Abstract
Background: Vestibular Meniere's disease (American Academy of Ophthalmology and Otolaryngology, 1972) also known as possible Meniere's disease (American Academy of Otolaryngology Head and Neck Surgery, 1995) or vestibular type of atypical Meniere's disease (V-AMD) (Japan Society for Equilibrium Research, 2017) is characterized by an episodic vertigo without hearing loss. Though named as Meniere's disease (MD), this entity may not be caused solely by endolymphatic hydrops (EH).Objective: To estimate the role of EH in vestibular Meniere's disease in comparison with definite Meniere's disease.Methods: Thirty patients with unilateral definite MD and 16 patients with vestibular Meniere's disease were included. Those who met the criteria for definite or probable vestibular migraine were excluded. All patients underwent vestibular assessments including inner ear MRI 4 h after intravenous gadolinium injection, bithermal caloric testing, directional preponderance of vestibulo-ocular reflex in rotatory chair test, cervical- and ocular-vestibular evoked myogenic potential, stepping test, dizziness handicap inventory (DHI), and hospital anxiety and depression scale (HADS). All above tests and frequency/duration of vertigo spells were compared between vestibular Meniere's disease and MD.Results: Even in unilateral MD, cochlear and vestibular endolymphatic hydrops (c-, v-EH) were demonstrated not only in the affected side but also in the healthy side in more than half of patients. Positive rate of v-EH in vestibular Meniere's disease (68.8%) was as high as that of MD (80%). In vestibular Meniere's disease, the number of bilateral EH was higher in the vestibule (56.3%) than that in the cochlea (25.0%). There were no differences in vestibular tests and DHI between vestibular Meniere's disease and MD; however, the frequency of vertigo spells was lower in vestibular Meniere's disease (p = 0.001). The total HADS score in the MD group was significantly higher than that in the vestibular Meniere's disease group.Conclusions: MD is a systemic disease with bilateral involvement of inner ears. V-EH is a major pathophysiology of vestibular Meniere's disease, which would precede c-EH in the development of vestibular Meniere's disease, a milder subtype of MD. MRI is useful for differentiating MD from other vertigo attacks caused by different pathologies in bringing EH into evidence.
Highlights
Meniere’s disease is characterized by episodic vertigo, fluctuating progressive sensorineural hearing loss, and other cochlear symptoms such as tinnitus and aural fullness
No significant differences in age, duration of vertigo attack, and Dizziness Handicap Inventory (DHI) score were found
The vestibular function test revealed no significant differences in CP%, c-vestibular-evoked myogenic potentials (VEMP), o-VEMPs, vestibulo-ocular reflex directional preponderance (VOR-DP) in the rotatory chair test, and stepping test score between the Meniere’s disease and vestibular Meniere’s disease groups
Summary
Meniere’s disease is characterized by episodic vertigo, fluctuating progressive sensorineural hearing loss, and other cochlear symptoms such as tinnitus and aural fullness. Patients subsequently develop hearing loss and typical Meniere’s disease with aural pressure, whereas those in the other subgroup do not [2] This suggests that subvarieties that include endolymphatic hydrops (EH) and other pathophysiologies may be involved in vestibular Meniere’s disease. Twenty-three years later, the term “vestibular Meniere’s disease” was withdrawn from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) definitions of Meniere’s disease [3], probably because “vestibular Meniere’s disease” had been thought to be not solely caused by endolymphatic hydrops. Vestibular Meniere’s disease (American Academy of Ophthalmology and Otolaryngology, 1972) known as possible Meniere’s disease (American Academy of Otolaryngology Head and Neck Surgery, 1995) or vestibular type of atypical Meniere’s disease (V-AMD) (Japan Society for Equilibrium Research, 2017) is characterized by an episodic vertigo without hearing loss. Though named as Meniere’s disease (MD), this entity may not be caused solely by endolymphatic hydrops (EH)
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