Did you mean: meniere s disease
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Current Opinion in Neurology Feb 2022This article reviews recent developments in Ménière's disease including etiologic, diagnostic, and therapeutic investigations that have changed the landscape for... (Review)
Review
PURPOSE OF REVIEW
This article reviews recent developments in Ménière's disease including etiologic, diagnostic, and therapeutic investigations that have changed the landscape for medical providers. These updates shed light onto the complex nature of Ménière's disease and generate additional means to provide optimal care to patients.
RECENT FINDINGS
Given the multifactorial cause of Ménière's disease, five subtypes of Ménière's disease have recently been proposed. A knowledge of these subtypes will aid in the development of an appropriate treatment algorithm. Although newer treatments have not been developed, stepwise treatment algorithms have been proposed and can improve patient care. New MRI modalities and serum testing hold promise as clinical clues and biomarkers.
SUMMARY
As these updated diagnostic criteria are used, Ménière's disease can be identified and treated more precisely. This will in turn allow for future randomized controlled studies to improve the quality of treatment options available. Future imaging, vestibular testing, and the potential for serum biomarkers may illuminate additional diagnostic criteria, only furthering the improvement in clinical care.
Topics: Algorithms; Humans; Magnetic Resonance Imaging; Meniere Disease
PubMed: 34864755
DOI: 10.1097/WCO.0000000000001021 -
BMJ Clinical Evidence Nov 2015Menière's disease causes feelings of fullness or pressure in the ear, hearing loss, tinnitus, and recurrent bouts of vertigo, and mainly affects people aged 30-60... (Review)
Review
INTRODUCTION
Menière's disease causes feelings of fullness or pressure in the ear, hearing loss, tinnitus, and recurrent bouts of vertigo, and mainly affects people aged 30-60 years. Menière's disease is at first progressive but fluctuating, and episodes can occur in clusters. Vertigo usually resolves eventually, but the hearing deteriorates and the tinnitus and pressure may persist regardless of treatment.
METHODS AND OUTCOMES
We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of combination treatment (betahistine plus thiazide diuretic) to prevent attacks and delay disease progression of Menière's disease? What are the effects of intratympanic interventions to prevent attacks and delay disease progression of Menière's disease? What are the effects of non-drug interventions to prevent attacks and delay disease progression of Menière's disease? What are the effects of dietary interventions to prevent attacks and delay disease progression of Menière's disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
RESULTS
At this update, searching of electronic databases retrieved 200 studies. After deduplication and removal of conference abstracts, 151 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 100 studies and the further review of 51 full publications. Of the 51 full articles evaluated, five systematic reviews and four RCTs were added at this update. We performed a GRADE evaluation for eight PICO combinations.
CONCLUSIONS
In this systematic overview, we categorised the efficacy for seven interventions based on information about the effectiveness and safety of betahistine plus thiazide diuretic, caffeine restriction, intratympanic corticosteroids, intratympanic gentamicin, psychological support, salt restriction, and vestibular rehabilitation.
Topics: Diet; Humans; Meniere Disease
PubMed: 26545070
DOI: No ID Found -
The Journal of International Advanced... Aug 2018Meniere Disease keeps challenges in its diagnosis and treatment since was defined by Prosper Meniere at the beginning of 19th Century. Several classifications and... (Review)
Review
Meniere Disease keeps challenges in its diagnosis and treatment since was defined by Prosper Meniere at the beginning of 19th Century. Several classifications and definition were made until now and speculations still exist on its etiology. As the etiology remains speculative the treatment models remain in discussion also. The European Academy of Otology and Neurotology Vertigo Guidelines Study Group intended to work on the diagnosis and treatment of Meniere's disease and created the European Positional Statement Document also by resuming the consensus studies on it. The new techniques on diagnosis are emphasized as well as the treatment models for each stage of the disease are clarified by disregarding the dilemmas on its treatment. The conservative, noninvasive and invasive therapeutic models are highlighted.
Topics: Anti-Bacterial Agents; Betahistine; Consensus; Conservative Treatment; Denervation; Diuretics; Endolymphatic Sac; European Union; Gentamicins; Hearing Loss, Sensorineural; Histamine Agonists; Humans; Injection, Intratympanic; Meniere Disease; Neurotology; Otolaryngology; Practice Guidelines as Topic; Steroids; Vestibular Evoked Myogenic Potentials; Vestibular Nerve; Vestibule, Labyrinth
PubMed: 30256205
DOI: 10.5152/iao.2018.140818 -
Journal of Vestibular Research :... 2015This paper presents diagnostic criteria for Menière's disease jointly formulated by the Classification Committee of the Bárány Society, The Japan Society for...
