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CC BY-NC-ND 4.0 · Annals of Otology and Neurotology 2020; 3(02): 082-089
DOI: 10.1055/s-0041-1724221
Original Article

Meniere’s Disease: New Frontiers in Management for Better Results

Anand Velusamy
1   MCV Memorial ENT Hospital, Pollachi, Tamil Nadu, India
,
Aiswarya Anand
1   MCV Memorial ENT Hospital, Pollachi, Tamil Nadu, India
,
Sridurga Janarthanan
1   MCV Memorial ENT Hospital, Pollachi, Tamil Nadu, India
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Abstract

Introduction Meniere's disease (MD) remains a difficult disease to diagnose, especially in the early stages when not all of the symptoms may be present. Sensorineural hearing loss, tinnitus, and recurrent vertigo constitute the hallmark symptoms of MD. Endolymphatic hydrops (EH) has been described as the responsible pathology in MD. Since that description, the medical and surgical treatment of MD have been directed at reducing the volume of endolymph. Unfortunately, these approaches have had equivocal success in the control of vertigo and recovery of hearing. So, a routine treatment directed at resolution of EH may not be suitable for all patients. Treatment has to be directed at the cause of EH whenever possible.

Objectives The aim of this study was to define new findings in clinical tests and modes of treatment in MD, to determine the outcome of vertigo and hearing in patients after treatment, and to describe treatment which will prevent long term deterioration of hearing.

Materials and Methods Forty-six new patients with a diagnosis of MD were treated with antiviral drugs or diuretics. Drugs were used based on nature of dehydration test. Hearing test including pure tone average (PTA) and speech discrimination (SD) was performed prior to treatment and at 1 to 2 months, 6 months, and 1 year after initiation of treatment. Effect on dizziness was recorded at each evaluation; hearing was judged to be improved, if PTA was lowered by at least 10 to 15 dB or an increase in SD > 20%.

Results The antiviral approach has virtually eliminated the use of various surgical methods used in the past. Dehydration test-based treatment protocol with diuretics and antivirals and antimigraine prophylaxis when needed has led to remission of disease in 93.5% of patients. With prompt treatment, inner ear damage can be prevented.

Conclusion Orally administered antiviral drugs should be considered in the treatment of MD. Migraine-associated MD patients need migraine prophylaxis and this will lead to improvement in Meniere’s symptoms also. If Intratympanic therapy is considered, then targeted low-dose delivery method of using Gelfoam instillation of gentamicin is preferable according to our study to prevent any significant hearing loss.

Keywords

antivirals - balance diseases - dehydration test - intratympanic treatment - migraine


