Meniere's Disease Symptoms Research Articles

Constant Dizziness Versus Episodic Vertigo in Ménière's Disease: Health-Related Quality of Life, Cognitive Dissonance, and Postural Problems.

The aim was to explore and characterize dizziness and vertigo (constant vs episodic) and associated problems in patients with Ménière's disease (MD) to allow characterization of the impact of the disease. The study used a retrospective survey design. A total of 539 people with MD participated in this study. The online questionnaire included 36 items which had mixture of structured and open-ended questions that were focusing on MD symptoms, impact of their symptoms, vestibular rehabilitation, as well as health-related quality of life (HRQoL). Forty-six percent of the patients had episodic vertigo, 6% had constant dizziness, 15% had both episodic vertigo and constant dizziness, and 31% did not have vertigo or dizziness within the last 2 years. Patients with MD without any vertigo rated their HRQoL as 73.9%, those with episodic vertigo as 71.1%, those with constant dizziness as 56.9%, and those with constant dizziness and episodic vertigo as 57.9% indicating significant reduction in HRQoL in constant dizziness patients. Constant dizziness was associated with cognitive visual problems, fatigue, balance problems, vestibular drop attacks and syncope. The impact of balance problem was more severe among those with constant dizziness. The most common balance problem was tripping-off (34%), followed by swaying (25%) or rocking (8%) sensations. In the self-administered rehabilitative training, there were no differences between any of the vertigo or dizziness groups although disease profile of MD differed significantly. We emphasize that constant dizziness in MD constitutes a long-term maladaptation to a vestibular and visual cognitive function causing cognitive dissonance. Different types of vertigo and their associated complaints require different treatment strategies to the manage balance problems and to cope with the disease, but best practices is still under research.

Restriction of salt, alcohol and coffee intake and Ménière's disease: insight from Mendelian randomization study.

Restricting salt, caffeine, and alcohol intake is commonly recommended as a first-line treatment for patients with Ménière's disease (MD). However, it remains unclear whether these interventions effectively improve symptoms of MD. Therefore, we conducted a bidirectional two-sample Mendelian randomization (MR) analysis to evaluate the relationship between these dietary modifications and MD. Summary statistics for salt added to food, alcohol consumption, coffee consumption, and MD were sourced from the United Kingdom Biobank, GSCAN, and the FinnGen study, involving up to 941,280 participants. The main analyses were performed using the random-effects inverse-variance weighted (IVW) approach and were complemented by four additional methods. Multiple sensitivity analyses were performed to validate the findings, and both forward and reverse MR analyses were employed to address potential reverse causality bias. The primary MR results using the IVW method revealed that salt added to food (OR = 0.719, 95% CI: 0.429-1.206; p = 0.211), alcohol consumption (OR = 0.834, 95% CI: 0.427-1.628; p = 0.595), and coffee consumption (OR = 0.852, 95% CI: 0.555-1.306; p = 0.461) were not significantly correlated with MD. In reverse analysis, no evidence of significant effect was found from MD to salt added to food (OR = 1.000, 95% CI: 0.993-1.007; p = 0.957), alcohol consumption (OR = 0.998, 95% CI: 0.987-1.008; p = 0.682), and coffee consumption (OR = 0.998, 95% CI: 0.985-1.011; p = 0.72). This MR analysis did not identify convincing evidence to support the idea that restricting salt, caffeine, and alcohol intake is beneficial for the treatment of MD.

