Meniere's Attacks Research Articles

Pathophysiology of the Meniere attack: facts and theories.

A pathophysiological interpretation is discussed of the clinical findings that in one out of three cases at the onset of Meniere's disease the cochlear and vestibular symptoms start simultaneously and that during the course of Meniere's disease most attacks show both cochlear and vestibular symptoms. It is concluded that the Meniere attack is not caused by a slowly expanding endolymphatic system that finally ruptures or leaks, but that the pathogenesis of the attack is different from that of the underlying endolymphatic hydrops.

Vestibular signs and symptoms in Meniere's disorder: mechanical considerations.

Considerations of available evidence suggests that the vestibular signs and symptoms of typical Meniere attacks with return to normal function in the interval have mechanical causes as has long been advocated for their auditory counterparts. Membrane ruptures, the alternative explanation, are suggested to be the cause of the severe, and usually singular, attacks that are immediately followed by permanent auditory and vestibular impairments.

メニエール病の反復性めまいに対する免疫アレルギー的考察

The reality of allergic endolymphatic hydrops as a cause of recurrent episodes of Meniere's disease was suggested from the results of the following studies: 1) Clinical studiesa) The skin test using 34 sorts of food antigen extracts and the glycerol test were performed on 23 patients with Meniere's disease. The rate of positive glycerol test was higher in the group with the positive skin reaction than in the negative group (p=0.05).b) In some patients, whose episodes were provoked by the challenge-feeding test, improvement in hearing was produced after Portmann's endolymphatic operation. 2) Experimental studiesa) Labyrinthine reactions were produced when challenged with the antigen through the left foramen stylomastoideum in 4 groups of rabbits as follows: (A) rabbits sensitized by hen's serum, (B) control rabbits, (C) rabbits inoculated with BCG vaccine and (D) control rabbits. Among these 4 groups, the positional nystagmus observed in group A bore a striking resemblance to that of Meniere's attack. The electrocochleograph of group A showed a pattern of cochlear impairment and a histological study revealed endolymphatic hydrops in the ear on the challenged side. This endolymphatic hydrops was not found in the other groups. From these findings, endolymphatic hydrops does not appear to be induced by cell-mediated immunity, but by humoral immunity.b) To determine the place of antigen-antibody reaction, the labyrinths of guinea pigs sensitized by horseradish peroxidase (HRP) were investigated by electronmicroscopy after challenge with this antigen through the perilymphatic space. Particles of HRP could pass through the Reissner's membrane by intracellular transportation and clung to the surface of dark cells in the stria vascularis. These findings were not observed in the control study and suggest that hyper-permeability of the Reissner's membrane and hypersecretion of the stria vascularis induced by the antigen-antibody reaction are probable causes of endolymphatic hydrops.

ENG Findings During an Acute Course in a Case of Ménière's Disease

ENG recordings were performed on a case of Meniere's disease during vertigenous attack. The ENG findings obtained in this case was summarized as follows; (1) Nystagmus directing to the non-affected side occurred immediately after the vertigenous attack (although it is generally said that nystagmus during this period occurs to the affected side). (2) The nystagmus to the non-affected side changed the direction to the affected side after a “transition period”. (3) During the transition period the eye movement was unstable and nystagmus occurred periodically either to the right or to the left. It has been revealed that nystagmus occurring during an acute Meniere's attack showed precarious, dynamic changes.

Modifications of the osmotic pressure of perilymph and endolymph. An hypothesis on the pathogenesis of Menière's disease.

The introduction of a saturated solution of NaCI into the middle ear of a cat or guinea pig provoked a biphasic vestibular spontaneous picture, which is composed of a 1st phase of “irritative” signs (nystagmus beating towards the injected side, etc.) and of a 2nd phase of “paralytic” signs (nystagmus beating towards the non-injected side, etc). Histologi-cal, electrophysiological, biochemical, and biophysical (osmotic pressure measurements) investigations have been carried out in many series of experiments performed by the author and his collaborators. It has been demonstrated that the changes of osmotic pressure between the peri-lymph and the endolymph are the essential pathogenetic factors of all clinical, histological, and electrophysiological manifestations occurring in the experiment. Close analogies are indicated between the effects of the experiment and the pathogenetic factors and evolution of Meniere's acute attacks: in fact, a Meniere's attack shows “irritative” signs followed by “paralytic” signs. Furthermore, in these experiments and in a Meniere's attack there are identical histological pictures of a “collapse” of the endolymphatic duct.

The pathology and pathogenesis of endolymphatic hydrops. New investigation.

The examination of a case of unilateral Meniere's disease confirms the previously expressed opinion that the frequently observed circumscribed herniations of the saccular and utricular wall are not healed ruptures of the entire wall but only ruptures of the inner layer with outward bulging of the outer layer. Neither in this nor in any of the other observations reported in the literature is there any evidence that they could represent healed ruptures of the entire wall; true ruptures occasionally occur but are extremely rare. The theories which try to explain the pathogenesis of the Meniere attacks with periodic ruptures of the walls of the endolymphatic structures with subsequent healing are in our opinion not supported by the actual anatomical findings.