Potential Cause of Positional Vertigo in Ménière's Disease

Morita, Norimasa; Cüreoğlu, Sebahattin; Nomiya, Shigenobu; Nomiya, Rie; Joglekar, Shruti S.; Hashizume, Tamotsu; Paparella, Michael M.

doi:10.1097/mao.0b013e3181b24368

Cited by 18 publications

(9 citation statements)

References 10 publications

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“…The contralateral ears of patients with unilateral Ménière's disease show asymptomatic saccular hydrops in around 30 per cent of patients 18 . In our study, endolymphatic hydrops in the asymptomatic ear was observed in 8 per cent of patients (1 out of 12), which is in line with recent studies 19 …”

Section: Discussionsupporting

confidence: 92%

Intratympanic gadolinium magnetic resonance imaging supports the role of endolymphatic hydrops in the pathogenesis of immune-mediated inner-ear disease

et al. 2018

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This study confirms the presence of endolymphatic hydrops in immune-mediated inner-ear disease patients. The virtual absence of hydrops in patients with secondary immune-mediated inner-ear disease is remarkable, although firm conclusions cannot be drawn; this should be explored in a multicentre study with a larger sample of patients. A different immune reaction without development of endolymphatic hydrops should not be ruled out in secondary immune-mediated inner-ear disease patients.

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Section: Discussionsupporting

confidence: 92%

Intratympanic gadolinium magnetic resonance imaging supports the role of endolymphatic hydrops in the pathogenesis of immune-mediated inner-ear disease

et al. 2018

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“…Temporal bone studies have verified the existence of free-floating deposits in at least one semicircular canal of subjects with BPPV and MD, as well as significant differences in the incidence of cupular and free-floating deposits in the posterior and lateral semicircular canals between subjects with MD and healthy controls. The findings have been associated with the duration of disease rather than with aging [19]. Therefore, an exclusion of secondary BPPV should be incorporated in the clinical examination of patients with MD, especially those with a long history of the disease.…”

Section: Discussionmentioning

confidence: 99%

Inner Ear Disease and Benign Paroxysmal Positional Vertigo: A Critical Review of Incidence, Clinical Characteristics, and Management

Riga

Bibas

Xenellis

et al. 2011

International Journal of Otolaryngology

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Background. This study is a review of the incidence, clinical characteristics, and management of secondary BPPV. The different subtypes of secondary BPPV are compared to each other, as well as idiopathic BPPV. Furthermore, the study highlights the coexistence of BPPV with other inner ear pathologies. Methods. A comprehensive search for articles including in the abstract information on incidence, clinical characteristics, and management of secondary BPPV was conducted within the PubMed library. Results. Different referral patterns, different diagnostic criteria used for inner ear diseases, and different patient populations have led to greatly variable incidence results. The differences regarding clinical characteristics and treatment outcomes may support the hypothesis that idiopathic BPPV and the various subtypes of secondary BPPV do not share the exact same pathophysiological mechanisms. Conclusions. Secondary BPPV is often under-diagnosed, because dizziness may be atypical and attributed to the primary inner ear pathology. Reversely, a limited number of BPPV patients may not be subjected to a full examination and characterized as idiopathic, while other inner ear diseases are underdiagnosed. A higher suspicion index for the coexistence of BPPV with other inner ear pathologies, may lead to a more integrated diagnosis and consequently to a more efficient treatment of these patients.

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“…33 In addition, previous histopathological examinations have revealed that the contralateral ears of patients with unilateral Meniere's disease showed asymptomatic saccular hydrops in around 30% of patients. 34,35 Recently, Kato et al 36 reported that there was no significant association between the degree of EH and caloric responses, using MRI. Previous studies have suggested that not only static morphological hydrops but also dynamic changes of hydrops may be responsible for the symptoms of MD, and further support the validity of our new animal model for MD.…”

Section: Discussionmentioning

confidence: 99%

Morphological and functional changes in a new animal model of Ménière's disease

Egami

Kakigi

Sakamoto

et al. 2013

Laboratory Investigation

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The purpose of this study was to clarify the underlying mechanism of vertiginous attacks in Ménière's disease (MD) while obtaining insight into water homeostasis in the inner ear using a new animal model. We conducted both histopathological and functional assessment of the vestibular system in the guinea-pig. In the first experiment, all animals were maintained 1 or 4 weeks after electrocauterization of the endolymphatic sac of the left ear and were given either saline or desmopressin (vasopressin type 2 receptor agonist). The temporal bones from both ears were harvested and the extent of endolymphatic hydrops was quantitatively assessed. In the second experiment, either 1 or 4 weeks after surgery, animals were assessed for balance disorders and nystagmus after the administration of saline or desmopressin. In the first experiment, the proportion of endolymphatic space in the cochlea and the saccule was significantly greater in ears that survived for 4 weeks after surgery and were given desmopressin compared with other groups. In the second experiment, all animals that underwent surgery and were given desmopressin showed spontaneous nystagmus and balance disorder, whereas all animals that had surgery but without desmopressin administration were asymptomatic. Our animal model induced severe endolymphatic hydrops in the cochlea and the saccule, and showed episodes of balance disorder along with spontaneous nystagmus. These findings suggest that administration of desmopressin can exacerbate endolymphatic hydrops because of acute V2 (vasopressin type 2 receptor)-mediated effects, and, when combined with endolymphathic sac dysfunction, can cause temporary vestibular abnormalities that are similar to the vertiginous attacks in patients with MD. Ménière's disease (MD) is a well-known inner ear disorder characterized by symptoms including recurring attacks of vertigo typically lasting for hours, fluctuating sensorineural hearing loss, and tinnitus. Since the milestone findings on the temporal bones of MD patients, 1,2 endolymphatic hydrops (EH) has been considered as the histopathological origin of MD, as characteristic morphological changes were reported to be produced by surgical obstruction of the endolymphatic sac (ES) in guinea-pig. 3 This observation indicates that malabsorption of endolymph in the ES is one of the possible mechanisms underlying the development of EH. This experimentally induced EH has been frequently used as an animal model to investigate the pathogenesis of inner ear disorders associated with EH. In terms of vestibular function, while canal dysfunction and/or spontaneous nystagmus have been occasionally observed in this animal model, 4,5 episodes of vertiginous attack or balance disorder have only rarely been observed. 6 In other words, this model is insufficient for fully representing the common symptoms of MD.Water homeostasis of the inner ear is essential for maintaining the functions of hearing and balance. EH is considered to be the result of disruption of inner ear water homeostasis, which ...

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Potential Cause of Positional Vertigo in Ménière's Disease

Abstract: Our findings suggest a possible causative relationship between cupular and free-floating deposits in the semicircular canals and the symptom of positional vertigo in patients with Ménière's disease.

Cited by 18 publications

References 10 publications

Intratympanic gadolinium magnetic resonance imaging supports the role of endolymphatic hydrops in the pathogenesis of immune-mediated inner-ear disease

Intratympanic gadolinium magnetic resonance imaging supports the role of endolymphatic hydrops in the pathogenesis of immune-mediated inner-ear disease

Inner Ear Disease and Benign Paroxysmal Positional Vertigo: A Critical Review of Incidence, Clinical Characteristics, and Management

Morphological and functional changes in a new animal model of Ménière's disease

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