Effect of Late-Stage Meniere's Disease and Vestibular Functional Impairment on Hippocampal Atrophy.

OBJECTIVE: We investigated correlations among clinical features, degree of inner ear endolymphatic hydrops (EH), and hippocampal volume (HV) in different stages of Meniere's disease (MD). METHODS: From February 2021 to April 2022, clinical data were collected from 99 patients (39 males, 60 females, mean age: 50.4 ± 10.0 [range: 26-69] years) with unilateral MD admitted to the Department of Vertigo Disease of Shandong ENT Hospital. The left and right ears were affected in 64 and 35 patients, respectively. There were 50 and 49 cases in early (Stages 1, 2) and late stages (Stages 3, 4), respectively. Fifty healthy participants were included as controls. Audiovestibular function test results, EH grading using gadolinium-enhanced magnetic resonance imaging (MRI), and HV determined on MRI were analyzed for patients at different stages of MD. RESULTS: Between-group comparisons of early and late MD revealed significant differences in the disease course, vestibular function (VF), degree of EH, and HV. There were no significant between-group differences based on age, sex, affected side, subjective degree of dizziness, hospital anxiety, or depression. Mean HV in patients with early-stage MD was correlated with the canal paresis value of the caloric test and pure tone hearing threshold, HV in late-stage patients was correlated with vestibular EH. CONCLUSION: Patients with late-stage MD exhibited severe auditory and VF impairments, increased EH, and atrophy of the HV. More advanced disease was associated with greater vestibular damage and degree of EH. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:410-418, 2024.

Triple Semicircular Canal Plugging versus Labyrinthectomy for Meniere Disease: A Retrospective Study.

OBJECTIVES: The study goals were to compare the long-term efficacy of semicircular canal plugging (SCP) with labyrinthectomy in the treatment of advanced Meniere's disease (MD). STUDY DESIGN: A retrospective study. SETTING: Single tertiary medical center. METHODS: A total of 116 MD patients (TSCP group of 90; labyrinthectomy group of 26) with complete medical documents in Shandong Provincial ENT Hospital, from March 2017 to March 2019 were retrospectively analyzed, including a battery of auditory and vestibular function tests, recovery time from imbalance and function level scores (FLS). RESULTS: The total control rate of vertigo in the TSCP group was 96.7% (87/90). The rate of hearing loss was 23.3% (21/90). The control rate of vertigo in the labyrinthectomy group was 100% (26/26). All patients lost their auditory function after labyrinthectomy with a 100% hearing loss rate. There was no significant difference in the vertigo control rate between the two groups (P > 0.05). The hearing loss rate in the TSCP group was significantly lower than that in the labyrinthectomy group (P < 0.00). The median time recovered from imbalance was 15 days in TSCP group and 21 days in labyrinthectomy group, which is significantly different (P < 0.05). There was no significant difference in the FLS between the two groups (P > 0.05). CONCLUSIONS: Compared to labyrinthectomy, TSCP can preserve hearing at a high probability; meanwhile, otolith organ function preservation benefits patients from faster vestibular compensation. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:3178-3184, 2023.

Long-term efficacy of dexamethasone treatment via tympanic antrum catheterization for intractable Meniere's disease.

Objective: To explore the long-term efficacy and safety of dexamethasone treatment via tympanic antrum catheterization (TAC) in intractable Meniere's disease (MD). Methods: In this retrospective analysis, 60 unilateral intractable MD patients treated with TAC in our hospital from January 2020 to August 2020 were followed for 2 years. Fifty patients who underwent endolymphatic sac decompression (ESD) and 50 patients who accepted intratympanic steroids (ITS) were established as the control groups. Vertigo control, hearing level, tinnitus, aural fullness and functional level were assessed during the study. Results: The effective vertigo control rate of intractable MD patients with TAC treatment was 76.7% (46/60) after 2 years follow-up, with a complete control rate of 58.3% (35/60) and a substantial control rate of 18.3% (11/60). The vertigo control rate of TAC was comparable to that of ESD (χ 2 = 0.313, p > 0.05), and significantly higher than that of ITS (χ 2 = 4.380, p < 0.05). The hearing loss rate of these patients was 10.8% (4/37), which was not significantly different from the control groups (χ 2 = 2.452, p > 0.05). The tinnitus improvement rate of patients with TAC was 56.7% (34/60), which was significantly higher than that of patients with ESD (χ 2 =11.962, p < 0.001) and ITS (χ 2 =15.278, p < 0.001). The aural fullness improvement rate in the TAC group was 56.7% (34/60), which was significantly higher than that in the ESD (χ 2 = 11.962, p < 0.001) and ITS groups (χ 2 = 5.635, p < 0.05). The functional level improvement rate in the TAC group was 71.7% (43/60), which was much higher than that in the ITS group (χ 2 = 17.256, p < 0.001), but there was no significant difference between TAC and ESD (χ 2 = 0.410, p > 0.05). No patients had complications or adverse reactions following TAC treatment. Conclusion: Dexamethasone treatment via TAC can effectively control vertigo attacks and improve related symptoms of intractable MD patients, providing valuable new insights into the treatment of MD.

