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The Annals of Otology, Rhinology, and... Oct 2023This study investigated the relationship between quantitative value of endolymphatic hydrops in the affected ear and the hearing threshold in patients with unilateral...
OBJECTIVES
This study investigated the relationship between quantitative value of endolymphatic hydrops in the affected ear and the hearing threshold in patients with unilateral Meniere's disease.
STUDY DESIGN
Prospective study.
METHODS
Forty patients with unilateral definite Meniere's disease were diagnosed in outpatient clinic. We recorded their clinical symptoms (duration of vertigo and tinnitus and duration of vertigo attacks), and obtained the hearing thresholds of high, middle, and low by pure tone audiometry. A 3D-FLAIR MRI revealed endolymphatic hydrops and assessed quantitative values of cochlear and vestibular endolymphatic hydrops. We assessed the correlation between hearing thresholds and quantitative values of endolymphatic hydrops.
RESULTS
All patients showed varying degrees of endolymphatic hydrops in the affected ear. With the duration of vertigo, tinnitus and vertigo attacks as control variables, partial correlation analysis showed that the correlation coefficients between quantitative value of cochlear hydrops and hearing thresholds of low, middle, and high tone in the affected ear were 0.581, 0.610, and 0.125, respectively. The correlation coefficients between quantitative value of vestibular hydrops and hearing thresholds of low, middle, and high tone in the affected ear were 0.727, 0.569, and 0.201, respectively.
CONCLUSIONS
The degree of endolymphatic hydrops in Meniere's disease can be revealed and assessed by 3D-FLAIR MRI after intravenous administration of double doses of gadoterate meglumine. Clinical evaluation of endolymphatic hydrops in Meniere's disease can be assisted by low- and middle-tone hearing thresholds, thereby providing anatomical support for the clinical symptoms of Meniere's disease.
Topics: Humans; Meniere Disease; Tinnitus; Prospective Studies; Endolymphatic Hydrops; Vertigo; Hearing; Magnetic Resonance Imaging; Edema
PubMed: 36412145
DOI: 10.1177/00034894221134729 -
Otology & Neurotology : Official... Jan 2024To investigate ictal nystagmus and audiovestibular characteristics in episodic spontaneous vertigo after cochlear implantation (CI).
OBJECTIVE
To investigate ictal nystagmus and audiovestibular characteristics in episodic spontaneous vertigo after cochlear implantation (CI).
STUDY DESIGN
Retrospective and prospective case series.
PATIENTS
Twenty-one CI patients with episodic spontaneous vertigo after implantation were recruited.
INTERVENTIONS
Patient-initiated home video-oculography recordings were performed during one or more attacks of vertigo, using miniature portable home video-glasses. To assess canal and otolith function, video head-impulse tests (vHITs) and vestibular-evoked myogenic potential tests were conducted.
MAIN OUTCOME MEASURES
Nystagmus slow-phase velocities (SPVs), the presence of horizontal direction-changing nystagmus, and post-CI audiovestibular tests.
RESULTS
Main final diagnoses were post-CI secondary endolymphatic hydrops (48%) and exacerbation of existing Ménière's disease (29%). Symptomatic patients demonstrated high-velocity horizontal ictal-nystagmus (SPV, 44.2°/s and 68.2°/s in post-CI secondary endolymphatic hydrop and Ménière's disease). Direction-changing nystagmus was observed in 80 and 75%. Two were diagnosed with presumed autoimmune inner ear disease (SPV, 6.6°/s and 172.9°/s). One patient was diagnosed with probable vestibular migraine (15.1°/s).VHIT gains were 0.80 ± 0.20 (lateral), 0.70 ± 0.17 (anterior), and 0.62 ± 0.27 (posterior) in the implanted ear, with abnormal values in 33, 35, and 35% of each canal. Bone-conducted cervical and ocular vestibular-evoked myogenic potentials were asymmetric in 52 and 29% of patients (all lateralized to the implanted ear) with mean asymmetry ratios of 51.2 and 35.7%. Reversible reduction in vHIT gain was recorded in three acutely symptomatic patients.
