Endolymphatic Mastoid Shunt Surgery in Unilateral Meniere's Disease

One-hundred endolymphatic mastoid shunt operations in patients with classic unilateral Meniere's disease were analyzed. The patients were carefully preselected with a comprehensive protocol of audiovestibular and metabolic investigations. All patients had definitive electrophysiologic evidence of endolymphatic hydrops with an enhanced negative summating potential on transtympanic electrocochleography. The surgical results were analyzed both by the original American Academy of Ophthalmology and Otolaryngology Guidelines (AAOO, 1972), and the more recent modifications of the American Academy of Otolaryngology— Head and Neck Surgery (AA-HNS, 1985). Control of vertigo was achieved in 79% of the patients overall, with 42% sustaining complete control and 37% substantial control. A significant hearing improvement was obtained in 15% of cases, there was no change in 56% of patients, and hearing became worse in 29%. Tinnitus improved following surgery in 35% of patients, was the same in 56%, and worse in 9%. Postoperatively, there was no disability in 42% of the patients, some degree of disability in 50%, and severe disability and inability to sustain gainful employment in only 8%.

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Is Vestibular Meniere's Disease Associated With Endolymphatic Hydrops?

Frontiers in Surgery ◽

10.3389/fsurg.2020.601692 ◽

2020 ◽

Vol 7 ◽

Author(s):

Yuka Morita ◽

Kuniyuki Takahashi ◽

Shinsuke Ohshima ◽

Chihiro Yagi ◽

Meiko Kitazawa ◽

...

Keyword(s):

American Academy ◽

Endolymphatic Hydrops ◽

Systemic Disease ◽

Depression Scale ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Ménière's Disease

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.

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Diagnostic Significance of Transtympanic Electrocochleography in Menière's Disease

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948309200212 ◽

1983 ◽

Vol 92 (2) ◽

pp. 155-159 ◽

Cited By ~ 78

Author(s):

W. P. R. Gibson ◽

D. K. Prasher ◽

G.P.G. Kilkenny

Keyword(s):

Endolymphatic Hydrops ◽

Cell Damage ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Intensity Level ◽

Menière's Disease ◽

Summating Potential ◽

Ménière's Disease

Transtympanic electrocochleography (ECoG) was performed on 32 normal ears, 40 ears affected by hair cell damage without any evidence of endolymphatic hydrops (sensory damage) and 44 ears affected by established Menière's disease. The amplitude of the summating potential (SP) and the amplitude of the action potential (AP) were measured at a click stimulus intensity level of 100 dB HL. The SP amplitude was expressed as a percentage of the AP amplitude. In normal ears, the mean SP/AP ratio was 25% (range 10%-63%). In sensory damage, the SP/AP ratio was 13% (range 0%-29%), and in Menière's ears, the SP/AP ratio was 51% (range 29%-89%). In this series, an SP/AP ratio of 29% provided a diagnostic dividing mark between the sensory damage and Menière's-affected ears. Although this precise division was probably fortuitous, it does suggest that ECoG is a useful tool in the differential diagnosis of these two types of cochlear disorders.

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Dynamics in Endolymphatic Hydrops & Symptoms in Meniere's Disease After Endolymphatic Duct Blockage, Preliminary Results

Frontiers in Neurology ◽

10.3389/fneur.2020.622760 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jun He ◽

Anquan Peng ◽

Junjiao Hu ◽

Zhiwen Zhang ◽

Yichao Chen ◽

...

Keyword(s):

Endolymphatic Hydrops ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Complete Control ◽

Significant Difference ◽

Endolymphatic Duct ◽

Ménière's Disease

Objective: The purpose of the present study was to evaluate the dynamics of endolymphatic hydrops (EH) and symptoms in a group of patients who underwent endolymphatic duct blockage (EDB) for treatment of intractable Meniere's Disease (MD), and to explore a metric for verifying the effectiveness of EDB procedure.Methods: A total of 22 patients with intractable MD patients who underwent EDB participated in the present study. EH was visualized using locally enhanced inner ear magnetic resonance imaging (MRI) prior to and following surgery. The vestibular hydrops ratio (VHR) in the second MRI examination was compared with the pre-surgery recordings.Results: Following EDB, 6 patients exhibited complete or partial reversal of EH, complete control of vertigo spells and reported improvement in hearing; 13 patients showed no changes in EH or hearing, but 5 of these patients exhibited complete control of vertigo attacks, and the other 8 patients exhibited improved control of vertigo attacks. The final 3 patients showed an increase in EH, but symptomatic worsening in 2 patients, and symptomatic improvement in 1 patient. There was a significant difference in the average VHR prior to and following EDB. Postoperative VHR was positively correlated with the frequency of vertigo spells in the latest 6 months of follow-up and improvement of postoperative average hearing threshold.Conclusion: The decreased EH accompanying the reduction in vertigo attacks and hearing preservation may provide a metric for verifying the effectiveness of EDB treatment in patients with MD.

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Bilateral Electrocochleographic Findings in Unilateral Meniere's Disease

Otolaryngology ◽

10.1177/019459989210700304 ◽

1992 ◽

Vol 107 (3) ◽

pp. 370-372 ◽

Cited By ~ 24

Author(s):

David A. Moffat ◽

David M. Baguley ◽

Meredydd Ll Harries ◽

Marcus Atlas ◽

Catherine A. Lynch

Keyword(s):

Endolymphatic Hydrops ◽

Early Recognition ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Summating Potential ◽

Unilateral Disease ◽

Ménière's Disease

At present, electrocochleography is the only proven investigation that can demonstrate objectively the presence of endolymphatic hydrops. The electrophysiologic recordings in response to sound stimuli show an enhancement of the negative summating potential in these cases. It is well established that patients with unilateral Meniere's disease have a high likelihood of development of the disease bilaterally in the fullness of time. Using transtympanic electrocochleography in 40 patients who manifested unilateral clinical Meniere's disease, we have recorded bilateral abnormalities indicative of endolymphatic hydrops in 35% of cases. The early recognition of incipient Meniere's disease in the asymptomatic contralateral ear of a patient with known unilateral disease has obvious profound implications for patient management.

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Electrocochleography in the Evaluation of Patients with Ménière's Disease/Endolymphatic Hydrops

Journal of the American Academy of Audiology ◽

10.3766/jaaa.17.1.6 ◽

2006 ◽

Vol 17 (01) ◽

pp. 045-068 ◽

Cited By ~ 58

Author(s):

John A. Ferraro ◽

John D. Durrant

Keyword(s):

Endolymphatic Hydrops ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Recording Electrode ◽

Menière's Disease ◽

Summating Potential ◽

Simple Measurement ◽

Ménière's Disease

Electrocochleography (ECochG) has evolved as an important tool in the diagnosis/assessment/monitoring of Ménière's disease/endolymphatic hydrops (MD/ELH). This manuscript provides an update on the use of ECochG for these purposes. The material presented includes descriptions of the components of the electrocochleogram; ECochG recording approaches and parameters; how to prepare for an exam, including subject/patient considerations; construction and placement of a tympanic membrane recording electrode; and interpretation the electrocochleogram. Various approaches aimed at improving ECochG's sensitivity and specificity to MD/ELH also are described. These approaches go beyond simple measurement of the now-conventional summating potential (SP)/action potential (AP) magnitude ratio to include the SP magnitude to tonebursts, the SP/AP area ratio, and the AP latency difference to clicks of opposing polarity.

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