Sensory organization of balance control in children with vestibular migraine and recurrent vertigo of childhood.

Background: Migraine plays an important role in some subgroups of children with recurrent vertigo. Moreover, the migraine component varies from definite to possibly absent as defined in this spectrum of three disorders-vestibular migraine of childhood (VMC), probable VMC (pVMC), and recurrent vertigo of childhood (RVC). However, studies on the sensory organization of balance control in these three disorders are rare. Objective: To explore the balance control of children with RVC, VMC, and pVMC, when the three sensory systems are challenged. Method: A retrospective analysis was performed on 125 children with VMC (18 female and 15 male; aged 11.64 ± 2.74), pVMC (10 female and eight male; aged 11.78 ± 2.51), and RVC (32 female and 42 male; aged 11.10 ± 2.60). All children in each subtype were divided into groups of children aged ≤ 12 years old and 13-17 years old. Vestibular examination screening and assessment for postural control using the six conditions of the sensory organization test (SOT) were performed. The three primary outcome measures were: equilibrium score (ES), strategy score (SS), and sensory analysis score of the SOT. Results: Equilibrium score under six different conditions and composite score increased with age (all P-values < 0.05). The somatosensory and visual scores also improved with growing (P-values < 0.05). However, vestibular scores did not increase significantly with age as the other senses did (P > 0.05). In the children ≤ 12 year-old group, children with VMC had a significantly higher visual preference score than those with pVMC and RVC (P < 0.05). There was an effect of age on the horizontal HIT. Ocular vestibular evoked myogenic potential (oVEMP), cervical vestibular evoked myogenic potential (cVEMP), and unilateral weakness (UW) values showed no significant difference among three diseases. Conclusion: Compared with patients at the age of 13-17 years old and with RVC and pVMC (both ≤ 12 years old), children with VMC had a higher degree of reliance on visual signals to maintain their balance and a poorer central integration of peripheral information before reaching 12 years of age. In addition, vision may predominate by weakening vestibular function based on visuo-vestibular interactions. It must be noted that peripheral vestibular examinations could not distinguish the three disease subtypes.

Dexamethasone protects the hearing of Meniere's disease patients after triple semicircular canal plugging.

Background: TSCP has shown its efficacy in vertigo control for intractable Meniere's disease. However, hearing impairment remains a problem and hampered the application of the surgery.Aims/objectives: To investigate the effect of dexamethasone on the hearing of Meniere's disease patients after TSCP to determine whether inflammation is involved in this processMaterial and methods: Meniere's disease patients who received TSCP surgeries were treated with or without dexamethasone postoperatively. All patients' hearing function were evaluated during a follow up of 2 years after surgery and compared between the two groups.Results: Hearing worsening and word recognition score loss were milder in the dexamethasone group than in the non-dexamethasone group. The rates of profound hearing worsening and word recognition score loss remained significantly lower in the dexamethasone group than in the non-dexamethasone group even 2 years after surgery.Conclusions: Dexamethasone protects the hearing of Meniere's patients after TSCP. Inflammation may be involved in the mechanism by which TSCP causes hearing impairment in these patients.Significance: This finding suggests that steroids should be used routinely after TSCP for hearing preservation, and operative precedures need to be modified to minimize inflammation in the inner ear.

Long-term outcomes of triple semicircular canal plugging for the treatment of intractable Meniere's disease: A single center experience of 361 cases.

