and migraine.
PMID: 33579883 [PubMed – as supplied by publisher]
PubMed:33579883
Aquaporins (AQPs) and diseases pathogenesis: From trivial to undeniable involvements, a disease-based point of view
https://www.ncbi.nlm.nih.gov/pubmed/33559160?dopt=Abstract
https://onlinelibrary.wiley.com/doi/10.1002/jcp.30318
Aquaporins and diseases pathogenesis: From trivial to undeniable involvements, a disease-based point of view.
Related Articles
Aquaporins and diseases pathogenesis: From trivial to undeniable involvements, a disease-based point of view.
J Cell Physiol. 2021 Feb 08;:
Authors: Ala M, Mohammad Jafari R, Hajiabbasi A, Dehpour AR
Abstract
Aquaporins (AQPs), as transmembrane proteins, were primarily identified as water channels with the ability of regulating the transmission of water, glycerol, urea, and other small-sized molecules. The classic view of AQPs involvement in therapeutic plan restricted them and their regulators into managing only a narrow spectrum of the diseases such as diabetes insipidus and the syndrome of inappropriate ADH secretion. However, further investigations performed, especially in the third millennium, has found that their cooperation in water transmission control can be manipulated to handle other burden-imposing diseases such as cirrhosis, heart failure, Meniere’s disease, cancer, bullous pemphigoid, eczema, and Sjögren’s syndrome.
PMID: 33559160 [PubMed – as supplied by publisher]
PubMed:33559160
Genetics and the Individualized Therapy of Vestibular Disorders
CATEGORY:
Research
SCREENSHOT:
TITLE:
Genetics and the Individualized Therapy of Vestibular Disorders
CONTENT:
Front Neurol. 2021 Feb 5;12:633207. doi: 10.3389/fneur.2021.633207. eCollection 2021.
ABSTRACT
Background: Vestibular disorders (VDs) are a clinically divergent group of conditions that stem from pathology at the level of the inner ear, vestibulocochlear nerve, or central vestibular pathway. No etiology can be identified in the majority of patients with VDs. Relatively few families have been reported with VD, and so far, no causative genes have been identified despite the fact that more than 100 genes have been identified for inherited hearing loss. Inherited VDs, similar to deafness, are genetically heterogeneous and follow Mendelian inheritance patterns with all modes of transmission, as well as multifactorial inheritance. With advances in genetic sequencing, evidence of familial clustering in VD has begun to highlight the genetic causes of these disorders, potentially opening up new avenues of treatment, particularly in Meniere’s disease and disorders with comorbid hearing loss, such as Usher syndrome. In this review, we aim to present recent findings on the genetics of VDs, review the role of genetic sequencing tools, and explore the potential for individualized medicine in the treatment of these disorders. Methods: A search of the PubMed database was performed for English language studies relevant to the genetic basis of and therapies for vestibular disorders, using search terms including but not limited to: “genetics,” “genomics,” “vestibular disorders,” “hearing loss with vestibular dysfunction,” “individualized medicine,” “genome-wide association studies,” “precision medicine,” and “Meniere’s syndrome.” Results: Increasing numbers of studies on vestibular disorder genetics have been published in recent years. Next-generation sequencing and new genetic tools are being utilized to unearth the significance of the genomic findings in terms of understanding disease etiology and clinical utility, with growing research interest being shown for individualized gene therapy for some disorders. Conclusions: The genetic knowledge base for vestibular disorders is still in its infancy. Identifying the genetic causes of balance problems is imperative in our understanding of the biology of normal function of the vestibule and the disease etiology and process. There is an increasing effort to use new and efficient genetic sequencing tools to discover the genetic causes for these diseases, leading to the hope for precise and personalized treatment for these patients.
PMID:33613440 | PMC:PMC7892966 | DOI:10.3389/fneur.2021.633207
SOURCE:
Frontiers in neurology
PUBLISHER:
PMID:
pubmed:33613440
ID:
5dfa010a544eb3c21dde51db84c2481bpubmed:33613440
DOI:
10.3389/fneur.2021.633207
DATE – PUBLISHED:
Mon, 22 Feb 2021 06:00:00 -0500
DATE – DOI:
2021-02-05T18:51:58Z
DATE – ADDED:
03/07/21 02:55PM
LINK – PUBMED:
https://pubmed.ncbi.nlm.nih.gov/33613440/
LINK – DOI:
https://doi.org/10.3389/fneur.2021.633207
LINK – PUBLISHER:
https://www.frontiersin.org/articles/10.3389/fneur.2021.633207/full?utm_source=menierestreatmentreport.com
IMAGE:
REFERENCE:
Hearing Loss Treatment Report, Urgent Research, 2021-03-07T19:55:27+00:00, https://www.menierestreatmentreport.com.
Pharmacological, Surgical and Diagnostic Innovations in Meniere’s Disease: A Review
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
The value of 3D-real IR MRI with intravenous gadolinium injection in the diagnosis of suspected Meniere’s disease in children
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
Menière’s disease caused by CGRP – A new hypothesis explaining etiology and pathophysiology
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
Effectiveness of Intratympanic Administration of Gentamicin in Unilateral Meniere’s Disease
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
Pharmacologic and surgical therapies for patients with Meniere’s disease: A systematic review and network meta-analysis
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237523
https://www.ncbi.nlm.nih.gov/pubmed/32870918?dopt=Abstract
Pharmacologic and surgical therapies for patients with Meniere’s disease: A systematic review and network meta-analysis.
Related Articles
Pharmacologic and surgical therapies for patients with Meniere’s disease: A systematic review and network meta-analysis.
PLoS One. 2020;15(9):e0237523
Authors: Ahmadzai N, Cheng W, Kilty S, Esmaeilisaraji L, Wolfe D, Bonaparte J, Schramm D, Fitzpatrick E, Lin V, Skidmore B, Hutton B
Abstract
BACKGROUND: Meniere’s disease (MD) is a chronic condition of the inner ear consisting of symptoms that include vertigo attacks, fluctuating sensorineural hearing loss, tinnitus and aural fullness. Despite availability of various interventions, there is uncertainty surrounding their relative efficacy, thus making it difficult to select the appropriate treatments for MD. The objective of this systematic review was to assess the relative effects of the available pharmacologic and surgical interventions in patients with MD with regard to vertigo and other key patient outcomes based on data from randomized clinical trials (RCTs).
METHODS: Our published protocol registered with PROSPERO (CRD42019119129) provides details on eligibility criteria and methods. We searched various databases including MEDLINE, Embase and the Cochrane Library from inception to December 10th, 2018. Screening at citation and full-text levels and risk of bias assessment were performed by two independent reviewers in duplicate, with discrepancies resolved by consensus or third-party adjudication. Bayesian network meta-analyses (NMA) were performed for hearing change and vertigo control outcomes, along with pairwise meta-analyses for these and additional outcomes.
RESULTS: We identified 2,889 unique citations, that yielded 23 relevant publications describing 18 unique RCTs (n = 1,231 patients). Overall, risk-of bias appraisal suggested the evidence base to be at unclear or high risk of bias. Amongst pharmacologics, we constructed treatment networks of five intervention groups that included placebo, intratympanic (IT) gentamicin, oral high-dose betahistine, IT steroid and IT steroid plus high-dose betahistine for NMAs of hearing change (improvement or deterioration) and complete vertigo control. IT steroid plus high-dose betahistine was associated with the largest difference in hearing improvement compared to placebo, followed by high-dose betahistine and IT steroid (though 95% credible intervals failed to rule out the possibility of no difference), while IT gentamicin was worse than IT steroid. The NMA of complete vertigo control suggested IT gentamicin was associated with the highest probability of achieving better complete vertigo control compared to placebo, followed by IT steroid plus high-dose betahistine. Only two studies related to surgical interventions were found, and data suggested no statistically significant difference in hearing changes between endolymphatic duct blockage (EDB) versus endolymphatic sac decompression (ESD), and ESD with or without steroid injection. One trial reported that 96.5% of patients in EDB group compared to 37.5% of the patients in ESD group achieved complete vertigo control 24 months after surgery (p = 0.002).
