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Concept: Ménière's disease

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To evaluate the onset of vertigo, hearing loss and tinnitus in Ménière’s disease and the associated endolymphatic hydrops (EH) of the inner ear.

Concepts: Auditory system, Cochlea, Hearing impairment, Ear, Tinnitus, Ménière's disease, Inner ear, Endolymph

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Dizziness is a common symptom in daily clinical practice. Dizziness and vertigo affect the quality of life as they are associated with the risk of falls leading to limited ability of independent locomotion and thus to a reduction in social contact. The source of problems with dizziness is localized in the area of visual, somatosensory and vestibular sense inputs. The ear nose and throat (ENT) specialist is involved in an interdisciplinary context to elucidate and treat peripheral vestibular disorders. The subjective symptoms of dizziness have to be clarified by taking a careful patient history. By means of objective tests (cVEMP, oVEMP, video-head impulse test) the ENT specialist is able to selectively analyze the function of the five vestibular receptors; therefore, a topological assignment in peripheral vestibulopathy is possible. The exact diagnosis is a prerequisite for a specific therapy and many diseases can be evidence-based, safe and effectively treated.

Concepts: Medicine, Disease, Greek loanwords, Sensory system, Otology, Ménière's disease, Otolaryngology, Otoplasty

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Abstract Background The oral tetracyclines, especially minocycline hydrochloride, are often used as an effective treatment for perioral dermatitis, however they are sometimes difficult to use because of the side effects, especially in children. Objective The effectiveness of β-lactam antibiotics was evaluated in three cases of perioral dermatitis. Methods Three Japanese patients with perioral dermatitis were treated with cefcapene pivoxil hydrochloride hydrate per os 100 to 300 mg per day. They were one girl (age 10) and two adult women (age 32, 37). One of the adult patients had a past history of Meniere’s disease and the other had had a side effect, vertigo, from minocycline hydrochloride treatment. The presence of fusobacteria before and after the treatment was examined using the tape-stripping toluidine blue method. Results These patients showed the improvement in 1 to 2 weeks and were much improved or cured after 2 to 5 weeks. No side effects were found during the treatment. Fusobacteria were positive before treatment but became negative after the treatment in all of them. Conclusion β-lactam antibiotics might be a useful treatment for perioral dermatitis, especially in cases who cannot take tetracyclines.

Concepts: Effect, Effectiveness, Ménière's disease, Adverse effect, Acne vulgaris, Rosacea, Tetracycline antibiotics, Minocycline

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Meniere’s disease is characterized by sporadic episodes of vertigo, nystagmus, fluctuating sensorineural hearing loss, tinnitus and aural pressure. Since Meniere’s disease can affect different regions of the vestibular labyrinth, we investigated if electrical vestibular stimulation (EVS) which excites the entire vestibular labyrinth may be useful to reveal patchy endorgan pathology. We recorded three-dimensional electrically evoked vestibulo-ocular reflex (eVOR) to transient EVS using bilateral, bipolar 100-ms current steps at intensities of 0.9, 2.5, 5.0, 7.5 and 10.0 mA with dual-search coils in 12 unilateral Meniere’s patients. Their results were compared to 17 normal subjects. Normal eVOR had tonic and phasic spatiotemporal properties best described by the torsional component, which was four times larger than horizontal and vertical components. At EVS onset and offset of 8.9 ms latency, there were phasic eVOR initiation (M = 1,267 °/s(2)) and cessation (M = -1,675 °/s(2)) acceleration pulses, whereas during the constant portion of the EVS, there was a maintained tonic eVOR (M = 9.1 °/s) at 10 mA. However in Meniere’s disease, whilst latency of EVS onset and offset was normal at 9.0 ms, phasic eVOR initiation (M = 1,720 °/s(2)) and cessation (M = -2,523 °/s(2)) were enlarged at 10 mA. The initiation profile was a bimodal response, whilst the cessation profile frequently did not return to baseline. The tonic eVOR (M = 20.5 °/s) exhibited a ramped enhancement of about twice normal at 10 mA. Tonic eVOR enhancement was present for EVS >0.9 mA and disproportionately enhanced the torsional, vertical and horizontal components. These eVOR abnormalities may be a diagnostic indicator of Meniere’s disease and may explain the vertigo attacks in the presence of declining mechanically evoked vestibular responses.

Concepts: Vestibular system, Vestibulo-ocular reflex, Ear, Tinnitus, Ménière's disease, Pathologic nystagmus, Organ of Corti, Endolymph

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Abstract Conclusion: The percentage of the unilateral weakness of the caloric response also reflects the clinical progress of Meniere’s disease (MD), including clinical hearing loss. Objective: To evaluate the relationship between hearing status and vestibular function in patients with MD. Methods: Seventy-nine patients with unilateral definite MD underwent bithermal air caloric testing, vestibular evoked myogenic potential (VEMP) testing, and pure tone audiometry (PTA). The stages of the disease, clinical hearing level of the diseased ears, and dPTA (the difference in hearing level between ears in each patient) were compared with the percentage of the unilateral weakness of the caloric response and the interaural amplitude difference (IAD) ratio of the VEMP response. Results: Twenty ears (25.3%) revealed normal caloric responses and 59 ears (74.7%) showed reduced caloric responses. Testing revealed that the VEMPs were normal in 49 ears (62%), while 30 ears (38%) had abnormal VEMPs. The percentage of the unilateral weakness of the caloric response was positively correlated with the clinical hearing level of the diseased ears (p = 0.006) and the dPTA (p = 0.013).