INTRODUCTION: Meniere's disease is a common chronic inner ear disease. Because the definitive pathogenesis is still unknown, there is currently no cure for this disorder. Semicircular canal plugging (SCP), first used to treat patients with intractable benign paroxysmal positional vertigo, has since been applied to patients with intractable peripheral vertigo. This study was aimed to explore the long-term efficacy of triple semicircular canal plugging (TSCP) in the treatment of intractable Meniere's disease (MD) so as to provide a new method in the framework of treatment with MD. METHODS: Three hundred and sixty-one unilateral MD patients, who were treated with TSCP in our hospital between Dec. 2010 and Sep. 2016, were recruited in this study for retrospective analysis. Vertigo control and auditory function were monitored during a period of two-year follow-up. Seventy three patients who were subjected to intratympanic gentamicin were selected as a control group. Pure tone audiometry, caloric test, vestibular evoked myogenic potential (VEMP) were performed in two-year follow-up. RESULTS: The total control rate of vertigo in TSCP group was 97.8% (353/361) in the two-year follow-up, with complete control rate of 80.3% (290/361) and substantial control rate of 17.5% (63/361). The rate of hearing loss was 26.3% (95/361). The total control rate of vertigo in intratympanic gentamicin group was 83.6% (61/73), with complete control rate of 63.0% (46/73) and substantial control rate of 20.5% (15/73). The rate of hearing loss was 24.7% (18/73). The vertigo control rate of TSCP was significantly higher than that of chemical labyrinthectomy(χ2 = 24.798, p <  0.05). There was no significant difference of hearing loss rate between two groups. (χ2 = 0.087, p >  0.05). CONCLUSION: Triple semicircular canal plugging (TSCP), which can reduce vertiginous symptoms in patients with intractable Meniere's disease (MD), represents an effective therapy for this disorder. It might become a new important method in the framework of treatment with MD.

Otolith dysfunction in recurrent benign paroxysmal positional vertigo after mild traumatic brain injury.

BACKGROUND: The pathogenesis of recurrence of traumatic benign paroxysmal positional vertigo (BPPV) is poorly understood by far. OBJECTIVES: To evaluate the value of secondary otolith dysfunction using vestibular evoked myogenic potential (VEMP) test in the pathogenesis of recurrence of BPPV after mild traumatic brain injury (mTBI). MATERIAL AND METHODS: We reviewed 42 patients with BPPV after mTBI. According to recurrence, patients were divided into two groups. Both cervical VEMP (cVEMP) and ocular VEMP (oVEMP) tests were performed on all of them. RESULTS: We detected abnormal cVEMP responses in four (26.7%) patients in the recurrent BPPV group after mTBI and five (18.5%) patients in the non-recurrent BPPV group after mTBI, and there was no significant difference between both groups. We detected abnormal oVMEP responses in nine (60.0%) patients in the recurrent BPPV group after mTBI and six (22.2%) patients in the non-recurrent BPPV group after mTBI, and there was a significant difference between both groups. CONCLUSIONS AND SIGNIFICANCE: Our study shows that oVEMP abnormalities in recurrent BPPV group after mTBI are significantly higher than those in non-recurrent BPPV group after mTBI. Therefore, we can conclude that secondary utricular dysfunction may be a potential pathogenesis of recurrence of traumatic BPPV.

Correlation between auditory-vestibular functions and estrogen levels in postmenopausal patients with Meniere's disease.

BACKGROUND: To investigate auditory and vestibular functions, estrogen levels, and its clinical correlation in postmenopausal females with Meniere's disease (MD). METHODS: We retrospectively analyzed the serum estradiol (E2) levels and the auditory and vestibular functions measured by auditory brainstem response (ABR) to high click rate, pure-tone audiometry (PTA), and caloric test on postmenopausal women who suffered from MD or not at the Specialist Clinic of Vertigo, Shandong Provincial Hospital, during September 2010 to October 2014. RESULTS: A total of 76 postmenopausal patients with MD and 50 healthy postmenopausal controls were included. The patients with MD had lower estrogen levels (22.50 ± 16.66 pg/mL vs 30.69 ± 18.59 pg/mL, P = 0.011), longer I-V interpeak latency of ABR (left 0.22 ± 0.16 mseconds vs 0.18 ± 0.10 mseconds, P = 0.118; right 0.24 ± 0.13 mseconds vs 0.17 ± 0.09 mseconds, P = 0.001), and higher unilateral weakness (UW) value (P < 0.001) in comparison with the controls. The mean pure-tone thresholds of at the speech frequency (500 Hz, 1 kHz, 2 kHz, and 3 kHz) were significantly elevated in patients with MD than those in the controls (left P < 0.001, right P < 0.01). The estradiol level of patients with MD was correlated with ABR latency (left r = -0.229, P < 0.05; right r = -0.220, P < 0.05) and UW value (r = -0.328, P < 0.05), but not with mean pure-tone threshold. CONCLUSIONS: Estrogen levels correlated with auditory and vestibular function in postmenopausal patients with MD. Low estrogen may be involved in the microcirculatory disturbance of the inner ear, affecting the occurrence and development of MD.