CONCLUSION: To achieve both hearing preservation and vertigo control, the best treatment option among the pharmacologic interventions compared may be IT steroid plus high-dose betahistine, considering that IT gentamicin may have good performance to control vertigo but may be detrimental to hearing preservation with high cumulative dosage and short interval between injections. However, IT steroid plus high-dose betahistine has not been compared in head-to-head trials against other interventions except for IT steroid alone in one trial, thus future trials that compare it with other interventions will help establish comparative effectiveness with direct evidence.
PMID: 32870918 [PubMed – as supplied by publisher]
PubMed:32870918
The role of endogenous Antisecretory Factor (AF) in the treatment of Ménière’s Disease: A two-year follow-up study
https://www.sciencedirect.com/science/article/abs/pii/S0196070920303677?via%3Dihub
https://www.ncbi.nlm.nih.gov/pubmed/32829060?dopt=Abstract
The role of endogenous Antisecretory Factor (AF) in the treatment of Ménière’s Disease: A two-year follow-up study. Preliminary results.
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 Aug 11;41(6):102673
Authors: Viola P, Pisani D, Scarpa A, Cassandro C, Laria C, Aragona T, Ciriolo M, Spadera L, Ralli M, Cavaliere M, Iengo M, Chiarella G
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.
PMID: 32829060 [PubMed – as supplied by publisher]
PubMed:32829060
Nystagmus during an acute Ménière’s attack: from prodrome to recovery
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
Live imaging and functional changes of the inner ear in an animal model of Meniere’s disease
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
The pharmacological management of vertigo in Meniere disease: summary with evidence from preclinical and clinical studies
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
Cochlear Implantation in Patients With Menière’s Disease: Does Disease Activity Affect the Outcome?
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
MicroRNA Profiling as a Methodology to Diagnose Ménière’s Disease: Potential Application of Machine Learning
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
Intratympanic gentamicin is superior to intratympanic steroids in reducing the number of vertigo attacks in the treatment of Meniere’s disease
https://link.springer.com/article/10.1007%2Fs00415-020-10011-5
https://www.ncbi.nlm.nih.gov/pubmed/32588183?dopt=Abstract
What is the efficacy of gentamicin on the incidence of vertigo attacks and hearing in patients with Meniere’s disease compared with steroids? A meta-analysis.
Related Articles
What is the efficacy of gentamicin on the incidence of vertigo attacks and hearing in patients with Meniere’s disease compared with steroids? A meta-analysis.
J Neurol. 2020 Jun 25;:
Authors: Jiang M, Zhang Z, Zhao C
Abstract
OBJECTIVE: To compare the efficacy of gentamicin and steroids in patients with Meniere’s disease (MD).
METHODS: The study protocol was structured in accordance with the Population, Intervention, Comparison and Outcome (PICO) framework. We used “Endnote” (Thomson ResearchSoft; Stanford, Connecticut, the United States) to retrieve database documents. A systematic literature search of Web of Science and PubMed Database through May 2020 was conducted using specific search terms. Inclusion criteria, exclusion criteria, vertigo improvement, and exact hearing changes were defined. Review Manager 5.3 (Cochrane) was used for data analysis.
RESULTS: A total of 80 articles were searched from Web of Science and 23 articles were searched from PubMed database. After further reviewing the specific points of the inclusion criteria and exclusion criteria, 9 papers were finally selected. Intratympanic gentamicin (ITG) was superior to intratympanic steroid (ITS) in reducing the number of vertigo attacks (odds ratio (OR) 3.08, 95% confidence intervals (CI) [2.05-3.65]), probability (P) < 0.01). As for hearing improvement, we did the analysis twice. With all the studies included, the odds of hearing improvement (by "x") was 0.31 among patients receiving gentamicin compared to those treated by steroids (OR 0.31, 95% CI [0.16-0.61]). But after removing one study with outlying results from the analysis, this effect disappeared. Hearing loss of ITG and ITS was not statistically significant (P = 0.29). CONCLUSIONS: ITG is superior to ITS in reducing the number of vertigo attacks in the treatment of MD (P < 0.01); the impact on hearing is more heterogeneous in the studies. Overall, there was no clear difference between ITG and ITS on hearing improvement and on hearing loss. PMID: 32588183 [PubMed - as supplied by publisher] PubMed:32588183
Using betahistine in the treatment of patients with Menière’s disease: a meta-analysis with the current randomized-controlled evidence
https://www.tandfonline.com/doi/abs/10.1080/00016489.2020.1777326?journalCode=ioto20
https://www.ncbi.nlm.nih.gov/pubmed/32580600?dopt=Abstract
Using betahistine in the treatment of patients with Menière’s disease: a meta-analysis with the current randomized-controlled evidence.
Related Articles
Using betahistine in the treatment of patients with Menière’s disease: a meta-analysis with the current randomized-controlled evidence.
Acta Otolaryngol. 2020 Jun 25;:1-9
Authors: Devantier L, Hougaard D, Händel MN, Liviu-Adelin Guldfred F, Schmidt JH, Djurhuus B, Callesen HE
Abstract
Background: Betahistine is used worldwide to treat patients with Menière’s disease. However, despite it being used for decades, diverging opinions on the effect of betahistine on Menière’s symptomatology still exist.Aims: The objective of this systematic review was to provide an overview and rate the certainty of the current evidence base regarding the use of betahistine to treat patients with Menière’s disease.Materials and methods: A systematic literature search was conducted in October 2019. The search strategy was subdivided into searches for existing guidelines, systematic reviews and individual randomized controlled trials (RCT) investigating the usage of betahistine as compared to placebo, in patients with Ménière’s disease. The primary outcome was the frequency of vertigo attack(s) and occurrence of serious adverse events.Results: We identified three relevant guidelines and three systematic reviews: however, neither included any relevant trials matching our inclusion criteria. An individual search for RCTs identified one trial. The results from this particular trial showed no difference in effects on symptoms following treatment with betahistine.Conclusions and Significance: There is a need for further well-conducted placebo RCTs. Currently, there is still a lack of substantial evidence supporting betahistine as a significant and adequate treatment for patients diagnosed with Menière’s disease. Trial registration number: The protocol is registered in PROSPERO. Registration number: CRD42018110127 Accepted 11.10.2018.
PMID: 32580600 [PubMed – as supplied by publisher]
PubMed:32580600
Current status on researches of Meniere’s disease: a review
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
Dietary Restriction for The Treatment of Meniere’s Disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265917/
https://www.ncbi.nlm.nih.gov/pubmed/32523900?dopt=Abstract
Dietary Restriction for The Treatment of Meniere’s Disease.
Related Articles
Dietary Restriction for The Treatment of Meniere’s Disease.
Transl Med UniSa. 2020 May;22:5-9
Authors: De Luca P, Cassandro C, Ralli M, Gioacchini FM, Turchetta R, Orlando MP, Iaccarino I, Cavaliere M, Cassandro E, Scarpa A
Abstract
Meniere’s disease (MD) is an idiopathic inner ear disorder characterized by spontaneous recurrent vertigo, fluctuating sensorineural hearing loss (SNHL), aural fullness and tinnitus. Endolymphatic hydrops (EH) of the inner ear is currently considered the pathophysiological mechanisms that underlies typical symptoms of MD. MD diagnosis is based on the criteria of the Baràny Society. There are many therapeutic options for MD, but none is considered effective by the scientific community. The first-line treatment commonly includes dietary modification, as low salt diet and reduction of alcohol and caffeine daily intake. Although some studies showed a positive effect of these dietary restrictions, even in the prevention of recurrences, currently there is no uniform consensus on their usefulness. New dietary approach, such SPC-flakes, are being evaluated: further assessments will be needed to validate their use in clinical practice.
