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Neurological Research and Practice Aug 2023In a retrospective study, the data of direction-dependent deviations in dynamic subjective visual vertical (SVV) testing were analysed in 1811 dizzy patients (174 benign...
In a retrospective study, the data of direction-dependent deviations in dynamic subjective visual vertical (SVV) testing were analysed in 1811 dizzy patients (174 benign paroxysmal positional vertigo, 99 unilateral vestibulopathy, 67 bilateral vestibulopathy, 151 Menière's disease, 375 vestibular migraine, 82 cerebellar disorder, 522 functional dizziness, 341 unclear diagnosis) and in 59 healthy controls. Major findings were (i) a significant gender difference with higher directional deviations in females over the entire range of age, (ii) a significant increase of directional deviations with increasing age for both genders and in all disease subgroups as well as in healthy controls, and (iii) a lack of significant difference of directional deviations between all tested diseases. Thus, the data allow no recommendation for performing additional angular deviation analysis in dynamic SVV testing as part of routine clinical management of dizzy patients. However, as shown in earlier longitudinal studies, it still appears reasonable that dynamic SVV in acute rather than chronic vestibular disorders may provide a useful instrument for the monitoring of acute unilateral vestibular tonus imbalances in the course of the disease.
PubMed: 37612736
DOI: 10.1186/s42466-023-00266-4 -
Neurology. Clinical Practice Apr 2024
PubMed: 38223348
DOI: 10.1212/CPJ.0000000000200257 -
Journal of the American Academy of... Dec 2023The Masseter Vestibular-Evoked Myogenic Potential (mVEMP) test evaluates the vestibulo-masseteric reflex neural pathway between the sound-stimulated saccule hair cells...
BACKGROUND
The Masseter Vestibular-Evoked Myogenic Potential (mVEMP) test evaluates the vestibulo-masseteric reflex neural pathway between the sound-stimulated saccule hair cells and the motor neurons of the trigeminal nerve.
PURPOSE
This study aims to investigate the contribution of mVEMP to the conclusive diagnosis of recurrent vestibulopathy patients that were diagnosed with Possible Ménière's disease.
METHODS
The study includes 20 healthy individuals aged 18-40 years and 20 patients that were diagnosed with possible Ménière's disease according to the American Academy of Otorhinolaryngology and Head and Neck Surgery (AAO-HNS, 1995) Guidelines for the Definition of Ménière's Disease. In addition to the AAO-HNS, 1995 criteria, the presence of aural signs on the affected side was questioned according to the Meniere's criteria updated in 2015. mVEMP records were obtained by using surface electrodes placed on masseter muscles. Latency and amplitude values and asymmetry ratios of mVEMP waves were used for statistical analysis.
RESULTS
Asymmetry ratios were 15.9±9.7% for the control group, and 60.61±45.52 for the experimental group, this difference was statistically significant (p<0.05). The absolute latency and amplitude results were not statistically different between groups (p>0.05).
CONCLUSION
As Murofishi (2001) stated in the literature, cervical VEMP/ocular VEMP latencies were not affected in peripheral pathologies, and in our study, no difference was observed between the groups in mVEMP latencies. The findings of our study showed that asymmetry ratio and absence of waves should be used in the clinical evaluation of Possible Meniere's disease. We conclude that mVEMP can be used to determine the lateralization of vestibular disorders and to support the presence of a vestibular pathology. mVEMP can contribute to the vestibular test battery.
PubMed: 38081224
DOI: 10.1055/a-2225-7879 -
The Laryngoscope Feb 2024This narrative review examines how speculative belief that the autonomic nervous system causes Meniere's Disease (MD) led otolaryngologists to adopt invasive surgical... (Review)
Review
OBJECTIVE
This narrative review examines how speculative belief that the autonomic nervous system causes Meniere's Disease (MD) led otolaryngologists to adopt invasive surgical procedures and medical treatments still offered today.
DATA SOURCES
Google Scholar, PubMed.
REVIEW METHODS
A comprehensive literature review (1860-2022) was performed using the terms "Meniere AND (sympathetic OR sympathectomy OR vasomotor OR cervical ganglion)," returning 5360 items. All abstracts were briefly reviewed, relevant publications selected for further study, and key articles discussed by all authors. As it became clear that betahistine was related to the historical narrative, an additional search was performed using "Betahistine AND Meniere AND (vasomotor OR sympathetic OR sympathectomy OR cervical ganglion OR autonomic)," which yielded 336 results.
