Menière's disease as a manifestation of vestibular ganglionitis

Gacek, Richard R.; Gacek, Mark R.

doi:10.1053/ajot.2001.24822

Cited by 30 publications

(17 citation statements)

References 33 publications

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“…The initial localization of virus is in the meatal ganglion but over time there is cell-to-cell spread to ganglion cells in the superior vestibular division. Similar findings of degenerated ganglion cells in the meatal ganglion and focal axonal degeneration in the vestibular nerve were observed in MD (n = 8) [27,47,48] (fig. 5, 6).…”

Section: Pathology Of Vn MD and Bppvsupporting

confidence: 83%

“…However, if there is degeneration of a sense organ (otolith) which normally has an interrelationship with another sense organ (crista ampullaris), the syndrome of benign paroxysmal positional vertigo may appear. Since similar histopathological changes are found in the contralateral TB of patients with these vestibulopathies [27,47], antiviral treatment may have a role in the prevention of bilateral symptoms.…”

Section: Discussionmentioning

confidence: 88%

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A Perspective on Recurrent Vertigo

Gacek

2013

ORL

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The recurrent nature of the 3 most common vestibulopathies suggests a recurrent cause. Histopathology in temporal bones from patients with these syndromes - vestibular neuronitis (VN, n = 7), Ménière's disease (MD, n = 8) and benign paroxysmal positional vertigo (BPPV, n = 5) - shows focal degeneration of vestibular nerve axons and degenerated nearby facial nerve meatal ganglion cells. Transmission electron microscopic confirmation of intracytoplasmic viral particles in surgically excised vestibular nerves from patients with VN and MD support a viral etiology in these vestibulopathies. Antiviral treatment of these syndromes in a series of 211 patients with a 3- to 8-year follow-up resulted in complete control of vertigo in VN (88%), MD (90%) and BPPV (60%).

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Section: Pathology Of Vn MD and Bppvsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 88%

A Perspective on Recurrent Vertigo

Gacek

2013

ORL

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“…Adour et al [5,6] suggested that MD is part of a polyganglionitis. This concept was recently reinforced by morphologic observations of temporal bones reported by Gacek and Gacek [7,8] . Both the symptoms and the EH would result from the reactivation of neurotropic virus in the meatal ganglion of the facial nerve [9] .…”

Section: Introductionmentioning

confidence: 71%

Intratympanic Application of an Antiviral Agent for the Treatment of Ménière’s Disease

Guyot

Maire²,

Delaspre

2008

ORL

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It has been suggested that Ménière’s disease is part of a polyganglionitis in which symptoms result from the reactivation of neurotropic virus within the internal auditory canal, and that intratympanic applications of an antiviral agent might be an efficient therapy. In 2002, we performed a pilot study ending with encouraging results. Control of vertigo was achieved in 80% of the 17 patients included. We present here a prospective, double-blind study, with a 2-year follow-up, in 29 patients referred by ENT practitioners for a surgical treatment after failure of a medical therapy. The participation in the study was offered to patients prior to surgery. A solution of ganciclovir 50 mg/ml or of NaCl 9% was delivered for 10 consecutive days via a microwick inserted into the tympanic membrane in the direction of the round window or through a ventilation tube. One patient was withdrawn from the study immediately after the end of the injections. He could not complete the follow-up period, because of persisting vertigo. As he had received the placebo, he was then treated with the solution of ganciclovir. Symptoms persisted and he underwent a vestibular neurectomy. Among the remaining 28 patients, surgery could be postponed in 22 (81%). Surgery remained necessary to control vertigo in 3 patients from the group that received the antiviral agent, and in 3 from the control group. Using an analogical scale, patients of both groups indicated a similar improvement of their health immediately after the intratympanic injections. The scores obtained with a 36-item short-form health survey quality of life questionnaire and the Dizziness Handicap Inventory were also similar for both groups. In conclusion, most patients were improved after the intratympanic injections, but there was no obvious difference between the treated and control groups. The benefit might be due to the middle ear ventilation or reflect an improvement in the patients’ emotional state.

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“…Trauma [4], viral vestibular ganglionitis [5], and genetic predisposition [6] are among the most popular theories explaining the cause of Meniere's disease. Other researchers suspect pathologies of the stria vascularis to be responsible for the symptom complex in Meniere's disease [7].…”

Section: Introductionmentioning

confidence: 99%

Relative Efficiency of Cochlear Hydrops Analysis Masking Procedure and Cervical Vestibular Evoked Myogenic Potential in Identification of Meniere’s Disease

Singh

Krishnamurthy

Premkumar

2015

Advances in Otolaryngology

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Cervical vestibular evoked myogenic potential (cVEMP) and cochlear hydrops analysis masking procedure (CHAMP) have both shown sensitivity in identifying Meniere's disease. However none of the previous reports have compared the two tests for their relative efficacy in identifying Meniere's disease. Hence the present study aimed to compare the efficiency of cVEMP and CHAMP in evaluating Meniere's disease. The study included 58 individuals with unilateral definite Meniere's disease and an equal number of age and gender matched healthy individuals. cVEMP corresponding to 500 Hz tone burst was recorded from ipsilateral sternocleidomastoid muscle and CHAMP was acquired from the conventional electrode sites for single channel auditory brainstem response recording using a default protocol of the Biologic Navigator Pro evoked potential system. Both cVEMP and CHAMP showed statistically significant differences between the groups ( < 0.05). The receiver operating curves revealed 100% sensitivity and specificity for CHAMP as against 70.7% sensitivity and 100% specificity for cVEMP in identifying Meniere's disease. Therefore, CHAMP appears to be the test of choice provided the degree of hearing loss does not exceed a moderate degree. cVEMP could be used for all degrees of hearing losses, but with slight constraint on the sensitivity.

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Menière's disease as a manifestation of vestibular ganglionitis

Cited by 30 publications

References 33 publications

A Perspective on Recurrent Vertigo

A Perspective on Recurrent Vertigo

Intratympanic Application of an Antiviral Agent for the Treatment of Ménière’s Disease

Relative Efficiency of Cochlear Hydrops Analysis Masking Procedure and Cervical Vestibular Evoked Myogenic Potential in Identification of Meniere’s Disease

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