Endolymphatic Sac Drainage Surgery and Plasma Stress Hormone Vasopressin Levels in Meniere's Disease

Abstract

Meniere's disease is a common inner ear disorder accompanied by vertigo attacks and fluctuating hearing loss that some believe is due to a stressful lifestyle. To elucidate the scientific relationship in neuro-endocrinology between Meniere's disease and stress, we examined the surgical results of endolymphatic sac drainage surgery and changes in stress-induced plasma arginine-vasopressin levels. We enrolled 100 intractable Meniere's patients and examined surgical results and plasma vasopressin levels. Fifty-four chronic otitis media patients who underwent tympano-mastoidectomy formed a control group. We assessed surgical results during a 2-year follow-up period, including vertigo and hearing loss. We examined plasma vasopressin levels just before surgery and 1 week, 1 year, and 2 years after surgery. In patients with intractable Meniere's disease, plasma vasopressin levels were significantly reduced 1 week after surgery compared to the decrease observed in chronic otitis media patients after tympano-mastoidectomy. In intractable Meniere's disease, long-lasting low plasma vasopressin levels after surgery were associated with significantly good surgical results. In recurrent Meniere's disease, a gradual plasma vasopressin level elevation was observed after surgery, followed by recurrent vertigo attacks and sensorineural hearing loss. It is suggested that long-lasting high levels of plasma vasopressin could have adverse effects on inner ear water metabolism and the subsequent Meniere's disease symptoms. Effective treatments for Meniere's disease might be best based on the maintenance of low plasma vasopressin levels.

Smoking Is Positively Related and Alcohol Consumption Is Negatively Related to an Increased Risk of Meniere’s Disease

“…Indeed, the plasma level of vasopressin was increased in patients with MD [ 10 ]. In addition, in patients with intractable MD, plasma vasopressin levels were decreased following endolymphatic sac drainage surgery, which was correlated with recovery from symptoms of MD [ 26 ]. In summary, alcohol consumption could be associated with MD via suppression of diuresis and relief of endolymphatic hydrops.…”

Causality between alcohol usually taken with meals and Meniere disease: A 2-sample Mendelian randomization study

“…The reduction in plasma vasopressin levels after endolymphatic sac drainage in patients with MD suggests that vasopressin may have an effect on patients with MD. [ 24 ] When alcohol is consumed, the dose of vasopressin decreases, [ 25 ] and vasopressin can induce disturbances in patients with endolymphatic hydrops. [ 26 ] Disorder of the endolymphatic fluid is considered the signature feature of MD.…”

Multiple genetic variants involved in both autoimmunity and autoinflammation detected in Chinese patients with sporadic Meniere's disease: a preliminary study

“…The behavior patterns of patients with MD showed strong tendencies toward engrossment, self-inhibition, feeling pressed for time, and aggressiveness compared to those of controls that engender day-to-day stress and frustration ( 52 ). A recent study on the surgical results of endolymphatic sac drainage surgery and changes in stress-induced plasma arginine-vasopressin levels showed that a gradual plasma vasopressin level elevation in recurrent MD after surgery suggested a link between symptom attacks and internal stress ( 53 ). Although endolymphatic sac drainage surgery was reported to be non-specific for MD and the outcome of the surgery might be linked to other biological effects such as shear stress induced by drilling the mastoid ( 54 , 55 ), the results demonstrating patients without any symptom attacks having significantly low levels of plasma arginine-vasopressin compared to those with symptoms suggest a strong link between symptom attacks and stress ( 53 ).…”

“…A recent study on the surgical results of endolymphatic sac drainage surgery and changes in stress-induced plasma arginine-vasopressin levels showed that a gradual plasma vasopressin level elevation in recurrent MD after surgery suggested a link between symptom attacks and internal stress ( 53 ). Although endolymphatic sac drainage surgery was reported to be non-specific for MD and the outcome of the surgery might be linked to other biological effects such as shear stress induced by drilling the mastoid ( 54 , 55 ), the results demonstrating patients without any symptom attacks having significantly low levels of plasma arginine-vasopressin compared to those with symptoms suggest a strong link between symptom attacks and stress ( 53 ). It was also reported that acute stress affects endocrine, immune, and metabolic functions in humans, and mood plays a causal role in the modulation of responses to acute stress ( 56 ).…”