Ménière's disease as a form of cranial polyganglionitis

Abstract

Although endolymphatic hydrops is generally considered to be the most prominent factor in the etiology and pathology of Ménière's disease, we have concluded that this condition more probably represents a polyganglionitis caused by the herpes simplex virus with secondary hydrops changes. The wide range of symptoms occurring in the Ménière's disease complex is illustrated in seven selected cases which support this conclusion. Vestibular nerve section can stabilize hearing and relieve episodic vertigo by removing the locus of viral infection and precluding recurrent activation.

A Classification of Recurrent Vestibulopathy

“…Three of the most common clinical syndromes manifesting as recurrent vertigo are benign paroxysmal positional vertigo (BPV), Ménière's disease (MD) and vestibular neuronitis (VN). The morphologic evidence presented in previous chapters supported by molecular [1, 2], immunologic [3-6] and clinical observations [7][8][9][10][11][12][13][14][15][16][17][18][19] indicates that these common, and some less common, recurrent vestibulopathies are manifestations of reactivation of latent viral vestibular ganglionitis.The agents responsible for the ganglionitis are neurotropic (NT) viruses, likely herpes simplex (HSV) or zoster virus. Other NT viruses that may be included in this group are cytomegalovirus, Epstein-Barr and pseudorabies virus.…”

Intratympanic therapy in Meniere's syndrome or disease: up to date evidence for clinical practice

“…Twelve of the 16 cadaveric temporal bones of patients with Ménière's disease (75%) and only 2 of 26 control subjects were positive for the presence of HSV DNA in the endolymphatic sac ( P < 0.01). Adour et al . suggested that MS/D is part of a polyganglionitis and demonstrated that viral inclusion bodies were more frequent in temporal bones of patients with MS/D compared to patients without.…”

“…Twelve of the 16 cadaveric temporal bones of patients with M eni ere's disease (75%) and only 2 of 26 control subjects were positive for the presence of HSV DNA in the endolymphatic sac (P < 0.01). Adour et al 42,43 suggested that MS/D is part of a polyganglionitis and demonstrated that viral inclusion bodies were more frequent in temporal bones of patients with MS/D compared to patients without. This concept was reinforced by the morphologic observations of Gacek and Gacek 44,45 that showed histological changes in temporal bones of patients with MS/D compatible with viral vestibular ganglionitis.…”

Herpes Simplex Virus and Meniere's Disease

“…HSV was suspected to be responsible for acute facial paralysis, sudden HL, vestibular neuritis, and MD. 19–22 Despite the theoretical basis for a viral etiology, the evidence supporting these assertions was limited. 23…”