CONCLUSION
High-velocity, direction-changing nystagmus time-locked with vertigo attacks may be observed in post-CI implant vertigo and may indicate endolymphatic hydrops. Fluctuating vHIT gain may be an additional marker of a recurrent peripheral vestibulopathy.
Topics: Humans; Meniere Disease; Cochlear Implantation; Retrospective Studies; Vertigo; Nystagmus, Pathologic; Endolymphatic Hydrops; Vestibular Neuronitis
PubMed: 37853785
DOI: 10.1097/MAO.0000000000004037 -
The Laryngoscope Jul 2024To investigate the relationship between vestibular aqueduct (VA) morphology and Meniere's disease (MD) using ultrahigh-resolution computed tomography (U-HRCT).
OBJECTIVE
To investigate the relationship between vestibular aqueduct (VA) morphology and Meniere's disease (MD) using ultrahigh-resolution computed tomography (U-HRCT).
METHODS
Retrospective data were collected from 34 patients (40 ears) diagnosed with MD in our hospital who underwent temporal bone U-HRCT with isotropic 0.05-mm resolution, magnetic resonance with gadolinium-enhanced, and pure-tone audiometry; 34 age- and sex-matched controls (68 ears) who underwent U-HRCT were also included. VA patency was qualitatively classified as locally not shown (grade 1), locally faintly shown (grade 2), or clearly shown throughout (grade 3). The width of the outer orifice and VA length and angle were quantitatively measured. Differences in VA morphology between the MD and control groups were analyzed. The correlations between VA morphology and the degrees of hearing loss and endolymphatic hydrops (EH) were also analyzed.
RESULTS
VA was classified as grades 1-3 in 11, 17, and 12 ears in the MD group and 5, 26, and 37 ears in the control group, respectively. The patency differed significantly between the groups (p < 0.01). The width of the outer orifice and length of VA were significantly smaller in the MD group than those in the control group (p < 0.05). Both VA patency and length were correlated with the degree of EH in the cochlea and the vestibule (p < 0.05). No difference was found between VA morphology and the degree of hearing loss (p > 0.05).
CONCLUSION
The morphological characteristics of VA were found to be associated with the occurrence of MD and the degree of EH.
LEVEL OF EVIDENCE
4 Laryngoscope, 134:3349-3354, 2024.
Topics: Humans; Meniere Disease; Female; Male; Vestibular Aqueduct; Retrospective Studies; Middle Aged; Adult; Tomography, X-Ray Computed; Aged; Magnetic Resonance Imaging; Audiometry, Pure-Tone; Case-Control Studies; Endolymphatic Hydrops; Young Adult; Temporal Bone
PubMed: 38366775
DOI: 10.1002/lary.31339 -
Ear, Nose, & Throat Journal Jan 2024The purpose of this article is to review the literature and compile promising and clinically relevant biomarkers in autoimmune disease related to otolaryngology-head and... (Review)
Review
OBJECTIVE
The purpose of this article is to review the literature and compile promising and clinically relevant biomarkers in autoimmune disease related to otolaryngology-head and neck surgery.
STUDY DESIGN
Narrative review.
METHODS
Pubmed and Google Scholar were queried using combined key words such as "biomarkers" and "otolaryngology." Additional queries were made with combined key words such as "biomarkers" and a particular subspecialty such as "autoimmune" or "Meniere's" to maximize yield of relevant titles. Subsequently, specific biomarkers identified, such as "anti-TPO-antibodies," were used as key words. Relevant titles were reviewed and selected for abstract review. Applicable abstracts were then selected for review of the full text.
RESULTS
Biomarkers that are currently in clinical use for the management of autoimmune diseases within the field of otolaryngology were included in this review. The compiled biomarkers were then detailed individually regarding their molecular characteristics, function, and clinical significance.