E. Specially processed cereals (SPC)
Recently, the intake of antisecretory factor (AF)-inducing specially processed cereals (SPC)-flakes has been proposed as complementary therapy for Meniere’s disease.Antisecretory factor (AF) is a 41 kDa protein originally isolated due to its ability to inhibit experimental diarrhoea; the specific effect of endogenous AF is not completely understood, but it seems to modulate water and ion transport.
The intake of specially processed cereals (SPC-flakes) results in an increase of AF activity in plasma [56]. Hanner et al hypothesized that an increased AF activity could positively influence the course of MD: their work demonstrated that the intake of SPC-flakes not only significantly reduced vertigo in a half of the patients, but was also related to an increase level of active AF in plasma and positive clinical outcome.
Treatment with SPC appears to be well tolerated by most patients [57] without any complications and, in most of studies, more than half of the study cohort reported subjective improvement in functional level.
On the contrary, Ingvardsen and Klokker [58] observed that antisecretory factor-inducing (AF) SPC were not shown to significantly improve the functional level in patients with MD.
PMID: 32523900 [PubMed]
PubMed:32523900
Comparison of the video head impulse test results with caloric test in patients with Meniere’s disease and other vestibular disorders
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
Therapeutic role of intravenous glycerol for Meniere’ disease: Preliminary results
https://www.sciencedirect.com/science/article/abs/pii/S0196070920301800?via%3Dihub
https://www.ncbi.nlm.nih.gov/pubmed/32354483?dopt=Abstract
Therapeutic role of intravenous glycerol for Meniere’ disease. Preliminary results.
Related Articles
Therapeutic role of intravenous glycerol for Meniere’ disease. Preliminary results.
Am J Otolaryngol. 2020 Apr 21;:102498
Authors: Scarpa A, Cassandro C, De Luca P, Greco A, Chiarella G, de Vincentiis M, Cassandro E, Ralli M
Abstract
PURPOSE: Osmotic diuretics such as glycerol are used for diagnostic purposes in patients with a suspect of Meniere’s disease (MD). Scientific evidence in the animal model and in humans has shown that glycerol can induce a reduction in endolymphatic hydrops; however, its use for therapeutic purposes in MD has never been reported. The aim of this study was to evaluate the effectiveness on symptom control of intravenous glycerol in a sample of patients with definite unilateral MD not responsive to dietary restrictions.
MATERIALS AND METHODS: Forty patients with unilateral intractable MD were included in the study. After audio-vestibular evaluation, patients were treated with intravenous 10% glycerol with 0.9% sodium chloride, 0.5 g/kg ml once a day for 2 consecutive days every fifteen days for six months. Vertigo attacks were evaluated before and after therapy and categorized into classes A-F according to the 2015 Equilibrium Committee criteria. Tinnitus and quality of life were evaluated through the Tinnitus Handicap Inventory and the Functionality Level Scale questionnaires.
RESULTS: Before treatment, patients had an average of 3.2 vertigo attacks/month; during the six months after treatment the average number of attacks/month decreased to 1.2 (p < 0.0001). At the end of the study period, 25 patients (62.5%) were in Class B vertigo control; 10 patients (25%) in Class C; and 5 patients (12.5%) in Class D. No patients were in Class A, E and F. No hearing deterioration was found in all treated patients. Quality of life according to administered questionnaires improved after treatment. CONCLUSIONS: In our sample, intravenous infusion of glycerol for two consecutive days every fifteen days for six months based on the patient's weight improved vertigo attacks and reduced the discomfort generated by tinnitus raising quality of life in patients with unilateral MD unresponsive to dietary restrictions. PMID: 32354483 [PubMed - as supplied by publisher] PubMed:32354483
Epidemiology and Seasonal Variation of Ménière’s Disease
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
Phonophobia and migraine features in patients with definite meniere’s disease
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
Surgical Labyrinthectomy and Cochlear Implantation for the Treatment of Menière’s Disease: results on hearing, vertigo, and tinnitus
https://journals.lww.com/otology-neurotology/Abstract/9000/Surgical_Labyrinthectomy_and_Cochlear_Implantation.96146.aspx
https://www.ncbi.nlm.nih.gov/pubmed/32282785?dopt=Abstract
Surgical Labyrinthectomy and Cochlear Implantation in Menière’s Disease.
Surgical Labyrinthectomy and Cochlear Implantation in Menière’s Disease.
Otol Neurotol. 2020 Apr 10;:
Authors: Sykopetrites V, Giannuzzi AL, Lauda L, Di Rubbo V, Bassi M, Sanna M
Abstract
OBJECTIVE: The aim of this study was to analyze the results of labyrinthectomy and cochlear implantation (CI) on hearing, vertigo, and tinnitus and evaluate the adequacy of labyrinthectomy and CI for the treatment of end stage Menière’s Disease (MD).
STUDY DESIGN: Retrospective case review.
SETTING: Tertiary referral center.
PATIENTS: Charts of 22 patients undergoing labyrinthectomy and CI in the same ear for intractable vertigo and hearing loss with both preoperatory and postoperatory documentation available, were reviewed.
INTERVENTION(S): Therapeutic.
MAIN OUTCOME MEASURE(S): Auditory outcomes were assessed with pure tone and speech audiometry, and compared with the preoperatory audiometric evaluation. Dizziness was graded according to the Dizziness Handicap Inventory Questionnaire (DHI). Tinnitus outcomes were assessed by the tinnitus handicap inventory (THI).
RESULTS: Post-CI pure tone average had a statistically significant improvement (p = 0.035, paired t test). Speech audiometry resulted in a non-statistically significant speech discrimination score variation (p = 0.056, paired t test). Postoperatory THI had a statistically significant variation (p = 0.0001, paired t test). Sixty seven per cent of the patients had complete resolution of the vestibular symptoms in their operated ear, however, patients over 70 years old had significantly more failures as evinced by the postoperative DHI (p = 0.0109, Fisher’s exact test).
CONCLUSIONS: Patients affected by end stage MD or secondary MD, with vertigo and severe hearing loss can successfully undergo labyrinthectomy and CI. Caution should be reserved in elderly patients for a risk of persistent instability. The CI confers significant benefit in hearing rehabilitation and tinnitus suppression.
PMID: 32282785 [PubMed – as supplied by publisher]
PubMed:32282785
Clinical Practice Guideline: Ménière’s Disease Executive Summary
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
Predictive Value of Vestibular Evoked Myogenic Potentials in the Diagnosis of Menière’s Disease and Vestibular Migraine
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
OTOG as a Relevant Gene in Familial Meniere’s Disease: the groundwork for genetic testing in MD
https://journals.lww.com/ear-hearing/Abstract/9000/Burden_of_Rare_Variants_in_the_OTOG_Gene_in.98668.aspx
https://www.ncbi.nlm.nih.gov/pubmed/32251013?dopt=Abstract
Burden of Rare Variants in the OTOG Gene in Familial Meniere’s Disease.
Burden of Rare Variants in the OTOG Gene in Familial Meniere’s Disease.
Ear Hear. 2020 Apr 02;:
Authors: Roman-Naranjo P, Gallego-Martinez A, Soto-Varela A, Aran I, Moleon MDC, Espinosa-Sanchez JM, Amor-Dorado JC, Batuecas-Caletrio A, Perez-Vazquez P, Lopez-Escamez JA
Abstract
OBJECTIVES: Meniere’s disease (MD) is a rare inner ear disorder characterized by sensorineural hearing loss, episodic vertigo, and tinnitus. Familial MD has been reported in 6 to 9% of sporadic cases, and few genes including FAM136A, DTNA, PRKCB, SEMA3D, and DPT have been involved in single families, suggesting genetic heterogeneity. In this study, the authors recruited 46 families with MD to search for relevant candidate genes for hearing loss in familial MD.