RESULTS
In the 19th and 20th centuries, growing knowledge of human anatomy led the scientific community to speculate that autonomic dysregulation caused many medical conditions. Excessive sympathetic mediated vasomotor changes were thought to cause hypertension, ischemia, and tissue damage. Clinicians applied the hypothesis to MD, assigning the sympathetic nervous system responsible for vertigo secondary to paroxysmal vasospasm and for hearing loss to poor cochlear nutrition. Despite limited animal experiments and isolated clinical observations, otolaryngologists performed sympathectomies, and, in the 1970s, replaced the procedure with betahistine as an alternative medical treatment.
CONCLUSION
Premature excitement about a plausible hypothesis led to unnecessary and unwarranted operations. Despite absent evidence of sympathetic overactivation in MD, surgeons eagerly adopted sympathectomies, and later betahistine. Rigorous evaluation of the validity of these treatment practices is needed.
LEVEL OF EVIDENCE
5 Laryngoscope, 134:535-542, 2024.
Topics: Humans; Meniere Disease; Betahistine; Vertigo; Hearing Loss; Deafness
PubMed: 37584400
DOI: 10.1002/lary.30944 -
Cureus Feb 2024Introduction Meniere's disease (MD) is a chronic condition characterized by episodic attacks of vertigo, fluctuating hearing loss, and tinnitus. MD can impart a...
Introduction Meniere's disease (MD) is a chronic condition characterized by episodic attacks of vertigo, fluctuating hearing loss, and tinnitus. MD can impart a significant socioeconomic impact with associated progressive hearing loss. First-line therapies consist of diuretics and antihistamines, with second-line therapies including intratympanic steroids and pulse therapy. Third-line treatments include endolymphatic sac surgery (ELSS) followed by intratympanic gentamicin injection and/or vestibular neurectomy. The gemmotherapy Sorbus domestica's inherent properties to regulate venous circulation and lymphatic drainage have been utilized in the European literature for the treatment of MD and the patients in this study. Methods Patients presenting for rehabilitation at Pulaski Health and Rehabilitation Facility with a history of vertigo were examined and, through history and specific exam, to define MD. This resulted in six patients whose symptoms and exam were consistent with MD and interfered with their therapeutic progression. These patients were offered and accepted treatment with Sorbus domestica for their MD. Results All patients responded with either resolution or significant improvement in their symptoms and hearing loss. Treatment also resulted in an improved and probably shortened rehabilitative course. All patients had no adverse reactions and were supplied with resources for continual treatment upon discharge. Conclusion Sorbus domestica is a safe and viable treatment option for MD. It has been useful, especially in treatment-resistant diseases, without side effects and can be utilized in initial cases with improvement or resolution of hearing loss.
PubMed: 38455836
DOI: 10.7759/cureus.53702 -
Ear and HearingA recently devised parameter of vestibular-evoked myogenic potential (VEMP) based on the principles of frequency tuning is the inter-frequency amplitude ratio (IFAR). It... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
A recently devised parameter of vestibular-evoked myogenic potential (VEMP) based on the principles of frequency tuning is the inter-frequency amplitude ratio (IFAR). It refers to the ratio of the amplitude of 1000 Hz tone burst evoked VEMP to 500 Hz evoked tone burst. A pathology like Meniere's disease changes the frequency response and alters the frequency tuning of the otolith organs. Because IFAR is based on the principle of frequency tuning of VEMP, it is likely to help identify Meniere's disease. Few studies in the last decade have investigated the utility of IFAR in identifying Meniere's disease. However, a systematic review and a meta-analysis on IFAR in Meniere's disease are lacking. The present study investigates whether the IFAR of VEMP helps identify Meniere's disease and differentiates it from healthy ears and other vestibular pathologies.
DESIGN
The present study is a systematic review and a meta-analysis. The studies investigating the IFAR of cervical and ocular VEMPs in Meniere's disease, healthy controls, and other vestibular pathologies were searched across research databases such as PubMed, Science Direct, and Scopus. The search strategy was developed using the PICO (population, intervention, comparison, and outcomes) format, and Medical Subject Headings (MeSH) terms and Boolean operators were employed. The systematic review was performed using the Rayyan software, whereas the Review Manager software was used to carry out the meta-analysis. A total of 16,605 articles were retrieved from the databases. After the duplicate removal, 2472 articles remained. These were eliminated using title screening, abstract screening, and full-length inspections. A total of nine articles were found eligible for quality assessment and meta-analysis, and the New Castle-Ottawa Scale was used for quality assessment. After the data extraction, 24 six articles were found to have the desired data format for the meta-analysis.