CONCLUSIONS
Based on this literature review, there are several biomarkers currently in clinical use within the field of otolaryngology relating to autoimmune diseases. The majority of these biomarkers are in the form of proteins such as Cogan peptide and c-ANCA. This survey may serve as a comprehensive resource on biomarkers for autoimmune diseases in clinical otolaryngology.
Topics: Humans; Otolaryngology; Biomarkers; Autoimmune Diseases
PubMed: 34281418
DOI: 10.1177/01455613211033121 -
Auris, Nasus, Larynx Dec 2023Since the first report by Hallpike and Yamakawa in 1938, many more patients with Meniere's disease (MD) with endolymphatic hydrops (EHs) have been described....
OBJECTIVES
Since the first report by Hallpike and Yamakawa in 1938, many more patients with Meniere's disease (MD) with endolymphatic hydrops (EHs) have been described. Mental/physical stress and a subsequent increase in the release of the anti-diuretic hormone (ADH) supposedly triggers MD. In the present study, to assess the relationship between stress and EHs, we conducted a series of stress-related questionnaires as well as a 3D endolymphatic space (ELS) analysis in patients with unilateral MD.
METHODS
We enrolled 76 patients with unilateral MD (uMD) as the active group and 75 patients with unilateral benign paroxysmal positional vertigo (uBPPV) as the control group; both underwent examinations between June 2014 and November 2019. All patients underwent 3-T magnetic resonance imaging (MRI) 4 h after intravenous gadolinium injection. We used the total fluid space (TFS), ELS, and ELS rate (ELS/TFS × 100), which is the percentage of the volume of the ELS relative to that of the TFS, for a precise evaluation of the ELS and EHs in MD. Stress was evaluated using the Self-Rating Depression Scale (SDS), the psychological Stress Response Scale (SRS), and the modified Dizziness Handicap Inventory (mDHI). Stress scores and blood ADH levels were compared across patient groups.
RESULTS
In patients with uMD, ELS rates significantly correlated with SRS scores on both the affected and the healthy side and with mDHI scores on the affected side, while the SDS and ADH showed no significant correlation with the ELS rates. Correlations were much stronger in the group with severe SDS and one with low ADH levels.
CONCLUSIONS
The present results indicate that stress may be involved in EHs development in uMD, not only in the ipsilateral but also the contralateral ear. They also suggest that patients with neuropsychiatric tendencies may develop EHs and MD in response to a stressful lifestyle.
Topics: Humans; Meniere Disease; Ear, Inner; Endolymphatic Hydrops; Benign Paroxysmal Positional Vertigo; Injections, Intravenous; Magnetic Resonance Imaging
PubMed: 37037749
DOI: 10.1016/j.anl.2023.03.006 -
The Laryngoscope Jan 2024We investigated correlations among clinical features, degree of inner ear endolymphatic hydrops (EH), and hippocampal volume (HV) in different stages of Meniere's...
OBJECTIVE
We investigated correlations among clinical features, degree of inner ear endolymphatic hydrops (EH), and hippocampal volume (HV) in different stages of Meniere's disease (MD).
METHODS
From February 2021 to April 2022, clinical data were collected from 99 patients (39 males, 60 females, mean age: 50.4 ± 10.0 [range: 26-69] years) with unilateral MD admitted to the Department of Vertigo Disease of Shandong ENT Hospital. The left and right ears were affected in 64 and 35 patients, respectively. There were 50 and 49 cases in early (Stages 1, 2) and late stages (Stages 3, 4), respectively. Fifty healthy participants were included as controls. Audiovestibular function test results, EH grading using gadolinium-enhanced magnetic resonance imaging (MRI), and HV determined on MRI were analyzed for patients at different stages of MD.