DESIGN: Exome sequencing data from MD patients were analyzed to search for rare variants in hearing loss genes in a case-control study. A total of 109 patients with MD (73 familial cases and 36 early-onset sporadic patients) diagnosed according to the diagnostic criteria defined by the Barany Society were recruited in 11 hospitals. The allelic frequencies of rare variants in hearing loss genes were calculated in individuals with familial MD. A single rare variant analysis and a gene burden analysis (GBA) were conducted in the dataset selecting 1 patient from each family. Allelic frequencies from European and Spanish reference datasets were used as controls.
RESULTS: A total of 5136 single-nucleotide variants in hearing loss genes were considered for single rare variant analysis in familial MD cases, but only 1 heterozygous likely pathogenic variant in the OTOG gene (rs552304627) was found in 2 unrelated families. The gene burden analysis found an enrichment of rare missense variants in the OTOG gene in familial MD. So, 15 of 46 families (33%) showed at least 1 rare missense variant in the OTOG gene, suggesting a key role in familial MD.
CONCLUSIONS: The authors found an enrichment of multiplex rare missense variants in the OTOG gene in familial MD. This finding supports OTOG as a relevant gene in familial MD and set the groundwork for genetic testing in MD.
PMID: 32251013 [PubMed – as supplied by publisher]
PubMed:32251013
Experimental Animal Models for Meniere’s Disease: updated resources regarding the current and desirable animal models for MD
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
Menière’s disease patients improve specific posturographic parameters following diagnostic intratympanic injection
https://www.ncbi.nlm.nih.gov/pubmed/32248954?dopt=Abstract
Menière’s disease patients improve specific posturographic parameters following diagnostic intratympanic injection.
Related Articles
Menière’s disease patients improve specific posturographic parameters following diagnostic intratympanic injection.
Am J Otolaryngol. 2020 Mar 24;:102468
Authors: Neri G, Bondi D, Scordella A, Tartaro A, Neri L, Cazzato F, Pini N, Mariggiò MA
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.
PMID: 32248954 [PubMed – as supplied by publisher]
PubMed:32248954
Hold the Salt: History of Salt Restriction as a First-line Therapy for Menière’s Disease
https://journals.lww.com/otology-neurotology/Abstract/9000/Hold_the_Salt__History_of_Salt_Restriction_as_a.96162.aspx
https://www.ncbi.nlm.nih.gov/pubmed/32221112?dopt=Abstract
Hold the Salt: History of Salt Restriction as a First-line Therapy for Menière’s Disease.
Related Articles
Hold the Salt: History of Salt Restriction as a First-line Therapy for Menière’s Disease.
Otol Neurotol. 2020 Mar 19;:
Authors: Shim T, Strum DP, Mudry A, Monfared A
Abstract
OBJECTIVES: To determine the historical origins of the usage of the salt restriction diet as an intervention for Menière’s disease (MD).
METHODS: Articles on MD and salt restriction were identified using Pubmed and Google scholar. Original manuscripts from 19th and 20th century as well as selected otological textbooks in English, German, and French were also reviewed.
RESULTS: The oldest recommendation of salt restriction in the literature was by Dederding (1889-1955) in 1929. She and her mentor, Sydney Holger Mygind (1884-1970), believed MD was caused by dysfunctional water metabolism. In several published manuscripts, they proposed that a reduced salt and fluid diet was an effective treatment for MD. Their contemporaries supported their findings, most notably, Albert C. Furstenberg (1890-1969) who suggested salt restriction alone as treatment for MD. Furstenberg, in his initial study implementing salt restriction in 15 patients with MD and then in a larger study with 150 patients, was the first to produce results that supported salt restriction as therapy for MD. It was not until 1980, when LB Jongkees first published his criticism of this treatment, that salt restriction was questioned. Since then, numerous published articles have been critical of salt restriction therapy and skeptical of its initial adoption into clinical practice.
CONCLUSIONS: Since Dederding’s and Mygind’s publications in 1929 and Furstenberg’s trial in 1934, the salt restriction diet has remained a primary first-line treatment for MD. Since the 1950s, various publications have both supported and argued this treatment, and the evidence of its validity remains inconclusive.
PMID: 32221112 [PubMed – as supplied by publisher]
PubMed:32221112
On-Demand and Low Dose Intratympanic Gentamicin for Meniere’s Disease: A Customized Approach
https://www.ncbi.nlm.nih.gov/pubmed/32176139?dopt=Abstract
https://journals.lww.com/otology-neurotology/Abstract/2020/04000/On_Demand_and_Low_Dose_Intratympanic_Gentamicin.22.aspx
On-Demand and Low Dose Intratympanic Gentamicin for Meniere’s Disease: A Customized Approach.
Related Articles
On-Demand and Low Dose Intratympanic Gentamicin for Meniere’s Disease: A Customized Approach.
Otol Neurotol. 2020 Apr;41(4):504-510
Authors: Celis-Aguilar E, Castro-Bórquez KM, Obeso-Pereda A, Escobar-Aispuro L, Burgos-Paez A, Alarid-Coronel JM, Verdiales-Lugo S, León-Leyva IC, Trejo-González CF, López-Favela LM, Martínez-Román L
Abstract
OBJECTIVE: To evaluate the efficacy of on demand and low dose intratympanic gentamicin (ITG) in patients with intractable Meniere’s disease (MD).
STUDY DESIGN: Clinical chart review.
SETTING: Secondary care center.
PATIENTS: Subjects with MD who failed conventional treatment and underwent on demand ITG infiltration from June 2013 to December 2018.
INTERVENTION: 0.4 to 0.5 ml of buffered gentamicin were administered through an intratympanic route. A total of 5 mg in case of low dose and 20 mg as a standard dose.
MAIN OUTCOME MEASURES: Vertigo control, Meniere’s Disease Functional Level Scale (MDFLS), Dizziness Handicap Inventory (DHI), and pure tone audiometry pre and posttreatment.
RESULTS: Thirty-one patients, 16 women and 15 men with a mean age of 52.81 (22-79) years were included. The number of ITG injections ranged from 1 to 7, with a mean of 2.52 applications per patient. Mean interval between doses was 212.15 (21-1442) days. Average follow-up was 24.03 months. An improvement on MDFLS was seen on 77.4% (n = 24) patients. DHI score improved after gentamicin treatment (mean 55.23 versus 24.06, p ≤ 0.001). Thirty patients (96.8%) reached complete or substantial vertigo control. Only one patient did not achieve control. Hearing was preserved in 43.5% (n = 10) of analyzed audiograms, whereas 17.4% (n = 4) developed hearing loss greater than 20 dB, which was not statistically significant (p = 0.099).
CONCLUSIONS: In our study, on demand and low dose ITG was effective for vertigo control in patients with intractable MD. Individualized therapy is recommended in all patients to minimize vestibular and cochlear toxicity.
PMID: 32176139 [PubMed – as supplied by publisher]
PubMed:32176139
Bone Mineral Density in Patients Suffering from Ménière’s Disease
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
Nutritional Mushroom Treatment in Meniere’s Disease With Coriolus versicolor: A Rationale for Therapeutic Intervention in Neuroinflammation and Antineurodegeneration
https://www.mdpi.com/1422-0067/21/1/284/htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981469/
Nutritional Mushroom Treatment in Meniere’s Disease With Coriolus versicolor: A Rationale for Therapeutic Intervention in Neuroinflammation and Antineurodegeneration
Are viral-infections associated with Ménière’s Disease?
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
Chronic cerebrospinal venous insufficiency and menière’s disease: Interventional versus medical therapy
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
Conservative Treatment Possibilities of Ménière Disease, Involving Vertigo Diaries
https://journals.sagepub.com/doi/10.1177/0145561319881838
https://www.ncbi.nlm.nih.gov/pubmed/31617407?dopt=Abstract
Conservative Treatment Possibilities of Ménière Disease, Involving Vertigo Diaries.
Conservative Treatment Possibilities of Ménière Disease, Involving Vertigo Diaries.