Innovative Formulation and Evaluation of Betahistine Floating Tablets for Vertigo Management

Floating tablets are designed to improve the effectiveness and consistency of medication delivery. These specializedoral drug delivery systems are engineered to float on the gastric fluid in the stomach for an extended period, ensuring prolongedgastric retention that leads to a slow and controlled drug release, ultimately enhancing its bioavailability and therapeutic efficacy.Meniere's disease comprises recurrent spontaneous rotatory vertigo spells that patients describe as a spinning or whirling feelingand sensorineural hearing loss (SNHL) accompanied by recruitment and tinnitus. This study aimed to create buoyant tabletscontaining Betahistine (BTH) for treating Meniere's disease, designed to float in fluids and discharge the drug gradually. Theapproach involved the utilization of HPMC K4M 100 and Chitosan in combination as agents for swelling. Gas generation wasfacilitated by sodium bicarbonate and citric acid, while lactose was incorporated as a bulking agent. Tablets were fabricated usingthe direct compression technique and subjected to various assessments, including thickness, hardness, weight consistency,friability, BTH content, swelling capacity, buoyancy, and BTH release patterns. Notably, FTIR analyses indicated the absence ofsignificant interactions between the BTH and its constituents. This comprehensive strategy underscores the potential of thesetablets as a reliable and enduring treatment choice for Meniere's disease. Among nine formulations, F5 displayed the least BTHdischarge (73.47±1.27% over 12 h), while F2 demonstrated the highest discharge (85.92±2.36% over 12 h). These findingshighlight formulation F5's potential for controlled BTH discharge, which could be beneficial in managing Meniere's diseasesymptoms. This thorough investigation contributes to optimizing the formulation to treat Meniere's disease with buoyant tabletsincorporating Betahistine efficiently.

Ménière's disease and allergy: Epidemiology, pathogenesis, and therapy.

The etiology of Ménière's disease (MD) remains controversial. Allergies are potential extrinsic factors that, in conjunction with underlying intrinsic factors, may cause MD. The link between allergies and MD was first described in 1923. For nearly a century, studies have demonstrated a possible link between allergies and MD, even though a causal relationship has not been definitively determined. Previous reviews have mainly focused on clinical epidemiology studies of patients. In this review, we shed light on the association between allergies and MD not only in terms of its epidemiology, but also from an immunology, pathophysiology, and immunotherapy perspective in both patients and animal models. Patients with MD tend to have a high risk of comorbid allergies or an allergy history, showing positive allergy immunology characteristics. Other MD-related diseases, such as migraine, may also interact with allergies. Allergy mediators such as IgE may worsen the symptoms of MD. Deposits of IgE in the vestibular end organs indicate the ability of the inner ear to participate in immune reactions. Allergic challenges can induce vertigo in animals and humans. Anti-allergy therapy plays a positive role in patients with MD and animal models of endolymphatic hydrops.

The role of selective serotonin reuptake inhibitors and tricyclic antidepressants in addressing reduction of Meniere's disease burden: A scoping review.

To assess the effect of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) in reducing vertigo, tinnitus, and hearing loss among patients with Meniere's disease (MD). The following databases were utilized in this scoping review: Ovid Medline, PubMed-NCBI, CINAHL, Cochrane Library, Web of Science, and Clinicaltrials.gov. Studies were identified through the following search phrases: "serotonin specific reuptake inhibitors" OR "tricyclic antidepressants" AND "Meniere's disease." References from included manuscripts were examined for possible inclusion of additional studies. The literature search yielded 23 results, which were screened by three independent reviewers. Seventeen studies and three duplicates were excluded. An examination of references from the included studies yielded two additional publications. A total of four published studies assessing SSRIs and TCAs among 147 patients with MD were ultimately included. Four studies described significant reductions in vertigo attack frequency among patients treated with either SSRIs or TCAs compared to their pretreatment baseline. Three studies assessed the drugs' effects on hearing, of which none found a significant difference among patients treated with SSRIs or TCAs. One study found a significant decrease in patient-reported tinnitus following treatment with TCAs or SSRIs compared to their pretreatment baseline. Data exploring SSRIs and TCAs among patients with MD suggests that these medications may reduce the frequency of tinnitus and vertigo, although there was significant heterogeneity in outcome reporting. There remains a need for larger-scale prospective studies that emphasize objective data to evaluate their effectiveness in reducing common MD symptoms.

