Do patients with Ménière’s disease have attacks of syncope?

Abstract

The aim of the present study was to evaluate the prevalence and associated factors for syncope among patients with Ménière's disease (MD). An attack of syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously and without a localizing neurological deficit. The study used an across-sectional survey design. Information from a database consisting of 961 individuals was collected from the Finnish Ménière Association. The data contained case histories, general health-related quality of life (HRQoL), and impact measurements of the complaints. In the current study sample, syncope occurred in 12.3% of the patients with MD. It was more prevalent among elderly persons and among those with a longer duration of MD. Syncope was significantly associated with disturbances of otolith function reflected as Tumarkin attacks, gait and balance problems, environmental change of pressure, and physical strain. It was also associated with visual blurring; in fact, patients with otolith dysfunction in MD often experience visual field changes. It was also associated with headache, but not with migraine. Syncope was experienced as frightening and HRQoL was significantly worsened. The patient had higher anxiety scores, and suffered more from fatigue. The results demonstrate that neurally mediated syncope occurs in patients with an advanced form of MD who suffer from Tumarkin attacks due to failure in otolith function. The mechanism seems to be triggered through the vestibular sympathetic reflex when the otolith system fails due to disrupted utricular otolithic membrane mediate erroneous positional information from the otolith organ to the vasomotor centres in the brain stem and medulla.

Vestibular syncope: clinical characteristics and mechanism

“…Previously, Meniere's attacks were suggested to provoke vestibular syncope by generating erroneous otolithic information. 3,4 However, in a recent study, we detailed a theory proposing a mechanism wherein false downward inertia estimated in the central vestibular system disturbs the interaction of neural reflexes participating in cardiovascular homeostasis; this phenomenon is referred to as dyssynergia between the vestibulo-sympathetic reflex and baroreflex. 5 Moreover, the false downward inertia in the central vestibular system was shown to arise from false canal cues as well as false otolith cues.…”

“…Recent research has introduced the concept of vestibular syncope, which refers to syncope as a result of a vertigo spell. It mostly occurs during Meniere's attacks and is ascribed to erroneous otolithic information during the spell, which may affect the cardiovascular system 3,4 . In our prior study, we considered vestibular syncope to be a form of neurally mediated syncope and explained the mechanism as an excessive increase in blood pressure attributed to dyssynergia of the vestibulo‐sympathetic reflex and baroreflex system, owing to non‐physiologic vestibular stimulation (vertigo attack) 5 .…”

“…It mostly occurs during Meniere's attacks and is ascribed to erroneous otolithic information during the spell, which may affect the cardiovascular system. 3,4 In our prior study, we considered vestibular syncope to be a form of neurally mediated syncope and explained the mechanism as an excessive increase in blood pressure attributed to dyssynergia of the vestibulo-sympathetic reflex and baroreflex system, owing to non-physiologic vestibular stimulation (vertigo attack). 5 Accordingly, vestibular syncope may occur in association with other vestibular disorders, but its clinical features and relationships with underlying disorders remain to be elucidated.…”

Vestibular syncope

“…However, in humans, the syncope associated with vestibular disorders has received attention just recently. Pyykko ¨et al reported unexplained syncope in five patients with Meniere's disease, and, using a survey, 4% prevalence of syncope during the attacks of Meniere's disease [8]. However, the clinical characteristics and mechanisms of vestibular syncope remain to be explored.…”

“…The vestibular system is also engaged in cardiovascular homeostasis [7]. Therefore, malfunction of the vestibular system can disturb the cardiovascular function and lead to syncope [8–10]. Indeed, some patients with vestibular disorders develop syncope in a close temporal relationship with their vertigo attacks, thereby giving birth to the concept of vestibular syncope [11 ▪▪ ,12 ▪▪ ].…”