Ear Nose Throat J. 2019 Oct 16;:145561319881838
Authors: Molnár A, Maihoub S, Tamás L, Szirmai Á
Abstract
Ménière disease is a disorder of the inner ear, characterized by rotational vertigo, hearing loss, tinnitus, and vegetative symptoms. The aim of the present research is to examine the effectiveness of betahistine and piracetam in the reduction of vertigo attacks in Ménière disease. To verify our hypothesis, 105 (31 male and 74 females, mean age [standard deviation], 57.4 [11.05]) adult patients with definite Ménière disease were enrolled in this investigation. Beside the analysis of the hospital records, the subjective complaints of the patients and the completed vertigo diaries were taken into consideration too. The statistical analysis was completed using the IBM SPSS version 24 software. Retrospective analysis, including a 12 years period was conducted. Based on our results, betahistine was successful in the reduction of attacks. Statistically significant decrease was achieved in frequency of dizziness (P = .000331) and vertigo (P < .00001) and in the duration of them (P = .000098), although in the mean power of them was not (P = .0887). The mean dose in the symptomatic treatment was determined as 87.5 ± 27.2 mg per day; however, there was no connection detected between the dose of the agent and the effectiveness of the symptomatic control. By using dual therapy (betahistine and piracetam), vertigo episodes appeared significantly less often (P = .027, Odds ratio: 4.9, 95% confidence interval: 1.2-20.2). Finally, it can be concluded that betahistine is effective in Ménière disease, but the daily dose of it should be set up for every patient individually. The advantage of the dual therapy was also confirmed. PMID: 31617407 [PubMed - as supplied by publisher] PubMed:31617407
Long-term outcomes of triple semicircular canal plugging (TSCP) for the treatment of intractable Meniere’s disease (MD)
https://content.iospress.com/articles/journal-of-vestibular-research/ves190682
https://www.ncbi.nlm.nih.gov/pubmed/31640108?dopt=Abstract
Long-term outcomes of triple semicircular canal plugging for the treatment of intractable Meniere’s disease: a single center experience of 361 cases.
Related Articles
Long-term outcomes of triple semicircular canal plugging for the treatment of intractable Meniere’s disease: a single center experience of 361 cases.
J Vestib Res. 2019 Oct 14;:
Authors: Zhang D, Lv Y, Han Y, Li Y, Li X, Wang J, Song Y, Kong L, Jian H, Fan Z, Wang H
Abstract
INTRODUCTION: Meniere’s disease is a common chronic inner ear disease. Because the definitive pathogenesis is still unknown, there is currently no cure for this disorder. Semicircular canal plugging (SCP), first used to treat patients with intractable benign paroxysmal positional vertigo, has since been applied to patients with intractable peripheral vertigo. This study was aimed to explore the long-term efficacy of triple semicircular canal plugging (TSCP) in the treatment of intractable Meniere’s disease (MD) so as to provide a new method in the framework of treatment with MD.
METHODS: Three hundred and sixty-one unilateral MD patients, who were treated with TSCP in our hospital between Dec. 2010 and Sep. 2016, were recruited in this study for retrospective analysis. Vertigo control and auditory function were monitored during a period of two-year follow-up. Seventy three patients who were subjected to intratympanic gentamicin were selected as a control group. Pure tone audiometry, caloric test, vestibular evoked myogenic potential (VEMP) were performed in two-year follow-up.
RESULTS: The total control rate of vertigo in TSCP group was 97.8% (353/361) in the two-year follow-up, with complete control rate of 80.3% (290/361) and substantial control rate of 17.5% (63/361). The rate of hearing loss was 26.3% (95/361). The total control rate of vertigo in intratympanic gentamicin group was 83.6% (61/73), with complete control rate of 63.0% (46/73) and substantial control rate of 20.5% (15/73). The rate of hearing loss was 24.7% (18/73). The vertigo control rate of TSCP was significantly higher than that of chemical labyrinthectomy(χ2 = 24.798, p < 0.05). There was no significant difference of hearing loss rate between two groups. (χ2 = 0.087, p > 0.05).
CONCLUSION: Triple semicircular canal plugging (TSCP), which can reduce vertiginous symptoms in patients with intractable Meniere’s disease (MD), represents an effective therapy for this disorder. It might become a new important method in the framework of treatment with MD.
PMID: 31640108 [PubMed – as supplied by publisher]
PubMed:31640108
A hypothetical proposal for association between migraine and Meniere’s disease
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
Food-induced stimulation of the antisecretory factor to improve symptoms in Meniere’s disease: our results
https://link.springer.com/article/10.1007%2Fs00405-019-05682-4
https://www.ncbi.nlm.nih.gov/pubmed/31605188?dopt=Abstract
Food-induced stimulation of the antisecretory factor to improve symptoms in Meniere’s disease: our results.
Related Articles
Food-induced stimulation of the antisecretory factor to improve symptoms in Meniere’s disease: our results.
Eur Arch Otorhinolaryngol. 2019 Oct 11;:
Authors: Scarpa A, Ralli M, Viola P, Cassandro C, Alicandri-Ciufelli M, Iengo M, Chiarella G, de Vincentiis M, Cavaliere M, Cassandro E
Abstract
PURPOSE: Specially processed cereals (SPC) that increase endogenous antisecretory factor (AF) synthesis have been proposed to improve symptoms of Meniere’s disease (MD) with controversial results. The aim of this study was to evaluate the effects of SPC in patients with definite unilateral MD and compare the results to a treatment protocol with intravenous glycerol and dexamethasone.
METHODS: Thirteen patients with unilateral MD were treated with SPC and 13 patients were treated with intravenous glycerol and dexamethasone for 12 months. Audio-vestibular evaluation was performed before (T0) and at the end of the treatments (T12). The number of vertigo spells were evaluated before and after therapy and the Efficacy Index (EI) was calculated. Questionnaires for hearing loss (HHIA), tinnitus (THI) and quality of life (TFL) were administered.
RESULTS: EI decreased in the SPC group in the second semester compared to the first although not significantly (p = 0.6323). There was a significant reduction for THI score in the SPC group at T12 (p = 0.0325). No significant differences were found between the two groups at T0 (p = 0.4723), while a significant difference was found at T12 (p = 0.0041). Quality of life showed an improvement in daily activities in the SPC group compared to infusion therapy group.
CONCLUSION: Our study shows a reduced number of vertigo attacks and a positive effect on the discomfort generated by tinnitus and 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.
PMID: 31605188 [PubMed – as supplied by publisher]
PubMed:31605188
Expression of aquaporins in inner ear diseases such as Meniere’s disease
https://onlinelibrary.wiley.com/doi/abs/10.1002/lary.28334
https://www.ncbi.nlm.nih.gov/pubmed/31593306?dopt=Abstract
Expression of aquaporins in inner ear disease.
Related Articles
Expression of aquaporins in inner ear disease.
Laryngoscope. 2019 Oct 08;:
Authors: Dong SH, Kim SS, Kim SH, Yeo SG
Abstract
The inner ear is responsible for hearing and balance and consists of a membranous labyrinth within a bony labyrinth. The balance structure is divided into the otolith organ that recognizes linear acceleration and the semicircular canal that is responsible for rotational movement. The cochlea is the hearing organ. The external and middle ear are covered with skin and mucosa, respectively, and the space is filled with air, whereas the inner ear is composed of endolymph and perilymph. The inner ear is a fluid-filled sensory organ composed of hair cells with cilia on the upper part of the cells that convert changes in sound energy and balance into electric energy through the hair cells to transmit signals to the auditory nerve through synapses. Aquaporins (AQPs) are a family of transmembrane proteins present in all species that can be roughly divided into three subfamilies according to structure and function: 1) classical AQP, 2) aquaglyceroporin, and 3) superaquaporin. Currently, the subfamily of mammalian species is known to include 13 AQP members (AQP0-AQP12). AQPs have a variety of functions depending on their structure and are related to inner ear diseases such as Meniere’s disease, sensorineural hearing loss, and presbycusis. Additional studies on the relationship between the inner ear and AQPs may be helpful in the diagnosis and treatment of inner ear disease. Laryngoscope, 2019.