Longitudinal variation of endolymphatic hydrops in patients with Ménière's disease.

The relationships of endolymphatic hydrops (EH) and perilymphatic enhancement (PE) with Ménière's disease (MD) remains unclear. This study aimed to describe the dynamic variation of EH and PE for MD patients over 2 hospitalizations by applying magnetic resonance imaging (MRI) to further clarify the relationships of EH and PE with MD. A total of 77 MD patients who underwent inner ear MRI after intravenous administration of gadolinium and pure-tone average (PTA) testing during a first and second hospitalization were included. The degree of EH and PE were evaluated via MRI, and the duration and frequency of vertigo attacks and PTA were collected and recorded. The PTA, EH, and PE for the 2 hospitalizations were compared, and the relationships of EH and cochlear PE with the MD stage were investigated. There was no difference between the 2 hospitalizations for duration of vertigo attacks or frequency of vertigo attacks. However, there were significant differences in PTA (Z=-3.02, P=0.003). Additionally, the cochlear and vestibular EH in the asymptomatic ear at the second hospitalization was significantly worse than that of the first hospitalization (Z=-2.33 and -2.49, P=0.020 and 0.013, respectively), while there were no differences in EH and PE in the affected ear (all P>0.05). Moreover, the degree of cochlear and vestibular EH was correlated with MD stage (both P<0.01). Although EH and PE in the affected ear were unchanged over 2 hospitalizations, an underlying EH in the asymptomatic ear and hearing loss in the affected ear for MD patients developed longitudinally with the duration of disease, and EH varied with the natural course of MD whereas PE did not. Therefore, EH instead of PE is necessary but insufficient to cause the clinical symptoms of MD.

Cochlear implantation in patients with Meniere's disease: A systematic review.

BackgroundMeniere's disease (MD) is an idiopathic disorder of the inner ear, which manifests as cochleo-vestibular dysfunction. Hearing loss will progress to a profound levelin a subset of patients with MD, and vestibular interventions can independently cause loss of hearing. The aim of this study was to systematically review the published literature describing the safety and efficacy of CI in patients with MD.Materials and methodsA systematic literature review was conducted in accordance PRISMA guidelines to identify articles that assessed at least one functional outcome in patients with MD who underwent CI. Demographic information, disease history, MD symptoms, outcomes measures, and complications related to CI were extracted from included studies.ResultsIn total, 17 studies were included, and 182 patients with MD underwent CI. The weighted-mean age was 61.9 years (range 27–85). Study objective and methodology varied, and there was significant heterogeneity in CI outcome measures reported. In total, 179 (98.3%) of 182 patients reported objective improvements in at least one hearing metric after CI. A total of 69 patients (37.9%) reported vertigo or severe dizziness prior to CI, compared to 22 patients (15.4%) postoperatively. Two studies reported significant reductions in postoperative Tinnitus Handicap Inventory score (THI). Quality of life assessments varied between studies. Complications rates were low with only nine patients (4.9%) reporting a serious CI-related complication.ConclusionsThis systematic review evaluated 17 studies describing the safety and efficacy of CI in patients with MD and encountered many challenges due to small sample sizes, and heterogeneity in study design and outcomes measured. Despite these limitations, this study of 182 patients is to the best of our knowledge the largest systematic review evaluating the safety and efficacy of CI in MD. The results of this study support the need for a standardized approach to evaluating outcomes of CI in patients with MD in future studies.

Endolymphatic Sac Drainage Surgery and Plasma Stress Hormone Vasopressin Levels in Meniere's Disease.