This paper presents diagnostic criteria for Menière's disease jointly formulated by the Classification Committee of the Bárány Society, The Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society. The classification includes two categories: definite Menière's disease and probable Menière's disease. The diagnosis of definite Menière's disease is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing, tinnitus and/or fullness) in the affected ear. Duration of vertigo episodes is limited to a period between 20 minutes and 12 hours. Probable Menière's disease is a broader concept defined by episodic vestibular symptoms (vertigo or dizziness) associated with fluctuating aural symptoms occurring in a period from 20 minutes to 24 hours.
Topics: Diagnostic Techniques, Neurological; Diagnostic Techniques, Otological; Hearing Loss, Sensorineural; Humans; Meniere Disease; Tinnitus; Vertigo; Vestibular Diseases
PubMed: 25882471
DOI: 10.3233/VES-150549 -
Advances in Oto-rhino-laryngology 2019This article reviews 3 aspects of Meniere's disease (MD), which have been recently revisited: namely, the pathologic mechanism causing the attacks of vertigo, the... (Review)
Review
This article reviews 3 aspects of Meniere's disease (MD), which have been recently revisited: namely, the pathologic mechanism causing the attacks of vertigo, the clinical diagnosis, and the medical and surgical treatments. The characteristic attacks of vertigo are unlikely to be due to membrane ruptures, so a hypothesis that the vertigo is caused by a volume of endolymph shifting suddenly from the cochlea into the pars superior is suggested. The definite diagnosis according to the American Academy of Otolaryngology HNS 1995 criteria [
13 ] failed to exclude vestibular migraine sufficiently and a revision in 2015 [14 ] has partly addressed this problem but another method which stresses the interaction of the cochlear and vestibular symptoms is described. The treatment of MD has been updated, providing evidence for each popular therapy. Newer treatments using intratympanic medications including steroid solutions and gentamicin are discussed. Finally, the role of cochlear implants is mentioned.Topics: Anti-Bacterial Agents; Diagnosis, Differential; Gentamicins; Humans; Meniere Disease; Otologic Surgical Procedures; Practice Guidelines as Topic; Steroids; Vestibular Function Tests
PubMed: 30947172
DOI: 10.1159/000490274 -
Otolaryngology--head and Neck Surgery :... Apr 2020Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency...
OBJECTIVE
Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies.
PURPOSE
The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.
Topics: Audiometry; Counseling; Diagnosis, Differential; Diuretics; Ear, Inner; Gentamicins; Glucocorticoids; Humans; Meniere Disease; Migraine Disorders; Patient Education as Topic; Quality of Life; Vertigo; Vestibular Diseases
PubMed: 32267799
DOI: 10.1177/0194599820909438 -
Audiology & Neuro-otology 2022Ménière's disease is characterized by recurrent episodes of vertigo, hearing loss, and tinnitus, often with a feeling of fullness in the ear. Although betahistine is...
BACKGROUND
Ménière's disease is characterized by recurrent episodes of vertigo, hearing loss, and tinnitus, often with a feeling of fullness in the ear. Although betahistine is thought to be specifically effective for Ménière's disease, no evidence for a benefit from the use of betahistine exists, despite its widespread use. Reassessment of the effect of betahistine for Ménière's disease is now warranted.
SEARCH METHODS
We searched for randomized controlled trials (RCTs) in the Central Register of Controlled Trials (CENTRAL), Ovid Medline, Ovid Embase, CINAHL, Web of Science, Clinicaltrials.gov, ICTRP, and additional sources for published and unpublished trials, in which betahistine was compared to placebo.
DATA COLLECTION AND ANALYSIS
Our outcomes involved vertigo, significant adverse effect (upper gastrointestinal discomfort), hearing loss, tinnitus, aural fullness, other adverse effects, and disease-specific health-related quality of life. We used GRADE to assess the quality of the evidence.
MAIN RESULTS
We included 10 studies: 5 studies used a crossover design and the remaining 5 were parallel-group RCTs. One study with a low risk of bias found no significant difference between the betahistine groups and placebo with respect to vertigo after a long-term follow-up period. No significant difference in the incidence of upper gastrointestinal discomfort was found in 2 studies (low-certainty evidence). No differences in hearing loss, tinnitus, or well-being and disease-specific health-related quality of life were found (low- to very low-certainty of evidence). Data on aural fullness could not be extracted. No significant difference between the betahistine and the placebo groups (low-certainty evidence) could be demonstrated in the other adverse effect outcome with respect to dull headache. The pooled risk ratio for other adverse effect in the long term demonstrated a lower risk in favor of placebo over betahistine.
CONCLUSIONS
High-quality studies evaluating the effect of betahistine on patients with Ménière's disease are lacking. However, one study with low risk of bias found no evidence of a difference in the effect of betahistine on the primary outcome, vertigo, in patients with Ménière's disease when compared to placebo. The main focus of future research should be on the use of comparable outcome measures by means of patient-reported outcome measures.