RESULTS
The results showed significantly higher IFAR in the affected ears of individuals in the Meniere's disease group than in the control group's unaffected ears. There was no significant difference between the unaffected ears of individuals in the Meniere's disease group and the ears of the control group. The only study on Meniere's disease and benign paroxysmal positional vertigo found significantly larger ocular VEMP IFAR in ears with Meniere's disease than in benign paroxysmal positional vertigo.
CONCLUSIONS
This systematic review and meta-analysis found IFAR efficient in differentiating Meniere's disease from healthy controls. We also found an enhanced IFAR as a potential marker for Meniere's disease. However, more investigations are needed to confirm the utility of an enhanced IFAR value in the exclusive identification of Meniere's disease.
Topics: Humans; Meniere Disease; Benign Paroxysmal Positional Vertigo; Vestibular Evoked Myogenic Potentials; Vestibule, Labyrinth; Saccule and Utricle
PubMed: 36859775
DOI: 10.1097/AUD.0000000000001343 -
Frontiers in Neurology 2024Inner ear disorders have a variety of causes, and many factors can contribute to the exacerbation of cochlear and vestibular pathology. This systematic review aimed to... (Review)
Review
Inner ear disorders have a variety of causes, and many factors can contribute to the exacerbation of cochlear and vestibular pathology. This systematic review aimed to analyze clinical data on the coexistence and potential causal interaction between allergic diseases and inner ear conditions. A search of PubMed and Web of Science identified 724 articles, of which 21 were selected for full-text analysis based on inclusion and exclusion criteria. The epidemiologic evidence found overwhelmingly supports an association between allergic disease and particular inner ear disorders represented by a high prevalence of allergic reactions in some patients with Ménière's disease (MD), idiopathic sudden sensorineural hearing loss (ISSHL), and acute low-tone hearing loss (ALHL). In addition, patients with MD, ISSHL, and ALHL had higher levels of total serum IgE than healthy subjects. Finally, in some cases, changes in cochlear potential may have been induced by antigen exposure, while desensitization alleviated allergy and inner ear-related symptoms. The exact mechanism of interaction between the auditory/vestibular and immune systems is not fully understood, and further clinical and basic research is needed to understand the relationship between the two systems fully.
PubMed: 38595846
DOI: 10.3389/fneur.2024.1378276 -
Journal of the Association For Research... Dec 2023Tinnitus would benefit from an objective biomarker. The goal of this study is to identify plasma biomarkers of constant and chronic tinnitus among selected circulating... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVE
Tinnitus would benefit from an objective biomarker. The goal of this study is to identify plasma biomarkers of constant and chronic tinnitus among selected circulating inflammatory proteins.
METHODS
A case-control retrospective study on 548 cases with constant tinnitus and 548 matched controls from the Swedish Tinnitus Outreach Project (STOP), whose plasma samples were examined using Olink's Inflammatory panel. Replication and meta-analysis were performed using the same method on samples from the TwinsUK cohort. Participants from LifeGene, whose blood was collected in Stockholm and Umeå, were recruited to STOP for a tinnitus subtyping study. An age and sex matching was performed at the individual level. TwinsUK participants (n = 928) were selected based on self-reported tinnitus status over 2 to 10 years. Primary outcomes include normalized levels for 96 circulating proteins, which were used as an index test. No reference standard was available in this study.
RESULTS
After adjustment for age, sex, BMI, smoking, hearing loss, and laboratory site, the top proteins identified were FGF-21, MCP4, GDNF, CXCL9, and MCP-1; however, these were no longer statistically significant after correction for multiple testing. Stratification by sex did not yield any significant associations. Similarly, associations with hearing loss or other tinnitus-related comorbidities such as stress, anxiety, depression, hyperacusis, temporomandibular joint disorders, and headache did not yield any significant associations. Analysis in the TwinsUK failed in replicating the top candidates. Meta-analysis of STOP and TwinsUK did not reveal any significant association. Using elastic net regularization, models exhibited poor predictive capacity tinnitus based on inflammatory markers [sensitivity = 0.52 (95% CI 0.47-0.57), specificity = 0.53 (0.48-0.58), positive predictive value = 0.52 (0.47-0.56), negative predictive values = 0.53 (0.49-0.58), and AUC = 0.53 (0.49-0.56)].