Meniere's disease is a common inner ear disorder accompanied by vertigo attacks and fluctuating hearing loss that some believe is due to a stressful lifestyle. To elucidate the scientific relationship in neuro-endocrinology between Meniere's disease and stress, we examined the surgical results of endolymphatic sac drainage surgery and changes in stress-induced plasma arginine-vasopressin levels. We enrolled 100 intractable Meniere's patients and examined surgical results and plasma vasopressin levels. Fifty-four chronic otitis media patients who underwent tympano-mastoidectomy formed a control group. We assessed surgical results during a 2-year follow-up period, including vertigo and hearing loss. We examined plasma vasopressin levels just before surgery and 1 week, 1 year, and 2 years after surgery. In patients with intractable Meniere's disease, plasma vasopressin levels were significantly reduced 1 week after surgery compared to the decrease observed in chronic otitis media patients after tympano-mastoidectomy. In intractable Meniere's disease, long-lasting low plasma vasopressin levels after surgery were associated with significantly good surgical results. In recurrent Meniere's disease, a gradual plasma vasopressin level elevation was observed after surgery, followed by recurrent vertigo attacks and sensorineural hearing loss. It is suggested that long-lasting high levels of plasma vasopressin could have adverse effects on inner ear water metabolism and the subsequent Meniere's disease symptoms. Effective treatments for Meniere's disease might be best based on the maintenance of low plasma vasopressin levels.

Novel Magnetic Resonance Imaging-Based Method for Accurate Diagnosis of Meniere's Disease.

Background: Pathologically, Meniere's disease symptoms are considered to be associated with endolymphatic hydrops. Examinations revealing endolymphatic hydrops can be useful for accurate Meniere's disease diagnosis. We previously reported a quantitative method for evaluating endolymphatic hydrops, i.e., by measuring the volume of the endolymphatic space using three-dimensional magnetic resonance imaging (MRI) of the inner ear. This study aimed to confirm the usefulness of our methods for diagnosing Meniere's disease. Here, we extracted new explanatory factors for diagnosing Meniere's disease by comparing the volume of the endolymphatic space between healthy volunteers and patients with Meniere's disease. Additionally, we validated our method by comparing its diagnostic accuracy with that of the conventional method.Methods and Findings: This is a prospective diagnostic accuracy study performed at vertigo/dizziness centre of our university hospital, a tertiary hospital. Eighty-six patients with definite unilateral Meniere's disease and 47 healthy volunteers (25 and 33 males, and 22 and 53 females in the control and patient groups, respectively) were enrolled. All participants underwent 3-Tesla MRI 4 h after intravenous injection of gadolinium to reveal the endolymphatic space. The volume of the endolymphatic space was measured and a model for Meniere's disease diagnosis was constructed and compared with models using conventional criteria to confirm the effectiveness of the methods used. The area under the receiver operating characteristic curve of the method proposed in this study was excellent (0.924), and significantly higher than that derived using the conventional criteria (0.877). The four indices, sensitivity, specificity, positive predictive value, and negative predictive value, were given at the threshold; all of these indices achieved higher scores for the 3D model compared to the 2D model. Cross-validation of the models revealed that the improvement was due to the incorporation of the semi-circular canals.Conclusions: Our method showed high diagnostic accuracy for Meniere's disease. Additionally, we revealed the importance of observing the semi-circular canals for Meniere's disease diagnosis. The proposed method can contribute toward providing effective symptomatic relief in Meniere's disease.

Effect of the stapedius and tensor tympani muscles tenotomy on the quality of life of patients suffering from Ménière's disease