Publication History

Article published online:
10 March 2021

© 2021. Indian Society of Otology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Ménière P. Memory on lesions of the inner ear giving rise to symptoms of apoplectiform cerebral congestion: read at the Imperial Academy of Medicine in the session of January 8, 1861 / by Prosper Ménière. France, Paris: Pariente
  • 2 Knapp H. A clinical analysis of the inflammatory affectation of the inner ear. Arch Ophthalmol Otolaryngol 1871; 4: 204-283
    Google Scholar
  • 3 Portmann G. Vertigo: surgical treatment by opening of the saccus endolymphaticus. Arch Otolaryngol 1927; 6: 309
    CrossrefGoogle Scholar
  • 4 Paparella MM, da Costa SS, Fox R, Yoo TH. Meniere's disease and other labyrinthine diseases. In: Paparella MM, Shumrick DA, Gluckmann J, Meyerhoff WL, eds. Otolaryngology. 3rd edition. Philadelphia: WB Saunders 1991: 1689-714
  • 5 Paparella MM. The cause (multifactorial inheritance) and pathogenesis (endolymphatic malabsorption) of Meniere’s disease and its symptoms (mechanical and chemical). Acta Otolaryngol 1985; 99 (3-4) 445-451
    CrossrefPubMedGoogle Scholar
  • 6 Bernstein JM. Occurrence of episodic vertigo and hearing loss in families. Ann Otol Rhinol Laryngol 1965; 74 (04) 1011-1021
    CrossrefPubMedGoogle Scholar
  • 7 Committee on Hearing and Equilibrium. Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. Otolaryngol Head Neck Surg 1995; 113 (03) 181-185
    CrossrefPubMedGoogle Scholar
  • 8 Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. Amer Acad Otolaryngol Head Neck Surg Foundation Inc. Otolaryngol Head Neck Surg 1995; 113: 176-178
    CrossrefPubMedGoogle Scholar
  • 9 Stahle J, Friberg U, Svedberg A. Long-term progression of Menière’s disease. Am J Otol 1989; 10 (03) 170-173
    Google Scholar
  • 10 Hallpike CS, Cairns H. Observations on the pathology of Meniere’s syndrome. Proc R Soc Med 1938; 31 (11) 1317-1336
    PubMedGoogle Scholar
  • 11 Paparella MM, Morizono T, Matsunaga T, Kyoshiro Yamakawa MD. temporal bone histopathology of Meniere’s patient reported in 1938. Commemoration of the centennial of his birth. Arch Otolaryngol Head Neck Surg 1992; Jun 118 (06) 660-662
    CrossrefPubMedGoogle Scholar
  • 12 Ruckenstein MJ, Rutka JA, Hawke M. The treatment of Menière’s disease: Torok revisited. Laryngoscope 1991; 101 (02) 211-218
    PubMedGoogle Scholar
  • 13 Lindsay JR, Kohut RI, Sciarra PA. Menière’s disease: pathology and manifestations. Ann Otol Rhinol Laryngol 1967; 76 (01) 5-22
    CrossrefPubMedGoogle Scholar
  • 14 Baloh RW. Harold Schuknecht and Pathology of the Ear. Otology & Neurotology 2001; 22 (01) 113-122
    CrossrefPubMedGoogle Scholar
  • 15 Bretlau P, Thomsen J, Tos M, Johnsen NJ. Placebo effect in surgery for Menière’s disease: nine-year follow-up. Am J Otol 1989; 10 (04) 259-261
    Google Scholar
  • 16 Chung JW, Fayad J, Linthicum F, Ishiyama A, Merchant SN. Histopathology after endolymphatic sac surgery for Ménière’s syndrome. Otol Neurotol 2011; 32 (04) 660-664
    CrossrefPubMedGoogle Scholar
  • 17 Paparella MM. Pathogenesis of Meniere’s disease and Meniere’s syndrome. Acta Otolaryngol Suppl 1984; 406: 10-25
    Google Scholar
  • 18 Merchant SN, Adams JC, Nadol Jr JB. Pathophysiology of Meniere’s syndrome: are symptoms caused by endolymphatic hydrops?. Otol Neurotol 2005; 26 (01) 74-81
    CrossrefPubMedGoogle Scholar
  • 19 Kimura RS, Schuknecht HF. Membranous hydrops in the inner ear of the guineapig after obliteration of the endolymphatic sac. Pract Otorhinolaryngol (Basel) 1965; 27: 343-354
    Google Scholar
  • 20 Kimura RS. Animal models of endolymphatic hydrops. Am J Otolaryngol 1982; 3 (06) 447-451
    CrossrefPubMedGoogle Scholar
  • 21 Schuknecht HF, Northrop C, Igarashi M. Cochlear pathology after destruction of the endolymphatic sac in the cat. Acta Otolaryngol 1968; 65 (05) 479-487
    CrossrefPubMedGoogle Scholar
  • 22 Arnold W, Niedermeyer HP. Herpes simplex virus antibodies in the perilymph of patients with Menière disease. Arch Otolaryngol Head Neck Surg 1997; 123 (01) 53-56
    CrossrefPubMedGoogle Scholar
  • 23 Welling DB, Daniels RL, Brainard J, Western LM, Prior TW. Detection of viral DNA in endolymphatic sac tissue from Menière’s disease patients. Am J Otol 1994; 15 (05) 639-643
    Google Scholar
  • 24 Altermatt HJ, Gebbers JO, Müller C, Arnold W, Laissue JA. Human endolymphatic sac: evidence for a role in inner ear immune defence. ORL J Otorhinolaryngol Relat Spec 1990; 52 (03) 143-148
    CrossrefPubMedGoogle Scholar
  • 25 Arenberg IK, Walker DW, Shambough Jr E. The Role of Endolymphatic Sac and Viruses in the Pathogenesis of Endo-lymphatic Hydrops: An Ultrastructural Analyses of Endo-lymphatic Sac Biopsies. Surgery of the Inner Ear. Amsterdam: Kugler 1991: 31-52
  • 26 Selmani Z, Marttila T, Pyykkö I. Incidence of virus infection as a cause of Meniere’s disease or endolymphatic hydrops assessed by electrocochleography. Eur Arch Otorhinolaryngol 2005; 262 (04) 331-334
    CrossrefPubMedGoogle Scholar
  • 27 Kumagami H. Detection of viral antigen in the endolymphatic sac. Eur Arch Otorhinolaryngol 1996; 253 (4-5) 264-267
    CrossrefPubMedGoogle Scholar
  • 28 Zemanick MC, Strick PL, Dix RD. Direction of transneuronal transport of herpes simplex virus 1 in the primate motor system is strain-dependent. Proc Natl Acad Sci U S A 1991; 88 (18) 8048-8051
    CrossrefPubMedGoogle Scholar
  • 29 Kuypers HG, Ugolini G. Viruses as transneuronal tracers. Trends Neurosci 1990; 13 (02) 71-75
    CrossrefPubMedGoogle Scholar
  • 30 Herriott RM. Infectious nucleic acids, a new dimension in virology. Science 1961; 134 (3474) 256-260
    CrossrefPubMedGoogle Scholar
  • 31 Wittmaack K. Die Entzundlichen Erkrankungsprozesse des Gehororganes. In: Wittmaack K, ed. Handbuch der speziellen Pathologischen Anatomie und Histologie. Berlin: Springer 1926: 102-379
  • 32 Gacek RR. The pathology of facial and vestibular neuronitis. Am J Otolaryngol 1999; 20 (04) 202-210
    CrossrefPubMedGoogle Scholar
  • 33 Denny Brown D, Adams RD, Fitzgerald PJ. Pathologic features of herpes zoster. A note on geniculate herpes. Arch Neurol Psychiatry 1949; 51: 216-231
    CrossrefGoogle Scholar
  • 34 Sawtell NM. The probability of in vivo reactivation of herpes simplex virus type 1 increases with the number of latently infected neurons in the ganglia. J Virol 1998; 72 (08) 6888-6892
    CrossrefPubMedGoogle Scholar
  • 35 Gacek RR, Gacek MR. Menière’s disease as a manifestation of vestibular ganglionitis. Am J Otolaryngol 2001; 22 (04) 241-250
    CrossrefPubMedGoogle Scholar
  • 36 Gacek RR. A perspective on recurrent vertigo. ORL J Otorhinolaryngol Relat Spec 2013; 75 (02) 91-107
    CrossrefPubMedGoogle Scholar
  • 37 Gacek RR, Gacek MR. Viral neuropathies in the temporal bone. Introduction. Adv Otorhinolaryngol 2002; 60: VII-IX
    PubMedGoogle Scholar