Topics: Betahistine; Deafness; Humans; Meniere Disease; Syndrome; Tinnitus; Vertigo
PubMed: 34233329
DOI: 10.1159/000515821 -
Journal of Neurology Apr 2016Menière's disease is a chronic condition with a prevalence of 200-500 per 100,000 and characterized by episodic attacks of vertigo, fluctuating hearing loss, tinnitus,... (Review)
Review
Menière's disease is a chronic condition with a prevalence of 200-500 per 100,000 and characterized by episodic attacks of vertigo, fluctuating hearing loss, tinnitus, aural pressure and a progressive loss of audiovestibular functions. Over 150 years ago, Prosper Menière was the first to recognize the inner ear as the site of lesion for this clinical syndrome. Over 75 years ago, endolymphatic hydrops was discovered as the pathologic correlate of Menière's disease. However, this pathologic finding could be ascertained only in post-mortem histologic studies. Due to this diagnostic dilemma and the variable manifestation of the various audiovestibular symptoms, diagnostic classification systems based on clinical findings have been repeatedly modified and have not been uniformly used in scientific publications on Menière's disease. Furthermore, the higher level measures of impact on quality of life such as vitality and social participation have been neglected hitherto. Recent developments of high-resolution MR imaging of the inner ear have now enabled us to visualize in vivo endolymphatic hydrops in patients with suspected Menière's disease. In this review, we summarize the existing knowledge from temporal bone histologic studies and from the emerging evidence on imaging-based evaluation of patients with suspected Menière's disease. These indicate that endolymphatic hydrops is responsible not only for the full-blown clinical triad of simultaneous attacks of auditory and vestibular dysfunction, but also for other clinical presentations such as "vestibular" and "cochlear Menière's disease". As a consequence, we propose a new terminology which is based on symptomatic and imaging characteristics of these clinical entities to clarify and simplify their diagnostic classification.
Topics: Animals; Endolymphatic Hydrops; Humans; Magnetic Resonance Imaging; Meniere Disease; Quality of Life
PubMed: 27083887
DOI: 10.1007/s00415-015-7930-1 -
European Annals of Otorhinolaryngology,... Feb 2018To present the international consensus for recommendations for Ménière's disease (MD) treatment. (Review)
Review
OBJECTIVE
To present the international consensus for recommendations for Ménière's disease (MD) treatment.
METHODS
Based on a literature review and report of 4 experts from 4 continents, the recommendations have been presented during the 21st IFOS congress in Paris, in June 2017 and are presented in this work.
RESULTS
The recommendation is to change the lifestyle, to use the vestibular rehabilitation in the intercritic period and to propose psychotherapy. As a conservative medical treatment of first line, the authors recommend to use diuretics and Betahistine or local pressure therapy. When medical treatment fails, the recommendation is to use a second line treatment, which consists in the intratympanic injection of steroids. Then as a third line treatment, depending on the hearing function, could be either the endolymphatic sac surgery (when hearing is worth being preserved) or the intratympanic injection of gentamicin (with higher risks of hearing loss). The very last option is the destructive surgical treatment labyrinthectomy, associated or not to cochlear implantation or vestibular nerve section (when hearing is worth being preserved), which is the most frequent option.
Topics: Algorithms; Humans; Internationality; Meniere Disease; Practice Guidelines as Topic
PubMed: 29338942
DOI: 10.1016/j.anorl.2017.12.006 -
Environmental Research Dec 2023Meniere's disease (MD) is a severe inner ear condition known by debilitating symptoms, including spontaneous vertigo, fluctuating and progressive hearing loss, tinnitus,... (Review)
Review
Meniere's disease (MD) is a severe inner ear condition known by debilitating symptoms, including spontaneous vertigo, fluctuating and progressive hearing loss, tinnitus, and aural fullness or pressure within the affected ear. Prosper Meniere first described the origins of MD in the 1860s, but its underlying mechanisms remain largely elusive today. Nevertheless, researchers have identified a key histopathological feature called Endolymphatic Hydrops (ELH), which refers to the excessive buildup of endolymph fluid in the membranous labyrinth of the inner ear. The exact root of ELH is not fully understood. Still, it is believed to involve several biological and bioenvironmental etiological factors such as genetics, autoimmunity, infection, trauma, allergy, and new theories, such as saccular otoconia blocking the endolymphatic duct and sac. Regarding treatment, there are no reliable and definitive cures for MD. Most therapies focus on managing symptoms and improving the overall quality of patients' life. To make significant advancements in addressing MD, it is crucial to gain a fundamental understanding of the disease process, laying the groundwork for more effective therapeutic approaches. This paper provides a comprehensive review of the pathophysiology of MD with a focus on old and recent theories. Current treatment strategies and future translational approaches (with low-level evidence but promising results) related to MD are also discussed, including patents, drug delivery, and nanotechnology, that may provide future benefits to patients suffering from MD.
Topics: Humans; Meniere Disease; Endolymphatic Hydrops; Otolithic Membrane
PubMed: 37648189
DOI: 10.1016/j.envres.2023.116972