Introduction: Tenotomy of the tendon of the stapedius and tensor tympani (TT) muscles is a minimal-invasive surgical therapeutic procedure in Ménière's disease (MD). It has been assumed that the TT medializes the stapes into the oval window, resulting in changes in perilymphatic pressures of the inner ear. By cutting the tendons of both middle ear muscles, they affect the pressure dynamics by not augmenting this pressure even further. Aim: The immediate and long-term investigation of the effect of middle ear muscle tenotomy on the quality of life of patients suffering from Ménière's disease, measured by the Dizziness Handicap Inventory (DHI) and the Tinnitus Handicap Inventory (THI). Method: A follow-up study of 22 patients with definite, unilateral Ménière's disease had undergone tenotomy under general or local anesthesia through an endaural approach. Pre- and postoperative DHI values were compared for all patients. Statistical analysis: The statistical analysis was completed by using the IBM SPSS V24 software. Since the parameters did not show normal distribution, non-parametric test (Mann-Whitney U test) was used. The significance level was specified as p<0.05. Results: A statistically significant reduction of DHI scores was noted in all patients. The tinnitus significantly reduced and all of the patients mentioned improved symptoms of MD. Conclusion: Although the follow-up period is short, and the pathomechanism (decrease of stapes medialization in the oval window) is not exactly clear, tenotomy seems to be a successful promising surgical treatment method with a high reduction of dizziness handicap score in conservative therapy-resistant Ménière's disease. Orv Hetil. 2020; 161(5): 177-182.

Endolymphatic hydrops imaging: Differential diagnosis in patients with Meniere disease symptoms.

The goal of this retrospective study was to investigate the differential diagnosis of endolymphatic hydrops in patients with Meniere's disease (MD) symptoms by using magnetic resonance imaging (MRI) with intravenous injection of gadolinium chelate and delayed acquisition. Two hundred patients (133 women, 67 men; mean age=67.2±11 ([SD] years) with unilateral MD underwent MRI at 3-T, between 4.5 and 5.5hours after intravenous administration of gadoterate meglumine at a dose of 0.1mmol/kg. MR images were analyzed for the presence of saccular hydrops, perilymphatic fistulae, inner ear malformations, semicircular canal (SCC) abnormal enhancement and brain lesions. We also tested the potential relationship between past history of gentamicin intratympanic administration and perilymphatic fistula presence and SCC aspect. Saccular hydrops were found in 96/200 patients with MD (48%). Three patients (1.5%) had perilymphatic fistulas associated with saccular hydrops, as confirmed by surgery. There was a correlation between the presence of perilymphatic fistula and past history of intratympanic gentamicin administration (P=0.02). We detected inner ear malformations in 5 patients (2.5%), SCC local enhancement in 15 patients (7.5%) always on the same side than the clinical symptoms of MD. There was a correlation between the presence of SCC abnormal enhancement and past intratympanic gentamicin administration (P=0.001). Five patients (2.5%) had brain lesions along central cochleovestibular pathways. MRI may reveal brain lesions, SCC abnormalities and perilymphatic fistulae in patients with clinical MD.

The Weather and Ménière's Disease: A Longitudinal Analysis in the UK.

Changes in the weather influence symptom severity in Ménière's disease (MD). MD is an unpredictable condition that significantly impacts on quality of life. It is suggested that fluctuations in the weather, especially atmospheric pressure may influence the symptoms of MD. However, to date, limited research has investigated the impact of the weather on MD. In a longitudinal study, a mobile phone application collected data from 397 individuals (277 females and 120 males with an average age of 50 yr) from the UK reporting consultant-diagnosed MD. Daily symptoms (vertigo, aural fullness, tinnitus, hearing loss, and attack prevalence) and GPS locations were collected; these data were linked with Met Office weather data (including atmospheric pressure, humidity, temperature, visibility, and wind speed). Symptom severity and attack prevalence were reduced on days when atmospheric pressure was higher. When atmospheric pressure was below 1,013 hectopascals, the risk of an attack was 1.30 (95% confidence interval: 1.10, 1.54); when the humidity was above 90%, the risk of an attack was 1.26 (95% confidence interval 1.06, 1.49). This study provides the strongest evidence to date that changes in atmospheric pressure and humidity are associated with symptom exacerbation in MD. Improving our understanding of the role of weather and other environmental triggers in Ménière's may reduce the uncertainty associated with living with this condition, significantly contributing to improved quality of life.

