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Otology & Neurotology Open Sep 2023Vestibular migraine represents a growing public health problem, imposing enormous societal burdens in the form of patient suffering, loss of productivity, and direct...
Vestibular migraine represents a growing public health problem, imposing enormous societal burdens in the form of patient suffering, loss of productivity, and direct healthcare costs. This raises the question of how we developed our ideas about vestibular migraine and how these ideas shape how we treat it. This review walks through the history of how our conceptualization of migraine and vestibular symptoms evolved, starting with clinical observations in ancient times, inclusion under the umbrella of Meniere's disease, and then separation from Meniere's disease with its own identity. Tradition, clinical observations, and diagnostic criteria developed by professional societies have played prominent roles in building our current concept of vestibular migraine. A review of the ideas that have shaped our current conception of vestibular migraine may help us to see which ones have stood the test of time and which ones should continue to evolve. As in other disciplines, we study history in medicine to be inspired, warned, and sometimes, to be freed.
PubMed: 38515642
DOI: 10.1097/ONO.0000000000000040 -
Scientific Reports Jun 2023We aimed to determine the prevalence of radiological temporal bone features that in previous studies showed only a weak or an inconsistent association with the clinical...
We aimed to determine the prevalence of radiological temporal bone features that in previous studies showed only a weak or an inconsistent association with the clinical diagnosis of Meniere's disease (MD), in two groups of MD patients (n = 71) with previously established distinct endolymphatic sac pathologies; i.e. the group MD-dg (ES degeneration) and the group MD-hp (ES hypoplasia). Delayed gadolinium-enhanced MRI and high-resolution CT data were used to determine and compare between and within (affected vs. non-affected side) groups geometric temporal bone features (lengths, widths, contours), air cell tract volume, height of the jugular bulb, sigmoid sinus width, and MRI signal intensity alterations of the ES. Temporal bone features with significant intergroup differences were the retrolabyrinthine bone thickness (1.04 ± 0.69 mm, MD-hp; 3.1 ± 1.9 mm, MD-dg; p < 0.0001); posterior contour tortuosity (mean arch-to-chord ratio 1.019 ± 0.013, MD-hp; 1.096 ± 0.038, MD-dg; p < 0.0001); and the pneumatized volume (1.37 [0.86] cm, MD-hp; 5.25 [3.45] cm, MD-dg; p = 0.03). Features with differences between the affected and non-affected sides within the MD-dg group were the sigmoid sinus width (6.5 ± 1.7 mm, affected; 7.6 ± 2.1 mm, non-affected; p = 0.04) and the MRI signal intensity of the endolymphatic sac (median signal intensity, affected vs. unaffected side, 0.59 [IQR 0.31-0.89]). Radiological temporal bone features known to be only weakly or inconsistently associated with the clinical diagnosis MD, are highly prevalent in either of two MD patient groups. These results support the existence of diverse-developmental and degenerative-disease etiologies manifesting with distinct radiological temporal bone abnormalities.
Topics: Humans; Meniere Disease; Temporal Bone; Radiography; Endolymphatic Sac; Magnetic Resonance Imaging
PubMed: 37365255
DOI: 10.1038/s41598-023-36479-5 -
Frontiers in Surgery 2020Vestibular Meniere's disease (American Academy of Ophthalmology and Otolaryngology, 1972) also known as possible Meniere's disease (American Academy of Otolaryngology...
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). To estimate the role of EH in vestibular Meniere's disease in comparison with definite Meniere's disease. 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. 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 ( = 0.001). The total HADS score in the MD group was significantly higher than that in the vestibular Meniere's disease group. 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.
PubMed: 33392247
DOI: 10.3389/fsurg.2020.601692 -
Acta Otorhinolaryngologica Italica :... Feb 2022This retrospective study aimed to verify the outcomes of stabilising occlusal splint therapy prescribed to 22 patients with unilateral definite Ménière's disease and...
OBJECTIVE
This retrospective study aimed to verify the outcomes of stabilising occlusal splint therapy prescribed to 22 patients with unilateral definite Ménière's disease and comorbid temporomandibular joint disorder.
METHODS
The results of a battery of audiometric and vestibular tests were recorded before and after 6 months of treatment, as well as the scores of disease-specific questionnaires.