Concepts: Vestibular evoked myogenic potential, Superior canal dehiscence, Otology, Ear, Tinnitus, Ménière's disease, Sound, Audiogram

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OBJECTIVES/HYPOTHESIS: Many otologic disorders have been attributed to dysfunction of the tensor tympani muscle, including tinnitus, otalgia, Meniere’s disease and sensorineural hearing loss. The objective of this study was to determine adequate stimuli for tensor tympani contraction in humans and determine markers of the hypercontracted state that could be used to detect this process in otologic disease. STUDY DESIGN: Multiple types of studies. METHODS: Studies included 1) measuring middle ear impedance changes in response to orbital puffs of air, facial stroking, and self-vocalization; 2) measuring changes in stapes and eardrum vibrations and middle ear acoustic impedance in response to force loading of the tensor tympani in fresh human cadaveric temporal bones; 3) measuring changes in acoustic impedance in two subjects who could voluntarily contract their tensor tympani, and performing an audiogram with the muscle contracted in one of these subjects; and 4) developing a lumped parameter computer model of the middle ear while simulating various levels of tensor tympani contraction. RESULTS: Orbital jets of air are the most effective stimuli for eliciting tensor tympani contraction. As markers for tensor tympani contraction, all investigations indicate that tensor tympani hypercontraction should result in a low-frequency hearing loss, predominantly conductive, with a decrease in middle ear compliance. CONCLUSIONS: These markers should be searched for in otologic pathology states where the tensor tympani is suspected of being hypercontracted.

Concepts: Auditory system, Cochlear implant, Otology, Ear, Tinnitus, Sensorineural hearing loss, Conductive hearing loss, Ménière's disease

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Increased auditory sensitivity, also called hyperacusis, is a pervasive complaint of people with tinnitus. The high prevalence of hyperacusis in tinnitus subjects suggests that both symptoms have a common origin. It has been suggested that they may result from a maladjusted increase of central gain attributable to sensory deafferentation. More specifically, tinnitus and hyperacusis could result from an increase of spontaneous and stimulus-induced activity, respectively. One prediction of this hypothesis is that auditory sensitivity should be increased in tinnitus compared with non-tinnitus subjects. The purpose of this study was to test this prediction by examining the loudness functions in tinnitus ears (n = 124) compared with non-tinnitus human ears (n = 106). Because tinnitus is often accompanied by hearing loss and that hearing loss makes it difficult to disentangle hypersensitivity (hyperacusis) to loudness recruitment, tinnitus and non-tinnitus ears were carefully matched for hearing loss. Our results show that auditory sensitivity is enhanced in tinnitus subjects compared with non-tinnitus subjects, including subjects with normal audiograms. We interpreted these findings as compatible with a maladaptive central gain in tinnitus.

Concepts: Auditory system, Hearing impairment, Sense, Otology, Ear, Tinnitus, Ménière's disease, Audiogram

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OBJECTIVES: Meniere’s disease is a common inner ear disease characterized by vertigo, hearing loss and tinnitus. Since Meniere’s disease is thought to be triggered by an immune insult to inner ear hydrops, we examined endolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids for intractable Meniere’s patients and observed long-term results from 2 years to over a decade until 13 years. METHODS: Between 1998 and 2009, we enrolled and assigned 286 intractable Meniere’s patients to two groups: group-I (G-I) included patients who underwent endolymphatic sac drainage with steroid instillation and group-II (G-II) included those who declined endolymphatic sac drainage. Definitive spells and hearing improvement in these two groups were determined for 2-13 years after treatment. RESULTS: According to the established criteria, vertigo was completely controlled in 88% of patients in G-I in the 2nd year, in 73% in the 12th year and in 70% in the 13th year. These results in G-I were significantly better than those in G-II for 13 years after treatment. Hearing was improved in 49% of patients in G-I in the 2nd year, in 27% in the 12th year and in 25% in the 13th year. These results in G-I were significantly better than those in G-II for 12 years after treatment, but this was not significant in the 13th year. CONCLUSIONS: Endolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids could improve long-term follow-up results of hearing as well as vertigo control. This means that the drainage with local steroids could also improve patients' long-term quality in the prime of life.

Concepts: Better, Improve, Ear, Tinnitus, Ménière's disease, Inner ear, Endolymph, Friday the 13th

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Abstract Conclusion: In the present study, about one-third of patients with Meniere’s disease developed benign paroxysmal positional vertigo (BPPV)-like attacks. Additionally, more than one-third of all vertigo attacks were BPPV-like attacks. Thus, vertigo attacks in patients with Meniere’s disease must be carefully treated because the therapy for such vertigo attacks is totally different from the therapy for BPPV. Objective: Physicians sometimes encounter patients with previously diagnosed Meniere’s disease who develop BPPV attacks during the course of clinical follow-up. In this study, we explored the frequency with which BPPV was involved in all vertiginous episodes among patients with Meniere’s disease. Methods: This retrospective study involved 296 patients with Meniere’s disease who visited Kyoto University Hospital. The diagnosis of Meniere’s disease was based on the guidelines for the diagnosis of Meniere’s disease proposed by the Committee on Hearing and Equilibrium. We judged the cause of vertigo as one of the following five types: (1) definite Meniere’s disease attack, (2) suspicious Meniere’s disease attack, (3) definite BPPV attack, (4) suspicious BPPV attack, or (5) unknown. Results: In all, 96 patients (32.8%) developed BPPV-like attacks, and 187 vertiginous episodes (37.9%) were caused by BPPV. The lateral semicircular canal was the most frequently involved canal.

Concepts: Hospital, Physician, Semicircular canal, Ear, Ménière's disease, Pathologic nystagmus, Benign paroxysmal positional vertigo, Diseases of inner ear

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