Distinct vestibular phenotypes in DFNA9 families with COCH variants.

Mutations of COCH can cause hearing loss and less frequently vestibular symptoms. However, vestibular phenotypes, especially in terms of the location of specific variants are not well documented yet. In this study, a retrospective and prospective cohort survey was performed in two tertiary referral hospitals to demonstrate vestibular phenotypes of DFNA9 subjects with a focus on the relationship with the location of COCH mutations. Two DFNA9 subjects were recruited from the previously collected cohort, each segregating p.G38D and p.C162Y of the COCH gene. Another two DFNA9 families were newly detected by targeted resequencing of known 129 deafness genes (TRS-129). These two families segregated the p.G38D variant of the COCH gene as the causative mutation, making p.G38D the most frequent COCH mutation in our Korean cohorts. Regarding the detailed clinical phenotype of the four DFNA9 families with documented vestibular phenotypes, we were able to classify them into two groups: one (p.C162Y variant) with a Meniere's disease (MD)-like phenotype and the other three (p.G38D variant) with significant bilateral vestibular loss without any definite MD symptoms. Distinct vestibular phenotypes depending on the location of COCH mutations were demonstrated, and this study correlates a genotype of p.G38D in COCH to the phenotype of bilateral total vestibular loss, therefore expanding the vestibular phenotypic spectrum of DFNA9 to range from bilateral vestibular loss without episodic vertigo to MD-like features with devastating episodic vertigo. In addition, the p.G38D variant of the COCH gene is suggested to be a frequent cause of progressive audiovestibular dysfunction in Koreans eventually requiring cochlear implantation.

Intratympanic dexamethasone as a symptomatic treatment for Ménière's disease.

Determine whether intratympanic (IT) dexamethasone, when given on an as needed basis, can successfully control Ménière's disease (MD) symptoms in a large percentage of patients and allow them to avoid ablative therapies. Retrospective chart review. Tertiary medical center. One hundred fifty-nine patients met the American Academy of Otolaryngology-Head and Neck Surgery criteria for unilateral definitive MD. All patients failed dietary and medical therapy and received at least one IT dexamethasone treatment by one of 4 otologists in an academic center. IT dexamethasone. Patients were determined to be treatment failures if they did not achieve satisfactory control of their symptoms with IT dexamethasone and chose another treatment modality. Treatment success was defined as IT dexamethasone providing control of MD symptoms to the degree that they did not require any other further treatment modalities. Successful avoidance of ablative surgery was achieved in 81.1% of patients with greater than 24 months of follow-up. No statistically significant associations were found related to age, sex, laterality, or duration of symptoms. For each IT dexamethasone perfusion sequence, there was a 20.0% increase in likelihood of successful treatment (OR, 1.20; 95% CI, 1.01-1.40; p = 0.01). IT dexamethasone is a successful adjuvant treatment for Ménière's disease in patients on medial therapy and dietary restrictions.

Cochlear Implantation in Ménière's Disease.

Though the effects of cochlear implantation (CI) on patients with hearing loss has been well described, its effect on the auditory and vestibular symptoms in patients with Ménière's disease (MD) has not been firmly established. To determine whether CI in patients with MD improves hearing performance as measured by standard post-CI audiometric testing and to describe the impact of CI on subjective auditory and vestibular quality-of-life measures. Retrospective review of all patients with MD 18 years or older who met diagnostic criteria for definite MD and underwent CI at Wake Forest University Baptist Medical Center, a tertiary care academic medical center, from 2000 through 2012. Patients were invited to answer questions regarding their current hearing ability, subjective perception of symptoms, and functional status related to their MD before and after CI. Patient records were reviewed for pertinent information. Results were then analyzed for statistical significance. Pre-CI and post-CI sentence testing scores, frequency and severity of MD vestibular and auditory symptoms via the MD Functional Level Scale (FLS), and hearing quality of life via the Hearing Handicap Index were reviewed. Eleven CIs were performed in 10 patients. Mean long-term follow-up was 41 months. The mean age at first implantation was 64 years. The mean sentence testing scores in quiet improved from 22.8% before CI to 77.0% after CI (P < .001) at the most recent follow-up. Mean (SD) pre-CI and post-CI MD-FLS vestibular scores were similar: 3.9 (1.9) and 3.4 (1.9) (P = .52). Patients with MD who undergo CI are capable of achieving substantial receptive communication improvement comparable to the gains experienced by patients without MD. Implantation seems to neither adversely alter the natural history of vestibular function nor notable exacerbate auditory symptoms.