RESULTS
Between-group comparisons of early and late MD revealed significant differences in the disease course, vestibular function (VF), degree of EH, and HV. There were no significant between-group differences based on age, sex, affected side, subjective degree of dizziness, hospital anxiety, or depression. Mean HV in patients with early-stage MD was correlated with the canal paresis value of the caloric test and pure tone hearing threshold, HV in late-stage patients was correlated with vestibular EH.
CONCLUSION
Patients with late-stage MD exhibited severe auditory and VF impairments, increased EH, and atrophy of the HV. More advanced disease was associated with greater vestibular damage and degree of EH.
LEVEL OF EVIDENCE
3 Laryngoscope, 134:410-418, 2024.
Topics: Male; Female; Humans; Adult; Middle Aged; Meniere Disease; Endolymphatic Hydrops; Vestibule, Labyrinth; Vertigo; Atrophy; Hippocampus; Magnetic Resonance Imaging
PubMed: 37314111
DOI: 10.1002/lary.30816 -
Ear, Nose, & Throat Journal Jun 2024Evaluation of the effectiveness and posttreatment effects of intratympanic gentamicin and corticosteroids in treating patients with Ménière's disease (MD). Based on...
Evaluation of the effectiveness and posttreatment effects of intratympanic gentamicin and corticosteroids in treating patients with Ménière's disease (MD). Based on PubMed and Embase databases, randomized controlled trials using intratympanic injections of 4 drugs (gentamicin, methylprednisolone, dexamethasone, and placebo) for the treatment of MD were searched from 1995 to October 2023, and the literature was screened according to inclusion and exclusion criteria, and data were netted for meta-analysis using Stata 17. A total of 13 studies were selected, involving 559 participants, with follow-up time ranging from 3 to 28 months. Meta-analysis showed that there was no statistically significant difference in pure-tone average between gentamicin and dexamethasone [standardized mean difference (SMD) = 0.09, 95% confidence interval (CI) (-0.42, 0.24), < .05]. Compared to placebo, intratympanic injection of gentamicin [risk ratio (RR) = 1.18, 95% CI (0.43, 1.93)], methylprednisolone [RR = 0.88, 95% CI (0.07, 1.70)], and dexamethasone [RR = 0.70, 95% CI (-0.01, 1.41)] all showed better efficacy in treating vertigo. For the treatment of tinnitus, the SUCRA ranking results showed that dexamethasone was the most effective, followed by methylprednisolone and gentamicin. Pharmacological intervention is more effective than placebo in treating MD. Although gentamicin treatment shows significant effects in treating vertigo, corticosteroid combination therapy is markedly superior to gentamicin in controlling hearing loss and vertigo symptoms.
PubMed: 38907653
DOI: 10.1177/01455613241264421 -
American Journal of Otolaryngology 2024Meniere's Disease is a condition known for its recurrent vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus. Previous studies have... (Meta-Analysis)
Meta-Analysis
PURPOSE
Meniere's Disease is a condition known for its recurrent vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus. Previous studies have demonstrated significant influence of placebo treatments. Our objective was to quantify the magnitude of the placebo effect in randomized controlled trials for Meniere's Disease.
MATERIALS AND METHODS
A systematic review was performed by searching PubMed, SCOPUS, CINAHL, and Cochrane databases from inception through September 27, 2022. Data extraction, quality rating, and risk of bias assessment were performed by two independent reviewers. A meta-analysis of mean differences with 95 % confidence interval, weighted summary proportions, and proportion differences were calculated using random and fixed effects models.
RESULTS
A total of 15 studies (N = 892) were included in the review. Significant improvement was seen in the functional level scores of the pooled placebo groups, with a mean difference of -0.6 points, (95%CI: -1.2 to -0.1). There was no difference in pure tone audiometry, speech discrimination score, or vertigo frequency at 1 and 3 months for the placebo group. Patient-reported vertigo episodes were improved in 52.5 % (95%CI: 39.2 to 65.5) of the placebo group and was significantly less than the pooled experimental group (90.1 %, 95%CI: 39.2 to 65.5, p < 0.001).