RESULTS
The average hearing threshold in the affected ear and the acoustic immittance were unchanged. No spontaneous and positional nystagmus were recorded. Caloric hypo-responsiveness and vestibular myogenic evoked responses did not vary. No changes of stabilometric body sway parameters in eyes opened condition and with optokinetic stimulation delivered to the unaffected labyrinth were observed. A significant reduction was recorded in eyes closed condition and with the optokinetic stimulation toward the affected ear. The Tinnitus Handicap Inventory, the Situational Vertigo Questionnaire and the Numeric Pain Rating Scale scores improved. The number of vertigo attacks was reduced.
CONCLUSIONS
Occlusal splint therapy is a favourable option to reduce aural symptoms of Ménière's disease and comorbid temporomandibular joint disorder, even if its pathophysiological mechanism remains elusive.
Topics: Humans; Meniere Disease; Occlusal Splints; Retrospective Studies; Temporomandibular Joint Disorders; Vestibule, Labyrinth
PubMed: 35129540
DOI: 10.14639/0392-100X-N1641 -
Ear, Nose, & Throat Journal Mar 2022
PubMed: 35324348
DOI: 10.1177/01455613221074149 -
The Journal of International Advanced... May 2022Water is a vital nutrient for the human body system and failing to consume enough water could cause health problems. The purpose of this study is to investigate the...
BACKGROUND
Water is a vital nutrient for the human body system and failing to consume enough water could cause health problems. The purpose of this study is to investigate the relationship between water intake and vestibular system disorders.
METHODS
Data from 93 patients (aged between 20 and 76 years) with vestibular disorders were analyzed in the study. The mean age of the patients was 46.96 ±13.94 years (female: 45.68 ±13.45, male: 49.96 ±14.85), and 69.9% (n=65) were female. Participants were sub-categorized into diagnostic groups as follows: benign paroxysmal positional vertigo, Meniere's disease, vestibular neuritis, vestibular migraine, and persistent postural perceptual dizziness. The water intake information was analyzed for total water, plain water, and caffeinated beverages separately and compared between groups.
RESULTS
There was a significant difference between vestibular neuritis and benign paroxysmal positional vertigo (P < .001) and also between vestibular neuritis and Meniere's disease (P = .021) in terms of the intake values of plain water and total water. No significant difference was found between groups in caffeinated beverages intake (P = .151), and it was found that there is no statistically significant difference in plain water and total water intake in terms of gender (P > .05).
CONCLUSION
The most significant result of this study is that inadequate water intake can be a risk factor for some forms of peripheral vestibular disorders. People should be informed about the importance of drinking water and be encouraged to increase their water intake.
Topics: Adult; Aged; Benign Paroxysmal Positional Vertigo; Dizziness; Drinking; Female; Humans; Male; Meniere Disease; Middle Aged; Risk Factors; Vestibular Diseases; Vestibular Neuronitis; Water; Young Adult
PubMed: 35608497
DOI: 10.5152/iao.2022.21303 -
Scientific Reports May 2022To date, no study has reported the objective metabolic laboratory findings worldwide or the comorbidities for Ménière's disease (MD) using a population-based design in...
To date, no study has reported the objective metabolic laboratory findings worldwide or the comorbidities for Ménière's disease (MD) using a population-based design in Asian populations. The aim of this study was to investigate the comorbidities and associated factors for MD using the Korean National Health Insurance Service database. This retrospective population-based study was conducted using a data from the National Sample Cohort database from 2009 to 2015. We only enrolled patients whose records showed a prescription for MD medicine and audiometry findings as well as an appropriate diagnostic code. We also included a matched cohort without MD who were enrolled randomly and matched for sex, age, year of diagnosis, income level, and residential area with the MD group with a ratio of 10:1. We evaluated comorbidities including autoimmune, allergic, metabolic diseases and cancer and the health screening data including general characteristics (height, weight, waist circumference, body mass index, and blood pressure), laboratory findings (fasting glucose, cholesterol, triglyceride, high-density lipoproteintryglyceride (HDL) cholesterol, low-density lipoproteintryglyceride cholesterol, hemoglobin, creatinine, aspartate aminotransferase and alanine aminotransferase, and gamma-glutamyltrans- peptidase (rGT)), and general health behaviors (smoking, alcohol, and exercise) of the MD group, and compared these characteristics with those of the MD-free control group. A total of 2,013 and 20,130 participants were included in the MD and MD-free control groups (1,640 and 15,458 for health screening data). We found the increase in incidence of allergic rhinitis and allergic asthma, decrease in systolic blood pressure, HDL cholesterol, and rGT, and less frequent alcohol consumption and less prevalent smoking in the MD group. No significant differences were observed between the groups in the incidence of autoimmune diseases, and cerebro- and cardiovascular disease as well as health screening data and objective laboratory findings. Inconsistence with published studies, the results of this study suggest that the autoimmunity and metabolic disorder, and skeletal growth might not be associated with the onset of MD. Another well-designed study for other races will be needed to the generalization of this study results.
