Intermittent pressure therapy of intractable Meniere's disease and delayed endolymphatic hydrops using the transtympanic membrane massage device: a preliminary report.

CONCLUSION: Middle ear pressure treatment by the tympanic membrane massage (TMM) device as well as the Meniett device is effective and provides minimally invasive options for intractable vertigo in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH). OBJECTIVE: The effects of the TMM device were evaluated according to the criteria of the Japan Society for Equilibrium Research (1995) in patients with MD and DEH and compared to those in patients treated with the Meniett device. METHODS: Twelve ears of 10 patients (MD 8; DEH 2) were treated with the TMM device, while 16 ears of 15 patients (MD 11; DEH 4) were treated with the Meniett device. All the patients had failed to respond to medical treatment including diuretics before each pressure treatment, and were followed up for more than 12 months after treatment. Tympanotomy is necessary before treatment for the Meniett device, not but for the TMM device. RESULTS: With both devices, the frequency of vertigo after treatment was significantly lower than before treatment (p < 0.05). The time course of vestibular symptoms with the TMM device was not significantly different from that with the Meniett device (p > 0.05). No complications were directly attributable to treatment with the TMM device.

Prognosis of sudden low-tone loss other than acute low-tone sensorineural hearing loss.

CONCLUSION: In clinical practice, sudden low-tone loss other than acute low-tone sensorineural hearing loss (ALHL) shows a potential for recurrence. OBJECTIVE: ALHL is often associated with recurrence and/or progression to Ménière's disease. We examined the prognosis of patients with sudden low-tone loss who were not classified in the audiometric definition of ALHL. METHODS: Sixty-three patients diagnosed at the university hospital with idiopathic sudden low-tone loss of sensorineural hearing loss and without subjective vertigo were followed up in the long term with a mean of over 4 years. The rates of recurrence and/or progression to Ménière's disease for patients with low-tone loss type other than ALHL (non-ALHL) were compared with those for ALHL patients. RESULTS: The recovery rate at the initial treatment was 47.6% for non-ALHL and 62.9% for ALHL. A Kaplan-Meier plot indicated that cumulative recurrence rates for non-ALHL were 20.2% at 1 year and 43.5% at 5 years, whereas the rates for ALHL were 12.2% at 1 year and 31.3% at 5 years. There was no statistically significant difference between the two patient groups.

Recurrence rate of idiopathic sudden low-tone sensorineural hearing loss without vertigo: a long-term follow-up study.

OBJECTIVE: Among the types of idiopathic sudden sensorineural hearing loss, low-tone type without vertigo has attracted attention for its recurrence and progression to Ménière's disease. The purpose of this article is to characterize the recurrent type of sudden low-tone sensorineural hearing loss without vertigo using neuro-otologic examination. STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. INTERVENTIONS: Diagnostic and prognostic. METHODS: Long-term follow-up of 82 patients diagnosed at the university hospital with idiopathic sudden low-tone sensorineural hearing loss without vertigo. The recurrence rate was determined according to results of electronystagmography (ENG) and electrocochleography (ECochG) tests at the onset of the first episode of hearing loss. RESULTS: Forty percent of the patients experienced recurrent hearing loss. Among the patients who experienced recurrence, 45% had a recurrence within 6 months from the first episode of hearing loss. The recurrence rate varied largely according to the results of the ENG and ECochG tests. In patients with an elevated ratio of the summating potential to the action potential and spontaneous nystagmus on ENG, the recurrence rate was 78.6%. However, in those with a normal ratio of the summating potential to the action potential and without spontaneous nystagmus, the recurrence rate was 31.8%. CONCLUSION: Our results indicate that idiopathic sudden low-tone sensorineural hearing loss without vertigo has a high recurrence rate when vestibular alteration and endolymphatic hydrops are detected on initial examination. A combination of nystagmus detection and ECochG test well characterizes the pathophysiology of sudden low-tone sensorineural hearing loss without vertigo.

Prognostic value of initial electronystagmography findings in idiopathic sudden sensorineural hearing loss without vertigo.

OBJECTIVE: We used electronystagmography (ENG) to characterize recurrent hearing loss and its progression to definite Ménière's disease in patients with idiopathic sudden sensorineural hearing loss (SSHL) without subjective vertigo. METHODS: We reviewed medical records of 1,334 patients with unilateral hearing loss initially diagnosed with idiopathic SSHL between 1985 and 2003 at our university hospital. Of the 1,334 patients, we examined 127 (86 with low-tone and 41 with high-tone SSHL) who underwent ENG within 30 days of the initial diagnosis and who could be followed up during the long term. RESULTS: Spontaneous nystagmus (SN) was observed in approximately half of the vertigo-unaccompanied group. Long-term follow-up with a mean of 67 months revealed that the recurrence rate of hearing loss was 51.2% in low-tone SSHL patients with SN. The recurrence rate of hearing loss was 27.9% in low-tone SSHL patients without SN. Progression to Ménière's disease occurred in 14.0% of the low-tone-type and 12.5% of the high-tone-type patients when SN was detected. In contrast, in both the low-tone-type and high-tone-type groups, none developed Ménière's disease when SN was absent. CONCLUSION: Our results suggest that the initial ENG findings could provide prognostic information for idiopathic SSHL patients, even those who have no vestibular symptoms at the first visit.

Prognosis of low-tone sudden deafness - does it inevitably progress to Meniere's disease?

CONCLUSION: We conclude that not all low-tone sudden deafness (SD) patients suffered from endolymphatic hydrops even if they had vertigo attack at the onset and that electrocochleography (ECochG) was a useful prognostic tool. OBJECTIVES: To investigate whether low-tone SD was a precursor of Meniere's disease and whether patients with low-tone SD suffered from endolymphatic hydrops. PATIENTS AND METHODS: This was a retrospective case review in the university hospital. A total of 184 patients with low-tone SD were divided into two groups with single and recurrent episodes. The progress, follow-up audiograms, and ECochG results of the patients were reviewed and compared with those of patients with high-tone SD and Meniere's disease. RESULTS: In all, 83 of 177 patients with low-tone SD unaccompanied by vertigo had recurrent hearing loss; 15 of the 83 developed vertiginous attacks. The remaining 94 patients had a single episode. Three of the seven patients with low-tone SD accompanied by vertigo had recurrent hearing loss; two of the three were subsequently confirmed to have Meniere's disease. The other four had a single episode. No difference in rate of progress from SD to Meniere's disease was observed among the low-tone and the high-tone SD groups. The average -SP/AP of each group with a single episode is smaller than that of other groups with recurrent episodes and Meniere's disease.

[Middle ear overpressure treatment in severe Menière's disease].

To evaluate the therapeutic effect of middle ear pressure pulse on endolymphatic hydrops in humans, Meniett20k was used for 12 months in two severe elderly patients with definite Meniere's disease. The average number of vertigo occurrences in the 6 months before treatment and in the 12 months after treatment started was compared. Numeric values (NV) among patients were calculated and categorized into an improved group (NV = 1-40). For hearing function, the pure-tone average (PTA) before and 12 months after treatment started was compared. PTA was calculated based on the following equation: PTA = (A + 2XB + C)/4. A, B, and C were thresholds of the pure-tone audiometory at 0.5, 1.0, and 2.0 kHz. In one case, hearing function was unchanged, but deteriorated in the other. Pressure pulse treatment may thus be useful in severe cases of Meniere's, especially in the elderly, bilateral cases, and in endolymphatic hydrops in a single hearing ear.