ABSTRACT
OBJECTIVES: To investigate whether or not and how often there is otolith dysfunction in an acute attack of Ménière's disease. PATIENTS: Twenty-two definite cases of unilateral Ménière's disease diagnosed in accordance with the 1995 criteria of the American Academy of Otolaryngology-Head and Neck Surgery for Ménière's disease. INTERVENTION: Subjective visual vertical (SVV) test was performed before, at, and after acute attacks on 22 patients with unilateral Ménière's disease who showed normal tilts of SVV before acute attacks. MAIN OUTCOME MEASURE: Abnormal tilts of SVV. RESULTS: Of 22 cases, 14 (63.6%) with unilateral Ménière's disease showed abnormal tilts of SVV in acute attacks. The tilts were toward the side of the affected ear in 13 (92.9%) of them. Abnormal tilts returned to normal within a few weeks after the acute attacks in 12 (85.7%) of the 14 cases with unilateral Ménière's disease. CONCLUSION: Otolith dysfunction occurred in acute attacks in a considerable number of patients with Ménière's disease. Subjective visual vertical can be used as a good tool for the evaluation of otolith dysfunction at acute attacks in patients with Ménière's disease.
Subject(s)
Meniere Disease/psychology , Visual Perception/physiology , Acute Disease , Adult , Aged , Aged, 80 and over , Ataxia/complications , Caloric Tests , Female , Humans , Male , Meniere Disease/physiopathology , Middle Aged , Nystagmus, Pathologic/complications , Otolithic Membrane/physiopathology , Vestibular Function Tests , Young AdultABSTRACT
OBJECTIVE: Erbium (Er.) YAG laser may be usable for middle ear surgery because of its ability to ablate bony tissue. We investigated the inner ear damage caused by the fenestration to the inner ear with Er. YAG laser. DESIGN: We investigated the influence of Er. YAG laser on the inner ear using electrophysiological technique. RESULTS: Several cases had a decrease in endocochlear potential (EP) and cochlear microphonics (CM) after the fenestration to the inner ear. CONCLUSIONS: Er. YAG laser is safe if it is used for the small and superficial fenestration to the stapes footplate. However, a few extra pulses after fenestration are dangerous.
Subject(s)
Fenestration, Labyrinth/methods , Laser Therapy , Acoustic Stimulation , Animals , Cochlear Microphonic Potentials/physiology , Guinea PigsABSTRACT
In this study, we measured human endolymphatic sac potential (ESP) in 8 patients with vestibular schwannoma and in five patients with Ménière's disease during surgery. ESP was measured with a glass electrode filled with 154 mM NaCl and with an outside tip diameter ranging from 2 to 3 microm. The mean value of human ESP in patients with vestibular schwannoma was +13.3+/-1.9 mV. Since electron microscopy showed that the endolymphatic sacs of the eight patients with vestibular schwannoma were normal in the ultrastructures the value can be close to normal human ESP. While in Ménière's disease, three cases showed low potentials and two cases showed almost the same values observed as in the eight patients with vestibular schwannoma. In the two cases with Ménière's disease, the epithelial cells of the endolymphatic sac were preserved. Our study can be considered as the first successful measurement of human ESP and revealed the existence of Ménière's disease having normal endolymphatic sac in function as well as morphology.
Subject(s)
Endolymphatic Sac/physiopathology , Meniere Disease/physiopathology , Neuroma, Acoustic/physiopathology , Adult , Aged , Electrophysiology , Endolymphatic Sac/pathology , Epithelial Cells/pathology , Female , Humans , Male , Meniere Disease/pathology , Microscopy, Electron , Microscopy, Electron, Scanning , Middle Aged , Neuroma, Acoustic/pathologyABSTRACT
OBJECTIVE: Vertiginous attacks of Ménière's disease (MD) are characterized by various types of vertigo, namely rotatory vertigo, dizziness and drop attack. When a patient complains of dizziness without spontaneous nystagmus, otolith dysfunction cannot be ruled out. The purpose of this study was to evaluate otolith dysfunction during vertiginous attacks of MD or delayed endolymphatic hydrops. MATERIAL AND METHODS: Vestibular function tests were carried out daily for several days in 11 patients (MD, n = 9; delayed endolymphatic hydrops, n = 2) during vertiginous attacks. Otolith function was evaluated by means of the static torsional position of both eyes [static ocular torsion (OT)] whilst in an upright position. We defined otolith dysfunction as an abnormal change (range) in OT without spontaneous nystagmus or as an abnormal change in OT without a change in spontaneous nystagmus. RESULTS: Four patients had an abnormal change (range) in OT without spontaneous nystagmus or an abnormal change in OT without a change in spontaneous nystagmus during vertiginous attacks of MD. CONCLUSIONS: Otolith dysfunction occurs in patients during vertiginous attacks of MD. In cases of ataxia without spontaneous nystagmus, otolith dysfunction most likely causes atypical attacks of MD.
