Menière's disease and disorders of the carbohydrate metabolism involving the inner ear

Introduction: Menière's disease was described in 1861, but there are still uncertainties regarding its pathophysiology and treatment. Endolymphatic hydrops is recognized as a fundamental pathological characteristic of the disease, as a result of an inadequate absorption of the endolymph. A milder type of endolymphatic hydrops results from an altered chemical composition of the endolymph, due to disorders of the carbohydrate metabolism. Objective: To describe the association of both types of hydrops in patients with Menière disease. Methods: This was a retrospective study of 98 patients with Menière's disease, 62 of whom also presented disorders of the carbohydrate metabolism, and 5 patients with delayed endolymphatic hydrops, 2 of whom also presented disorders of the carbohydrate metabolism. Results: The follow-up of these patients showed that the correction of the metabolic disorders may help in the clinical treatment of Menière's disease and of delayed endolymphatic hydrops, but this does not happen in the more severe types of the diseases. Conclusion: Patients with Menière's disease may present simultaneous disorders of the carbohydratemetabolism, affecting the inner ear. The correction of these disorders helps the clinical treatment but does not preclude the progression of the more severe cases of Menière disease (AU)

Associations between HLA-C alleles and definite Meniere's disease

Both genetic and environmental factors seem to play role in the etiology of Meniere's disease [MD]. Several genes may be involved in susceptibility of MD including Human Leukocyte Antigens [HLA]. The associations between MD and HLA alleles have been previously studied in other populations and certain HLA alleles were shown to be predisposing. The aim of this study was to determine the association between HLA-C allele frequencies and definite MD in patients who refer to Amir-Alam otolaryngology tertiary referral center in Tehran. Patients with definite MD [N=22] enrolled according to the diagnostic criteria of American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS]. Cases with all 3 symptoms of MD [Vertigo, Tinnitus and lower frequency of sensory-neural hearing loss] were included and those with suspected MD were excluded from study. HLA-Cw allele frequencies were determined in patients non-related healthy controls [N=91] using PCR -SSP. We found that the frequency of HLACw[*]04 was significantly higher in patients compared to the controls [P = 0.0015, OR; 20, 95% CI [3.7-196.9]]. Our results revealed that HLA-C is a genetic predisposing factor in definite MD in patients who refer to Amir-Alam otolaryngology tertiary referral center

Enfermedad de Ménière: caso clínico y revisión de la literatura / Meniere disease: clinical case and review of literature

Ménière’s disease is characterized by spontaneous attacks of vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus. The pathofisiology involves distortion of the membranous labyrinth with the formation of endolymphatic hydrops. Initial management of Ménière’s diseasecan involve a low-salt diet and a diuretic. Treatment with intratympanic injection of gentamicin can be beneficial when vertigo persists despite optimal medical management. Recent studies have shown that gentamicin reduces vestibular function in the treated ear, and is not always necessary to forgo the remaining hearing of the affected ear to achieve control of vertigo.

Síndrome de Menière: diagnóstico etiológico / Ménièreïssyndrome: etiologic diagnosis

A correta identificação da etiologia da síndrome de Ménière, alcançada em até 50 por cento dos casos permite, via de regra, uma melhora significativa do quadro, através do manejo da doença de base. O presente estudo objetiva discutir as principais doenças possívelmente asssociadas à gênese da síndrome de Ménière, enfocando prevalência, mecanismo etiopatogênico, implicação prognóstica. Além disso, apresentamos um fluxograma que serve como guia de busca etiológica para a síndrome de Ménière

Labirintopatia metabólica hiperinsulinêmica / Hyperinsulinemic labyrinthine disorder

A hiperinsulinemia é a causa mais frequente de labirintopatia metabólica. As manifestaçoes ocorrem mais em pessoas do sexo feminino entre 30 e 50 anos de idade, obesas e com antecedente diabético. Pode apresentar alteraçoes tanto à audiometria como à vestibulometria e à eletrococleografia. A dosagem de insulina comprovará a suspeita de hiperinsulinemia em 86 por cento desses pacientes.

Doença de Menière: revisäo / Menière's disease: review

Säo feitas consideraçöes sobre a Doença de Meniére, abrangendo aspectos históricos, incidência, faixa etária, etiologia, bilateralidade, prevalência, fisiopatologia, histopatologia, histoquímica, imunologia, sintomatologia, curvas audiométricas, impedanciometria, eletrococleografia, glicerol, alteraçöes vestibulares, psicologia, fenômeno de Tulio, diagnóstico por imagem, terapêutica, cirurgia e reabilitaçäo labiríntica

Doença de Ménière - Parte III / Ménière's disease - Parte III

Os autores fazem estudo do estado atual de conhecimentos sobre a doença de Ménière. Tecem considerações sobre o exame do aparelho vestibular, o que quer dizer, o estudo dos sistemas vestíbulo-espinhal e vestíbulo-oculomotor. Fazem referência a doença de Ménière não idiopática e apreciação sobre as causas, exames subsidiários e diagnóstico diferencial. Foram estudados 83 casos

Doença de Menière e arteriopatia vertebral / Meniere`s disease and vertebral arteriopathy

Os autores apresentam um caso clínico de doença de Maniere de uma etiopatogenia incomum, uma estenose traumática da artéria vertebral homônima associada a uma atelectasia da luz do saco endolinfático, desencadeadas por um acidente automobilístico aparentemente inofensivo, ocorrido há 2 anos. Aspectos da etiopatogenia säo discutidos e säo enfatizado os critérios de escolha para a única terapêutica que foi eficaz, a cirurgia do saco endolinfático, no presente caso. Os autores avaliam a eficácia da cirurgia do saco endolinfático, baseados em sua experiência pessoal, favorável a cirurgia do saco endolinfático, em 20 pacientes acompanhados com períodos evolutivos entre 2 a 7 anos

Vertigo

One hundred and four patients suffering from vertigo were assesed by clinical audiological and vestibular examination during 1983 and 1984. A detailed and critical history taking is one of the important contribution in understanding the pathology. A battery of audiological and vestibular tests should be performed to deduct help in localising pathology in sensory or neural areas and a single test cannot solely be relied upon. In this study a significant role has also been played by bithermal caloric stimulation of vestibular organs. This test is simple and quick, whether it is normal or abnormal it contributes towards understanding the site of lesion. Electronystagmography cannot be depended for diagnosis and is only supportive. The role of radiology and haematology cannot be ignored in assesing these patients. The commonest pathology in this series has been Menier's disease to be followed by Vertebrobasilar and Psychosomatic problems. Streptomycin toxicity should be kept in mind in our practice

El abordaje retrolaberíntico del ángulo pontocerebeloso / Retrolabirintine approach of pontocerebellar angle

Se presentan tres casos de abordaje retrolaberíntico del ángulo pontocerebeloso para la sección de la rama vestibular del VIII par en un enfermo con enfermedad de Meniére, en la resección de un quiste subaracnoideo y en la descompresión microvascular del nervio facial, a causa de un espasmo hemifacial. En todos los casos se conservó la audición. Se hace un análisis sobre las ventajas de esta vía de acceso al ángulo pontocerebeloso, la cual permite visualizar desde el V hasta el XI pares craneales así como las estructuras adyacentes, todo ello con poca morbimortalidad