Relationship between Multidetector CT Imaging of the Vestibular Aqueduct and Inner Ear Pathologies

This study investigated the relationships between morphological changes in the vestibular aqueduct (VA) in different inner ear pathologies. Eighty-eight patients (34 males and 54 females, ranging from seven to 88 years of age; average age 49.2 years) with cochleovestibular disorders underwent temporal bone CT (with a 64-channel helical CT system according to temporal bone protocol parameters; 0.6 mm slice thickness, 0.6 mm collimation, bone reconstruction algorithm). All patients with cochleovestibular disorders who underwent temporal bone CT had been previously divided into six different suspected clinical classes: A) suspected pathology of the third window; B) suspected retrocochlear hearing loss; C) defined Ménière's disease; D) labyrinth lithiasis; E) recurrent vertigo. On CT images we analyzed the length, width and morphology of the VA, contact between the VA and the jugular bulb (JB), the thickness of the osseous capsule covering the semicircular canals, the pneumatization rate of the temporal bone and the diameter of the internal auditory canal. At the end of the diagnostic work-up all patients were grouped into six pathological classes, represented as follow: 1) benign paroxysmal positional vertigo (BPPV), 2) recurrent vertigo (RV), 3) enlarged vestibular aqueduct syndrome (EVAS), 4) sudden or progressive unilateral sensorineural hearing loss (SNHL), 5) superior semicircular canal dehiscence syndrome (SSCD), 6) recurrent vestibulocochlear symptoms in Ménière's disease. We evaluated 176 temporal bones in 88 patients. The VA was clearly visualized in 166/176 temporal bones; in ten ears the VA was not visualized. In 14 ears (11 patients, in three of whom bilaterally) we found an enlarged VA while in 31 ears the VA was significantly narrower. In 16 ears a dehiscence of the JB with the vestibular or cochlear aqueduct was noted. In all six patients with suspected EVAS we found a AV wider than 1.5 mm on CT scans; moreover CT identified four patients with large VA and ill-defined clinical symptoms. Most patients with BPPV (11 patients, Class 1) we did not find any VA abnormalities on CT scans, confirming the clinical diagnosis in ten patients; in the remaining patients we found an enlarged VA, not clinically suspected. In the RV class (eight patients, Class 2) we found three patients with negative CT scans, two patients with narrow aqueduct and subsequently reclassified as Ménière's disease patients, and three patients with ectasic JB dehiscence with the VA. In patients suffering from SNHL we found no statistically significant correlation with the morphological abnormalities. The clinical suspicion of SSCD was confirmed by CT in 11/13 patients (84.6 %); in addition another seven patients showed a thinning or dehiscence of the superior semicircular canals as the prevailing alteration on CT scans, and were reclassified in this group. Ménière's disease symptoms were correlated with a VA alteration in more than half of the cases; the most striking finding in this class was that the VA was significantly narrower (21 patients). Our study demonstrates that alterations of the VA morphology are not only related to EVAS but are also found in other inner ear pathologies such as Ménière's disease. Furthermore, MDCT may confirm the presence of correlations between the morphology of inner ear structures such as VA, semicircular canals or JB dehiscence, and alterations of vestibulocochlear function.