PMID: 31593306 [PubMed – as supplied by publisher]
PubMed:31593306
Investigations of the Microvasculature of the Human Macula Utricle in Meniere’s Disease: towards the development of a non-invasive delivery strategy for the treatment of hearing and balance disorders such as MD
https://www.frontiersin.org/articles/10.3389/fncel.2019.00445/full?preview=true
https://www.ncbi.nlm.nih.gov/pubmed/31636542?dopt=Abstract
Investigations of the Microvasculature of the Human Macula Utricle in Meniere’s Disease.
Related Articles
Investigations of the Microvasculature of the Human Macula Utricle in Meniere’s Disease.
Front Cell Neurosci. 2019;13:445
Authors: Ishiyama G, Lopez IA, Acuna D, Ishiyama A
Abstract
The integrity and permeability of the blood labyrinthine barrier (BLB) in the inner ear is important to maintain adequate blood supply, and to control the passage of fluids, molecules and ions. Identifying the cellular and structural components of the BLB, the vascular endothelial cells (VECs), pericytes, and the perivascular basement membrane, is critical to understand the pathophysiology of the inner ear microvasculature and to design efficient delivery of therapeutics across the BLB. A recent study of the normal and pathological ultrastructural changes in the human macula utricle microvasculature demonstrated that the VECs are damaged in Meniere’s disease (MD), and further studies identified oxidative stress markers (iNOS and nitrotyrosine) in the VECs. Using fluorescence microscopy, the microvasculature was studied in the macula utricle of patients diagnosed with MD that required transmastoid labyrinthectomy for intractable vertigo (n = 5), and patients who required a translabyrinthine approach for vestibular schwannoma (VS) resection (n = 3). Normal utricles (controls) were also included (n = 3). VECs were identified using rabbit polyclonal antibodies against the glucose transporter-1 (GLUT-1) and pericytes were identified using mouse monoclonal antibodies against alpha-smooth muscle actin (α-SMA). Immunofluorescence (IF) staining was made in half of the utricle and flat mounted. The other half was used to study the integrity of the BLB using transmission electron microscopy (TEM). GLUT-1-IF, allowed delineation of the macula utricle microvasculature (located in the stroma underneath the sensory epithelia) in both MD and VS specimens. Three sizes of vessels were present in the utricle vasculature: Small size (<15 μm), medium size (15-25 μm) and large size >25 μm. α-SMA-IF was present in pericytes that surround the VECS in medium and thick size vessels. Thin size vessels showed almost no α-SMA-IF. AngioTool software was used for quantitative analysis. A significant decreased number of junctions, total vessel length, and average vessel length was detected in the microvasculature in MD specimens compared with VS and control specimens. The deeper understanding of the anatomy of the BLB in the human vestibular periphery and its pathological changes in disease will enable the development of non-invasive delivery strategy for the treatment of hearing and balance disorders.
PMID: 31636542 [PubMed]
PubMed:31636542
Rare Variants in the OTOG Gene Are a Frequent Cause of Familial Meniere’s Disease
https://www.biorxiv.org/content/10.1101/771527v1.full
Rare Variants in the OTOG Gene Are a Frequent Cause of Familial Meniere’s Disease
Solute carrier family 4 member 1 might participate in the pathogenesis of Meniere’s disease in a murine endolymphatic hydrop model
https://www.tandfonline.com/doi/abs/10.1080/00016489.2019.1663365?journalCode=ioto20
https://www.ncbi.nlm.nih.gov/pubmed/31536436?dopt=Abstract
Solute carrier family 4 member 1 might participate in the pathogenesis of Meniere’s disease in a murine endolymphatic hydrop model.
Solute carrier family 4 member 1 might participate in the pathogenesis of Meniere’s disease in a murine endolymphatic hydrop model.
Acta Otolaryngol. 2019 Sep 19;:1-11
Authors: Sun S, Zhang D, Sun G, Song Y, Cai J, Fan Z, Wang H
Abstract
Background: To date, the pathogenesis of Meniere’s disease (MD) remains unclear. Previous research found that the SLC4A1 gene significantly down-regulated. Aims: This study sought to understand the effect of SLC4A1 on the pathogenesis of MD. ELH C57 mice models were induced by intraperitoneal injection of AVP. Material and methods: The mRNA expression levels of SLC4A1, SLC4A10 and SLC26A4 were monitored by real-time quantitative PCR, the protein expression levels of SLC4A1 were monitored by immunoblotting and immunofluorescence before and after the ELH. DIDS is an inhibitor of SLC4A1. The expression levels of SLC4A1 were also monitored in the AVP + DIDS group. Results: We successfully established the model of ELH after applied AVP. The results of HE staining showed displacement of Reissner’s membrane with bulge to scala vestibule in ears of the AVP group. Cochlea/ELS SLC4A1 protein and SLC4A1, SLC4A10, SLC26A4 mRNA expressions were reduced significantly in C57 mice of the AVP group. The SLC4A1 protein expression levels and SLC4A1, SLC4A10, SLC26A4 mRNA expression levels declined more obvious in the cochlea and ELS in C57 mice of the AVP + DIDS group. Conclusions and significance: SLC4A1 was a protective factor in the pathogenesis of MD, but the mechanisms were unknown.
PMID: 31536436 [PubMed – as supplied by publisher]
PubMed:31536436
Rat Model of Ménière’s Attack: Intratympanic Injection of Potassium Chloride Produces Direction-Changing Spontaneous Nystagmus and Hearing Fluctuations
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
Menière’s disease treated by grommet insertion
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
Efficacy and safety of low-dose intratympanic gentamicin on vertigo attacks in Meniere’s disease
https://www.sciencedirect.com/science/article/abs/pii/S0196070919306866?via%3Dihub
https://www.ncbi.nlm.nih.gov/pubmed/31537428?dopt=Abstract
Low-dose intratympanic gentamicin administration for unilateral Meniere’s disease using a method based on clinical symptomatology: Preliminary results.
Related Articles
Low-dose intratympanic gentamicin administration for unilateral Meniere’s disease using a method based on clinical symptomatology: Preliminary results.
Am J Otolaryngol. 2019 Sep 09;:102289
Authors: Scarpa A, Ralli M, Cassandro C, Gioacchini FM, Alicandri-Ciufelli M, Viola P, Chiarella G, de Vincentiis M, Cassandro E
Abstract
PURPOSE: There are many therapeutic options for Meniere’s disease (MD); intratympanic (IT) gentamicin has been proposed for intractable cases although controversy about dosage and method exists. The purpose of this study was to assess the efficacy and safety of low-dose IT gentamicin on vertigo attacks in MD using a clinical symptomatology-based method in which administration was repeated only if vertigo attacks recurred, with a 2-week interval between injections.
MATERIALS AND METHODS: Forty-eight patients with unilateral intractable MD were included in the study. All patients received one to five IT injections with 0.5 ml of 10 mg of gentamicin (80 mg/2 ml) with an interval of 2 weeks between injections. Vertigo attacks were evaluated before and after therapy and categorized into classes A-F according to the 2015 Equilibrium Committee criteria. Audiovestibular assessment with pure tone audiometry, vestibular bed-side examination and video head impulse test was performed.
RESULTS: Before treatment patients had an average of 4.4 vertigo attacks/month; after treatment the average number decreased to 0.52. The majority of patients (77%) reached Class A vertigo control with 5 or less gentamicin injections. VOR gain was unaffected in the healthy side and significantly reduced in the affected side. No hearing deterioration was found in all treated patients.
CONCLUSIONS: Low-dose IT gentamicin administration based on clinical symptomatology can produce a satisfactory control of vertigo attacks after treatment; such protocol had an effect mainly on the vestibular function as demonstrated by the significant reduction in VOR gain in the affected side avoiding a cochlear damage.
