Meniére's Disease and Endolymphatic Hydrops Clinical-Histopathological Correlations

1980 ◽  
Vol 89 (6_suppl2) ◽  
pp. 2-22 ◽  
Author(s):  
Bernard G. Fraysse ◽  
Antonio Alonso ◽  
William F. House

The clinical-histopathological correlation between Menière's disease and endolymphatic hydrops was done to explain, as much as possible, causes of symptoms of Menière's disease. Twenty-three temporal bones with endolymphatic hydrops from 17 patients were reviewed and clinical and histopathological findings were correlated. Histopathological examination revealed frequent, severe deformities in the labyrinthine walls and permanent changes in Reissner's membranes. Evidence of rupture was difficult to assess. Of 21 ears of patients with the clinical diagnosis of Menière's disease, 93% had endolymphatic hydrops. A statistical correlation between increased area of the cochlear duct and hearing loss was found. Some correlation was also found between frequency of vertigo and results of electronystagmography with histopathological findings. Consequently, the mechanical effect of endolymphatic hydrops seems to have greater significance in the production of symptoms of Menière's disease than the biochemical effect of ruptures. In a review of ten unusual cases from this series of 17 patients, traumatic neuromas or remnants of vestibular structures were found after an incomplete labyrinthectomy. Histopathological findings of four patients who had undergone endolymphatic subarachnoid shunt surgery are described.

1987 ◽  
Vol 96 (4) ◽  
pp. 438-445 ◽  
Author(s):  
Taeko Okuno ◽  
Isamu Sando

The localization, frequency, and severity of endolymphatic hydrops in 22 temporal bones of 16 individuals with Meniere's disease were studied histopathologically. Endolymphatic hydrops was more often observed in the pars inferior (22/22) than in the pars superior (13/22) of the temporal bone, and severe hydrops was observed most frequently in the saccule, followed by the cochlea, the utricle, and the three semicircular canals. In the cochlea, the most severe hydrops was observed in the apical turn, followed by the hook portion, the middle turn, and the basal turn. Clinically interesting observations regarding endolymphatic hydrops included bulging into the perilymphatic space of the vestibule. In 17 of 22 bones the saccular membrane bulged into the vestibule laterally and was attached to the footplate of the stapes. In two of 22 bones, Reissner's membrane in the hook portion of the basal turn of the cochlea bulged superiorly into the vestibule, occupying most of the perilymphatic space of the vestibule.


1984 ◽  
Vol 93 (4_suppl) ◽  
pp. 31-35 ◽  
Author(s):  
Michael M. Paparella

From review of recent findings, the pathology of Meniere's disease is described and correlated with clinical signs. Since Meniere's disease can be seen only in humans, assessing its natural history is important. A recent survey of 500 patients demonstrated the three major symptoms to be vestibular, auditory, and aural pressure. Meniere's disease (idiopathic) is distinguished from Meniere's syndrome (symptoms with likely cause), which accounted for approximately one fourth of the patients. Atypical forms include vestibular and cochlear Meniere's disease. A recent review of our temporal bone collection and detailed study of the pathological conditions of 134 temporal bones described in the literature revealed characteristic pathological findings. Patients with clear-cut histories of Meniere's disease may demonstrate little or no endolymphatic hydrops at death. Nevertheless, hydrops of the pars inferior remains the most significant pathological correlate of Meniere's disease. On the basis of these findings, the pathogenesis of the disease (malabsorption of endolymph) and the pathophysiology of the symptoms (physical and chemical) are discussed.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Munehisa Fukushima ◽  
Yu Suekata ◽  
Takuya Kusumoto ◽  
Shiro Akahani ◽  
Hidehiko Okamoto ◽  
...  

2009 ◽  
Vol 129 (11) ◽  
pp. 1326-1329 ◽  
Author(s):  
Maiko Miyagawa ◽  
Hisakuni Fukuoka ◽  
Keita Tsukada ◽  
Tomohiro Oguchi ◽  
Yutaka Takumi ◽  
...  

2021 ◽  
Vol 12 ◽  
Author(s):  
Sun-Young Oh ◽  
Marianne Dieterich ◽  
Bit Na Lee ◽  
Rainer Boegle ◽  
Jin-Ju Kang ◽  
...  

Objective: Intravenous contrast agent enhanced, high-resolution magnetic resonance imaging of the inner ear (iMRI) confirmed that patients with Menière's disease (MD) and vestibular migraine (VM) could present with endolymphatic hydrops (EH). The present study aimed to investigate EH characteristics and their interrelation to neurotologic testing in patients with VM, MD, or VM with concurrent MD (VM-MD).Methods: Sixty–two patients (45 females, aged 23–81 years) with definite or probable VM (n = 25, 19 definite), MD (n = 29, 17 definite), or showing characteristics of both diseases (n = 8) were included in this study. Diagnostic workup included neurotologic assessments including video-oculography (VOG) during caloric stimulation and head-impulse test (HIT), ocular and cervical vestibular evoked myogenic potentials (o/cVEMP), pure tone audiometry (PTA), as well as iMRI. EH's degree was assessed visually and via volumetric quantification using a probabilistic atlas-based segmentation of the bony labyrinth and volumetric local thresholding (VOLT).Results: Although a relevant number of VM patients reported varying auditory symptoms (13 of 25, 52.0%), EH in VM was only observed twice. In contrast, EH in VM-MD was prevalent (2/8, 25%) and in MD frequent [23/29, 79.3%; χ2(2) = 29.1, p < 0.001, φ = 0.7]. Location and laterality of EH and neurophysiological testing classifications were highly associated (Fisher exact test, p < 0.005). In MD, visual semi-quantitative grading and volumetric quantification correlated highly to each other (rS = 0.8, p < 0.005, two-sided) and to side differences in VOG during caloric irrigation (vestibular EH ipsilateral: rS = 0.6, p < 0.05, two-sided). In VM, correlations were less pronounced. VM-MD assumed an intermediate position between VM and MD.Conclusion: Cochlear and vestibular hydrops can occur in MD and VM patients with auditory symptoms; this suggests inner ear damage irrespective of the diagnosis of MD or VM. The EH grades often correlated with auditory symptoms such as hearing impairment and tinnitus. Further research is required to uncover whether migraine is one causative factor of EH or whether EH in VM patients with auditory symptoms suggests an additional pathology due to MD.


1981 ◽  
Vol 90 (6) ◽  
pp. 619-623 ◽  
Author(s):  
Robert A. Jahrsdoerfer ◽  
Wayne S. Cail ◽  
Robert W. Cantrell

Herniation of the jugular bulb into the middle ear is uncommon. Extension of a jugular bulb diverticulum into the petrous pyramid is rare. In ten previously reported cases in the literature, only the radiographic appearance of the lesion was stressed. Of interest to otolaryngologists is the fact that in seven of the cases there was an ipsilateral sensorineural hearing loss. Other symptoms included tinnitus and vertigo. One patient had been diagnosed as having Menière's disease. We document an additional case (a patient who had “classical Menière's disease”) and report the first known surgical exploration of this venous anomaly. The diverticulum extended high into the petrous bone and was found to obliterate the distal segment of the endolymphatic duct. To our knowledge, this is the first time that a cause and effect relationship has been recognized between endolymphatic hydrops and a jugular bulb diverticulum. We propose that the diverticulum, by obstructing the endolymphatic duct, was directly responsible for the Menière's-like symptoms.


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