DISCUSSION
Our results did not identify significant associations of the selected inflammatory proteins with constant tinnitus. Future studies examining longitudinal relations among those with more severe tinnitus and using more recent expanded proteomics platforms and sampling of cerebrospinal fluid could increase the likelihood of identifying relevant molecular biomarkers.
Topics: Humans; Tinnitus; Retrospective Studies; Hearing Loss; Hyperacusis; Biomarkers
PubMed: 38079022
DOI: 10.1007/s10162-023-00920-3 -
Neurology. Clinical Practice Apr 2024The diagnosis of Meniere disease (MD) has based on characteristics of vertigo and findings of audiologic evaluation. This review focuses on the recent findings of the... (Review)
Review
PURPOSE OF REVIEW
The diagnosis of Meniere disease (MD) has based on characteristics of vertigo and findings of audiologic evaluation. This review focuses on the recent findings of the evolution of vestibular function and their underlying physiology during and between the attacks of MD and thus aims to help identify this common disorder with many faces according to the phase.
RECENT FINDINGS
During the attacks, the direction of spontaneous nystagmus changes over time, beating initially toward the affected ear (irritative nystagmus), then toward the healthy ear (paretic nystagmus), and finally back toward the affected ear again (recovery nystagmus). Apart from these direction changes, atypical forms of spontaneous nystagmus, such as downbeat, discordant horizontal-torsional, and aperiodic alternating nystagmus, can be observed. Head impulse tests (HITs) are mostly normal during the irritative/recovery phases, but positive in more than half of patients during the paretic phase. By contrast, caloric tests are usually abnormal irrespective of the phases, although paradoxical caloric hyper-responsiveness can be observed in 18% of patients during the irritative/recovery phases. Thus, dissociation in the findings of caloric tests-HITs can be observed during and between the attacks. Horizontal head shaking tends to augment spontaneous nystagmus during each phase, while skull vibration mostly induces nystagmus beating toward the healthy ear irrespective of the phases. During the attacks, ocular vestibular-evoked myogenic potentials (VEMPs) may be enhanced, whereas cervical VEMPs are usually decreased during stimulation of the involved ear.
SUMMARY
Recognizing these evolutions of vestibular findings during and between the attacks of MD would provide insights into its pathophysiology and aid in treatments and diagnosis.
PubMed: 38223349
DOI: 10.1212/CPJ.0000000000200235 -
Otology & Neurotology : Official... Aug 2023To evaluate the diagnostic role of combined electrocochleography and pure-tone audiometry monitoring during dehydrating test in Ménière's disease and consider its...
OBJECTIVES
To evaluate the diagnostic role of combined electrocochleography and pure-tone audiometry monitoring during dehydrating test in Ménière's disease and consider its suitability as a diagnostic tool to differentiate those patients with unclear differential diagnosis and therefore identify those with clear endolymphatic hydrops responsive to dehydrating test. To study the efficacy of dehydrating therapy on vertiginous symptoms and hearing loss in patients with Ménière's disease.
STUDY DESIGN
Prospective case series.
SETTINGS
University hospital, secondary referral center.
PATIENTS
Thirty patients, 20 women and 10 men, age range of 25 to 75 years, matching the criteria for definite Ménière's disease according to the Barany Society classification.
INTERVENTION
Diagnostic. During an active phase of the disease, electrocochleography and pure-tone audiometry were performed, and repeated at 30th, 45th, and 60th minutes after intramuscular injection of 40 mg furosemide and 40 mg methylprednisolone.
MAIN OUTCOME MEASURE
Data related to symptoms, electrocochleography, and pure-tone audiometry during the dehydrating test were collected at different times and statistically analyzed.
RESULTS
After the administration of dehydrating therapy, we observed that both summating potential and action potential ratio and summating potential and action potential area ratio were normalized in 21 of 30 subjects. Furthermore, pure-tone audiometry thresholds improved significantly. An improvement of ear fullness was also observed, whereas tinnitus unchangeably persisted.
CONCLUSIONS
The monitoring of the electrocochleography and pure-tone audiometry thresholds during dehydrating tests with furosemide and methylprednisolone could allow to detect an improvement of instrumental features and clinical symptoms related to endolymphatic hydrops, and therefore, it could be used as a diagnostic tool in the identification of those patients affected by Ménière's disease with unclear differential diagnosis.
Topics: Male; Humans; Female; Adult; Middle Aged; Aged; Meniere Disease; Audiometry, Evoked Response; Audiometry, Pure-Tone; Furosemide; Endolymphatic Hydrops
PubMed: 37400265
DOI: 10.1097/MAO.0000000000003942