PMID: 31537428 [PubMed – as supplied by publisher]
PubMed:31537428
Intratympanically administered steroid for progressive sensorineural hearing loss in Ménière’s disease
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
Correlation between Vestibular Evoked Myogenic Potentials and Disease Progression in Ménière’s Disease
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
Structural loss of the distal endolymphatic sac (ES) may contribute to the pathogenesis of Meniere’s disease
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
Evolution of Meniere’s Disease: from MD 1.0, via MD 1.5, to MD 2.0
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
Results in caloric test, video head impulse test and inner ear MRI in patients with Ménière’s disease
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
Approach to Ménière disease management
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
Dissociation of caloric and head impulse tests: a marker of Meniere’s disease
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
The Price of Immune Responses and the Role of Vitamin D in the Inner Ear
https://journals.lww.com/otology-neurotology/Abstract/2019/07000/The_Price_of_Immune_Responses_and_the_Role_of.2.aspx
https://www.ncbi.nlm.nih.gov/pubmed/31194714?dopt=Abstract
The Price of Immune Responses and the Role of Vitamin D in the Inner Ear.
The Price of Immune Responses and the Role of Vitamin D in the Inner Ear.
Otol Neurotol. 2019 Jul;40(6):701-709
Authors: Büki B, Jünger H, Zhang Y, Lundberg YW
Abstract
OBJECTIVE: In this review the authors discuss evidence from the literature concerning vitamin D and temporal bone diseases (benign paroxysmal positional vertigo [BPPV], Menière’s disease [MD], vestibular neuritis, idiopathic facial paralysis, idiopathic acute hearing loss). Common features shared by Menière’s disease, glaucoma, and the possible influence by vitamin D are briefly discussed.
DATA SOURCES, STUDY SELECTION: Publications from 1970 until recent times have been reviewed according to a keyword search (see above) in PubMed.
CONCLUSIONS: MD, BPPV, vestibular neuritis, idiopathic facial paralysis, idiopathic acute hearing loss may all have several etiological factors, but a common feature of the current theories is that an initial viral infection and a subsequent autoimmune/autoinflammatory reaction might be involved. Additionally, in some of these entities varying degrees of demyelination have been documented. Given the immunomodulatory effect of vitamin D, we postulate that it may play a role in suppressing an eventual postviral autoimmune reaction. This beneficial effect may be enhanced by the antioxidative activity of vitamin D and its potential in stabilizing endothelial cells. The association of vitamin D deficiency with demyelination has already been established in other entities such as multiple sclerosis and experimental autoimmune encephalitis. Mice without vitamin D receptor show degenerative features in inner ear ganglia, hair cells, as well as otoconia. The authors suggest further studies concerning the role of vitamin D deficiency in diseases of the temporal bone. Additionally, the possible presence and degree of demyelination in these entities will have to be elucidated more systematically in the future.
PMID: 31194714 [PubMed – in process]
PubMed:31194714
Effects of ventilation tube insertion on aural fullness in Ménière’s disease: a review
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
The role of ion channels and transporters in the pathophysiology of Ménière’s disease
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
Differential Proinflammatory Signature in Vestibular Migraine and Meniere Disease
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
Therapeutic Effect of Intratympanic Injection of Dexamethasone plus Hyaluronic Acid on Patients with Meniere’s disease
http://ijorl.mums.ac.ir/article_13110.html
Intratympanic dexamethasone/hyaluronic acid had a positive effect on the vertigo of patients with Meniere’s disease
Intratympanic Steroid for Menière’s Disease: A Systematic Review
https://journals.lww.com/otology-neurotology/Abstract/publishahead/Intratympanic_Steroid_for_Meni_re_s_Disease__A.96479.aspx
https://www.ncbi.nlm.nih.gov/pubmed/31135678?dopt=Abstract
Intratympanic Steroid for Menière’s Disease: A Systematic Review.
Intratympanic Steroid for Menière’s Disease: A Systematic Review.
Otol Neurotol. 2019 May 16;:
Authors: Devantier L, Djurhuus BD, Hougaard DD, Händel MN, Guldfred FL, Schmidt JH, Edemann-Callesen H
Abstract
OBJECTIVES: To investigate the beneficial effects and safety of intratympanic steroid installation compared with placebo in patients with Menière’s disease.
METHODS: We performed a systematic literature search in MEDLINE and EMBASE for existing systematic reviews and individual randomized controlled trials (RCTs). Studies were included if they investigated the usage intratympanic steroids in patients aged 18 and above, with definite or probable Menière’s disease. The quality of the identified existing reviews was assessed using the AMSTAR tool. The risk of bias in RCTs was assessed using the Cochrane Risk of Bias Tool and overall quality of the individual outcomes was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method.
RESULTS: The literature search provided four systematic reviews, from which one yielded a sufficient AMSTAR evaluation and subsequently provided three RCTs relevant for inclusion. Due to the lack of sufficient reporting of the data, quantitative synthesis was not applicable. In the qualitative synthesis for the primary outcome, the results from the RCTs showed that there was a slight indication of steroid treatment reducing the frequency of vertiginous attacks. No serious adverse events were reported. Based on the GRADE approach the quality for both findings is very low. No studies reported on the secondary outcomes.
CONCLUSION: The effect of intratympanic steroid treatment in Menière’s disease is questionable. There is a great need for further research to sufficiently assess whether steroid treatment may be considered as a safe and effective treatment for patients with Menière’s disease.
PMID: 31135678 [PubMed – as supplied by publisher]
PubMed:31135678
Different medications for the treatment of Ménière’s disease by intratympanic injection: a systematic review and network meta-analysis
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
Can verapamil be effective in controlling vertigo and headache attacks in vestibular migraine accompanied with Meniere’s disease? A preliminary study
https://link.springer.com/article/10.1007%2Fs00415-019-09309-w
https://www.ncbi.nlm.nih.gov/pubmed/30989371?dopt=Abstract
Can verapamil be effective in controlling vertigo and headache attacks in vestibular migraine accompanied with Meniere’s disease? A preliminary study.
Related Articles
Can verapamil be effective in controlling vertigo and headache attacks in vestibular migraine accompanied with Meniere’s disease? A preliminary study.
J Neurol. 2019 Apr 15;:
Authors: Kaya I, Eraslan S, Tarhan C, Bilgen C, Kirazli T, Gokcay F, Karapolat H, Celebisoy N
PMID: 30989371 [PubMed – as supplied by publisher]
PubMed:30989371
The Clinical Benefit of Device Therapy for Meniere’s Disease in Adults: Systematic Review and Meta-Analysis
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
Positive pressure therapy for Ménière’s disease
We concluded positive pressure therapy probably leads to slightly worse hearing and makes little or no difference in the intensity of vertigo.
https://www.ncbi.nlm.nih.gov/pubmed/30985738?dopt=Abstract
http://www.medwave.cl/link.cgi/Medwave/PuestaDia/ResEpis/7610.act
Positive pressure therapy for Ménières disease.
Positive pressure therapy for Ménières disease.
Medwave. 2019 Apr 08;19(3):e7610
Authors: Holmberg J, de Amesti M, Rosenbaum A, Winter M
Abstract
INTRODUCTION: Ménière’s disease is a disorder of the inner ear characterized by episodes of spontaneous vertigo, fluctuating hearing loss and tinnitus. Positive pressure therapy has been used to reduce the intensity and frequency of episodes, but it is not clear whether it is actually effective.
METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach.
RESULTS AND CONCLUSIONS: We identified five systematic reviews including 22 studies overall, of which five were randomized trials. We concluded positive pressure therapy probably leads to slightly worse hearing and makes little or no difference in the intensity of vertigo. In addition, we are uncertain whether positive pressure therapy improves functionality or decreases vertigo attacks as the certainty of the evidence has been assessed as very low.