Topics: Autoimmune Diseases; Cholesterol; Comorbidity; Humans; Incidence; Meniere Disease; Retrospective Studies; Risk Factors
PubMed: 35585157
DOI: 10.1038/s41598-022-12492-y -
Journal of the Association For Research... Oct 2022The sensory end-organs responsible for hearing and balance in the mammalian inner ear are connected via a small membranous duct known as the ductus reuniens (also known...
The sensory end-organs responsible for hearing and balance in the mammalian inner ear are connected via a small membranous duct known as the ductus reuniens (also known as the reuniting duct (DR)). The DR serves as a vital nexus linking the hearing and balance systems by providing the only endolymphatic connection between the cochlea and vestibular labyrinth. Recent studies have hypothesized new roles of the DR in inner ear function and disease, but a lack of knowledge regarding its 3D morphology and spatial configuration precludes testing of such hypotheses. We reconstructed the 3D morphology of the DR and surrounding anatomy using osmium tetroxide micro-computed tomography and digital visualizations of three human inner ear specimens. This provides a detailed, quantitative description of the DR's morphology, spatial relationships to surrounding structures, and an estimation of its orientation relative to head position. Univariate measurements of the DR, inner ear, and cranial planes were taken using the software packages 3D Slicer and Zbrush. The DR forms a narrow, curved, flattened tube varying in lumen size, shape, and wall thickness, with its middle third being the narrowest. The DR runs in a shallow bony sulcus superior to the osseus spiral lamina and adjacent to a ridge of bone that we term the "crista reuniens" oriented posteromedially within the cranium. The DR's morphology and structural configuration relative to surrounding anatomy has important implications for understanding aspects of inner ear function and disease, particularly after surgical alteration of the labyrinth and potential causative factors for Ménière's disease.
Topics: Humans; Hearing; Meniere Disease; Vestibule, Labyrinth; X-Ray Microtomography
PubMed: 35804276
DOI: 10.1007/s10162-022-00858-y -
Turkish Archives of Otorhinolaryngology Mar 2021To evaluate the long-term balance outcomes of vestibular nerve section (VNS) and labyrinthectomy (L) operations. The indirect outcomes will be the correlation of...
OBJECTIVE
To evaluate the long-term balance outcomes of vestibular nerve section (VNS) and labyrinthectomy (L) operations. The indirect outcomes will be the correlation of objective and subjective test results and an analysis of anterior-posterior versus medial-lateral computerized posturography (CP) scores.
METHODS
This retrospective study evaluated objective CP and subjective Dizziness Handicap Inventory (DHI) results of patients who underwent VNS and L surgeries for Ménière's disease.
RESULTS
A total of 55 (31 VNS and 24 L) patients were included in the study. The two operation groups were similar in terms of age, and mean time between surgery and the tests (p=0.465 and p=0.616) respectively. The vestibular and global scores at anterior-posterior CP showed statistically significant differences between the groups (p=0.000 and p=0.007) respectively in favor of the VNS group. In addition, the comparison of the vestibular CP scores of anterior-posterior and medial-lateral evaluations of the entire study population was lower in the medial-lateral evaluation (p=0.000). The mean DHI scores did not show statistically significant differences (p=0.359) between operation groups, nor did the correlation analysis between CP and DHI scores reveal statistical significance (p values >0.05).
CONCLUSION
In the long term, objective balance outcomes are better for VNS patients than for L patients. Additionally, medial-lateral balance outcomes are more affected than anterior-posterior balance outcomes from unilateral ablative surgeries. Subjective balance perception is not different between the two surgery groups, and DHI scores do not show a correlation with CP scores.
PubMed: 33912856
DOI: 10.4274/tao.2020.6032