CONCLUSIONS
The placebo effect in Meniere's Disease trials is associated with some symptomatic improvement in subjective outcomes, such as patient reported vertigo episodes. However, the clinical significance is questionable across other outcomes measures, especially when analyzing objective data. The extent and strength of the placebo effect continues to be a hurdle in the search for better treatment options.
Topics: Humans; Meniere Disease; Placebo Effect; Randomized Controlled Trials as Topic; Vertigo; Tinnitus
PubMed: 38101129
DOI: 10.1016/j.amjoto.2023.104178 -
Clinical and Experimental... Feb 2024The study aimed to assess the relationship of tinnitus with hyperacusis with cognitive impairment as indicated by the Montreal Cognitive Assessment (MoCA) tool.
OBJECTIVES
The study aimed to assess the relationship of tinnitus with hyperacusis with cognitive impairment as indicated by the Montreal Cognitive Assessment (MoCA) tool.
METHODS
This multicenter cross-sectional study included individuals with chronic tinnitus from the "Unification of Treatments and Interventions for Tinnitus Patients" (UNITI) database. Participants were recruited from four different tertiary clinical centers located in Athens and Granada (Mediterranean group), as well as Berlin and Regensburg (German group). In total, 380 individuals with a diagnosis of non-pulsatile chronic tinnitus (permanent and constant tinnitus lasting more than 6 months) and no evidence of severe cognitive impairment (MoCA score >22) were enrolled. The evaluation utilized the following tools: MoCA, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (GÜF), Patient Health Questionnaire (PHQ-9), and the European School for Interdisciplinary Tinnitus Research Screening Questionnaire.
RESULTS
MoCA scores differed between German and Mediterranean individuals (P<0.01), necessitating separate analyses for each group. In both cohorts, MoCA scores were significantly associated with education level, age, hearing threshold at 8 kHz, and THI. Furthermore, a significant correlation was observed between PHQ-9 scores and both THI and GÜF (P<0.01 for both Germans and those from the Mediterranean).
CONCLUSION
Our data suggest an association between tinnitus handicap, high-frequency hearing loss, and mild cognitive impairment. Additionally, PHQ-9 scores were associated with tinnitus and hyperacusis scores, independent of hearing loss thresholds.
PubMed: 37974057
DOI: 10.21053/ceo.2023.00808 -
Journal of Otology Jan 2024The vestibular system connects the inner ear to the midbrain and subcortical structures and can affect cognition. Patients with vertigo often experience cognitive...
The vestibular system connects the inner ear to the midbrain and subcortical structures and can affect cognition. Patients with vertigo often experience cognitive symptoms such as attention deficits, memory problems, and spatial perception difficulties. This study aimed to explore the cognitive impairments associated with Benign paroxysmal positional vertigo (BPPV) and Meniere's Disease (MD). A non-experimental group comparison design was used with 107 participants divided into three groups: Group I (clinically normal), Group II (BPPV), and Group III (MD). Participants completed a questionnaire with 10 cognition-related questions, and their responses were scored. The data were found to be non-normally distributed. The analysis revealed a significant difference in scores between Group I and both Group II and Group III. Chi-square tests showed that the responses to cognition-related questions varied among the groups, with Group II exhibiting more cognitive problems. Associated conditions like hypertension, diabetes, and hearing loss did not significantly influence the responses within each group. This study suggests a significant relationship between cognitive problems and patients with BPPV and MD. However, there was no association found between the cognitive problems experienced in BPPV and MD patients. These findings align with previous research indicating that vestibular disorders can lead to deficits in spatial memory, attention, and other cognitive functions. By understanding the link between cognition and vestibular disorders, we can improve diagnosis and rehabilitation services to enhance the quality of life for these patients.
PubMed: 38313758
DOI: 10.1016/j.joto.2023.11.001