Menstruation and its Association with Vertigo in Meniere's Disease: A Prospective Study

Study design: Prospective case control study. Method: This study was conducted in Department of Otorhinolaryngology, Head & Neck Surgery, S.M.H.S Hospital, an associated hospital of Government Medical College Srinagar, for a period of 22 w.e.f January 2011 to October 2012. In this prospective study 40 patients presenting with symptom complex of Meniere's disease were enrolled. Patients were divided into two groups. Group A included 26 female patients of premenopausal age group and Group B included 14 female patients of postmenopausal age group. The main outcome measure used was the average no. of definitive episodes of vertigo per month averaged over a period of 12 months was computed in two groups and compared. Results: • In Group A average number of definitive episodes of vertigo averaged over a period of 12 was 0.272 as against 0.143 in Group B.(p< 0.05) • Of 23 patients in Group A, 17 patients (70%) reported exacerbation of Meniere's disease symptoms during premenstrual period. • Of 12 patients in Group B, 8 patients had premenopausal onset of Meniere's disease and out of these 8 patients, 5 patients (62.5%) reported improvement of Meniere's disease symptoms after menopause. Conclusion: Hormonal changes occurring during premenstrual period have a definitive impact on symptomatic profile of Meniere's disease.

Proton pump inhibitors: A possible effect on Ménière's disease?

Background: The model of explanation for the pathogenesis of Meniere's disease (MD) proposed by our group postulates a crucial role for the maintained activity of the labyrinthine gastric-type proton pump under ischaemic conditions. Thus, the administration of the common proton pump inhibitors (PPI) could exert a favourable influence on MD symptoms. Method: In order to help assess the validity of this hypothesis a questionnaire was administered to a selected population of sufferers from MD; the aim was to verify the percentage of PPI users and the incidence of MD symptoms among users and non-users. Results: These showed a higher prevalence of PPI users in the selected sample compared to an unselected large series in the literature; the difference was statistically significant in all cases. In contrast, no statistically significant differences between users and non-users were found regarding the incidence of symptoms in the previous six months, even though the group of PPI users had a slightly better perfo...

Gluten sensitivity in Meniere's disease

Wheat is one of the most common food allergens found in patients with Meniere's disease (MD). Gluten from wheat has been identified to have a etiopathogenetic role in celiac disease, IgE hypersensitivity to wheat disease, and recently to gluten sensitivity. The aim of this study was to verify the incidence of gliadin prick test response in patients affected by MD. Prospective individual case-control study. There were 58 adult patients with definite MD, 25 healthy volunteers, and 25 patients with grass pollen rhinoconjunctivitis tested with skin prick test to gliadin. A total of 33 MD patients (56.9%) proved to be sensitive to gliadin, eight of whom were positive to prick test after 20 minutes, 13 after 6 hours, 11 after 12 hours, and one after 24 hours. This is the first report of gliadin skin test response in MD. Further studies are needed to define the relationship between immune response to wheat proteins and MD symptoms.

Transtympanic Electrocochleography for the Diagnosis of Ménière's Disease

This paper evaluated the diagnostic power of electrocochleography (ECochG) in detecting Ménière's disease (MD) as compared with two subjective assessment methods, including the clinical guidelines provided by the American Academy of Otolaryngology—Head and Neck Surgery Committee on Hearing Equilibrium and the Gibson score. A retrospective study of 250 suspected MD cases was conducted. The agreement between the three assessment methods was found to be relatively high, with a total reliability being higher than 70%. Participants who tested “positive” with ECochG exhibited a higher occurrence rate of asymmetric hearing threshold as well as the four MD symptoms, namely, vertigo, hearing loss, tinnitus, and aural fullness. The “positive” ECochG group also showed a high correlation between the ECochG measures in response to stimuli at adjacent frequency ranges, suggesting that the interfrequency ECochG correspondence may be sensitive to the presence of endolymphatic hydrops and thus may serve as a useful diagnostic marker for MD.