PMID: 30985738 [PubMed – in process]
PubMed:30985738
CASP9 genotype confers gentamicin susceptibility in intratympanic treatment of intractable vertigo caused by Ménière’s disease
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
Menière’s Disease and Disorders of the Carbohydrate Metabolism Involving the Inner Ear
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.
Related Articles
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
Long-Term Follow-Up of Intratympanic Methylprednisolone Versus Gentamicin in Patients With Unilateral Menière’s Disease
https://journals.lww.com/otology-neurotology/Abstract/publishahead/Long_Term_Follow_Up_of_Intratympanic.96542.aspx
Peripheral vestibular disorders: an update
https://insights.ovid.com/crossref?an=00019052-201902000-00026
Peripheral vestibular disorders: an update
Treatment of Ménière’s disease focusing on vascular risk factors may allow a better control of symptoms and result in a decreased need for ablative procedures
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
Meniere’s Disease: A Review of Pathologic Mechanism, Clinical Diagnosis, and New Treatments
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
Novel therapy which uses gelatin sponge particles to help deliver high-dose steroids to the inner ear, relieves vertigo, tinnitus, and hearing loss in refractory Ménière’s disease
https://www.sciencedirect.com/science/article/pii/S1672293018300916
https://www.ncbi.nlm.nih.gov/pubmed/31223300?dopt=Abstract
Autoinflammatory characteristics and short-term effects of delivering high-dose steroids to the surface of the intact endolymphatic sac and incus in refractory Ménière’s disease.
J Otol. 2019 Jun;14(2):40-50
Authors: Zou J
Abstract
Objective: To investigate immune-related genetic background in intractable Meniere’s disease (MD) and the immediate results of a novel therapy by delivering steroids to the surface of the intact endolymphatic sac (ES) and incus in a sustainable manner.
Case report and methods: Candidate genes involved in immune regulation were sequenced using a next-generation sequencing method in a patient with intractable MD. Mutations were confirmed using the Sanger sequencing method. The ES was exposed, and gelatin sponge particles were immersed in high-dose methylprednisolone solution and placed onto the surface of ES. “L”-shaped gelatin sponge strips were immersed in dexamethasone solution and served as a guiding device for the steroids by touching the incus and gelatin sponge particles on the surface of the ES. Gelatin sponge particles immersed in dexamethasone solution were placed around the gelatin sponge strips and sealed using fibrin glue.
Results: Autoinflammation in the refractory MD case was indicated by genotype, including novel heterozygous mutations of PRF1, UNC13D, SLC29A3, ITCH, and JAK3, as well as phenotype. The vertigo was fully relieved immediately after operation. Tinnitus and aural fullness were resolved 3 weeks after operation, whereas hearing improved in 2 mon postoperation. No recurrence was noted during the 5-monfollow-up, and the final MRI supported the novel therapeutic hypothesis.
Conclusion: Autoinflammation was involved in a refractory MD. This novel therapy, which involves the delivery of steroids to the surface of the intact ES and incus, is effective in relieving vertigo and tinnitus and improves hearing function of refractory MD.
PMID: 31223300 [PubMed]
PubMed:31223300
Effects of dietary restriction of salt, caffeine and alcohol intake in patients with Ménière’s disease or syndrome
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012173.pub2/full
https://www.ncbi.nlm.nih.gov/pubmed/30596397?dopt=Abstract
Restriction of salt, caffeine and alcohol intake for the treatment of Ménière’s disease or syndrome.
Cochrane Database Syst Rev
Restriction of salt, caffeine and alcohol intake for the treatment of Ménière’s disease or syndrome.
Cochrane Database Syst Rev. 2018 Dec 31;12:CD012173
Authors: Hussain K, Murdin L, Schilder AG
Abstract
BACKGROUND: Ménière’s disease or syndrome is a chronic inner ear disorder that results in sporadic attacks of vertigo, sensorineural hearing loss, aural fullness and tinnitus.There is no definitive treatment for Ménière’s disease and treatment options range from dietary modification through medication to surgery.Modification of diet, including restriction of salt, caffeine and alcohol intake, is a management option that is widely recommended to patients with Ménière’s as a first-line treatment. There has not previously been a systematic review of this intervention.
OBJECTIVES: To assess the effects of dietary restriction of salt, caffeine and alcohol intake in patients with Ménière’s disease or syndrome.
SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 28 March 2018.
SELECTION CRITERIA: Randomised controlled trials of dietary modification, specifically salt, caffeine and alcohol restriction or substitution (or both), compared to no modification of these agents or a placebo intervention, in adult patients with Ménière’s disease or syndrome.
DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. Our primary outcomes were control of vertigo or decrease in vertigo attacks, and adverse effects. Secondary outcomes included hearing (change in hearing loss or its progression), tinnitus (severity), perception of aural fullness, well-being and quality of life (overall changes), and other adverse effects. We planned to use GRADE to assess the quality of the evidence for each outcome.
MAIN RESULTS: We did not identify any studies that met the inclusion criteria for the review.
AUTHORS’ CONCLUSIONS: There is no evidence from randomised controlled trials to support or refute the restriction of salt, caffeine or alcohol intake in patients with Ménière’s disease or syndrome. High-quality research in this field is warranted. The best evidence may come from a randomised controlled trial comparing dietary interventions (e.g. low salt versus general healthy diet advice), using rigorous methodology for patient selection, randomisation and blinding, and strictly adhering to the Bárány Society diagnostic criteria. However, this research question might be more pragmatically addressed by using information from carefully constructed patient registries that include information on dietary intake of substances of interest such as salt, caffeine and alcohol. It will be important to address the question of any possible harms or unwanted effects of dietary modification.
PMID: 30596397 [PubMed – as supplied by publisher]
PubMed:30596397
The pathophysiological mechanism of Ménière’s disease: Has the key been found?
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?
Related Articles
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
Long Term Outcomes of Intratympanic Dexamethasone in Intractable Unilateral Meniere’s Disease
https://link.springer.com/article/10.1007%2Fs12070-018-1431-3
https://www.ncbi.nlm.nih.gov/pubmed/31750179?dopt=Abstract
Long Term Outcomes of Intratympanic Dexamethasone in Intractable Unilateral Meniere’s Disease.
Long Term Outcomes of Intratympanic Dexamethasone in Intractable Unilateral Meniere’s Disease.
Indian J Otolaryngol Head Neck Surg. 2019 Nov;71(Suppl 2):1369-1373
Authors: Pradhan P, Lal P, Sen K
Abstract
To evaluate the long term effect of Intratympanic dexamethasone in intractable Meniere’s disease. 30 patients with refractory Meniere’s disease which did not respond to the standard medical management, were treated with Intratympanic dexamethasone injections. Post treatment hearing outcome and dizziness scores were compared with the pretreatment values respectively. The mean dizziness handicap inventory (DHI) score was reduced from 91.58 (range 80-100) to be 31.00 (p = 0.00) at 3 months of treatment. With the successive follow-up periods, the mean DHI scores were reduced to 51.50, 46.6, and 50.90 at the end of, 6, 12, and 24 months (p = 0.04, 0.35, and 0.49 respectively). Again at the end of 24 months, 23.80% of patients were free of vertigo (p = 0.01). No patient had improvement in the hearing (> 10 dB) in any of the follow-up periods and 6.6% demonstrated deterioration in hearing. There were no major intraoperative or postoperative complications detected. Intratympanic injection of steroid is a safe and effective method for treating intractable Meniere’s disease. Although short term improvement in the vertigo is well documented, still in 23% of the patients were found to be free of vertigo at even the end of 24 months. There was no significant improvement in hearing noticed, either in short term or in long term.
PMID: 31750179 [PubMed]
PubMed:31750179
Gene Delivery into the Inner Ear and Its Clinical Implications for Hearing and Balance
https://www.mdpi.com/1420-3049/23/10/2507
Gene Delivery into the Inner Ear and Its Clinical Implications for Hearing and Balance