Long-term effect of transtympanic intermittent pressure therapy using a tympanic membrane massage device for intractable meniere's disease and delayed endolymphatic hydrops.

BACKGROUND: A 12-month follow-up study showed that middle ear pressure treatment with a transtympanic membrane massage (TMM) device had a similar effect to a Meniett device. OBJECTIVES: The effects of pressure treatment with a TMM device were retrospectively compared to the effects of treatment with a Meniett device in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) who were followed for a minimum of 24 months. MATERIALS AND METHODS: Twenty-seven patients were treated with the TMM device and 14 patients were treated with a Meniett device. The insertion of a transtympanic ventilation tube was necessary for the Meniett device but not for the TMM device. RESULTS: In patients treated with the TMM and Meniett devices, the frequency of vertigo significantly improved at 19-24 months after treatment. The distribution of vertigo at 19-24 months after treatment did not differ between the patients treated with the two types of devices. Pressure treatment for 8 months or more was suitable to achieve remission. CONCLUSIONS AND SIGNIFICANCE: Middle ear pressure treatment for 8 months or more with a TMM or Meniett device was equally effective and provided minimally invasive treatment options for intractable MD and DEH.

Effects of transtympanic intermittent pressure therapy using a new tympanic membrane massage device for intractable Meniere's disease and delayed endolymphatic hydrops: a prospective study.

BACKGROUND: The retrospective study showed that the effect of the middle ear pressure treatment by the tramstympanic membrane massage (TMM) device was similar to that of the Meniett device. OBJECTIVES: The new TMM device named EFET device was prospectively evaluated in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) and we compared the effects to the Meniett device. MATERIALS AND METHODS: 23 ears of 19 patients were treated with an EFET device, and 17 ears of 15 patients were treated with the Meniett device. All patients suffering from intractable MD and DEH were treated for 4 months. The insertion of a transtympanic ventilation tube was necessary for the Meniett device, but not the EFET device. RESULTS: In patients treated by the EFET and Meniett devices, the frequency of vertigo significantly improved after treatment. The distribution of vertigo outcomes at 4 months after treatment did not differ between patients treated with the both devices. CONCLUSIONS AND SIGNIFICANCE: Middle ear pressure treatment by the EFET device is effective and provides minimally invasive options for intractable MD and DEH like the Meniett device.

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.

Evaluation of the vestibular evoked myogenic potential during parabolic flight in humans.

The purpose of this study was to investigate how gravity affects the vestibular evoked myogenic potential (VEMP). Eight healthy subjects (seven men, one woman; age range 19-45 years) participated in experiments in which three different gravity levels [microgravity (MG), normal gravity (NG), and hypergravity (HG)] were imposed during a parabolic flight procedure. The VEMP was evoked in response to an intense mono-aural click while the subjects kept the sternocleidomastoid (SCM) muscle contracted bilaterally. Background electromyographic activity of the SCM during the test was corrected. The p13-n23 amplitude was significantly greater under MG than under NG or HG. There was no difference in p13 latency between the three gravity levels. Possible mechanisms related to this phenomenon are discussed.

Effects of vestibular nerve section on sound-evoked myogenic potentials in the sternocleidomastoid muscle of monkeys.

OBJECTIVE: The aim of this study was to elucidate the neural pathway for sound-evoked myogenic potentials (SEMPs) in monkeys with characteristics similar to those of vestibular evoked myogenic potentials in humans. METHODS: Six macaque monkeys were examined. The effects of total and selective vestibular nerve section on the SEMPs were evaluated in three monkeys. RESULTS: After total vestibular nerve section, the SEMPs and caloric nystagmus were eliminated, and the auditory brainstem response remained. After selective superior vestibular nerve section, the SEMPs remained, but caloric nystagmus was eliminated. CONCLUSIONS: The inferior vestibular nerve comprises a neural pathway for SEMPs in monkeys. SIGNIFICANCE: SEMP in monkeys may provide a model of human VEMPs.

Effects of selective cochlear toxicity and vestibular deafferentation on vestibular evoked myogenic potentials in guinea pigs.

CONCLUSION: The findings suggest that sound-evoked myogenic potentials on the guinea pig sternocleidomastoid muscle (SM) originate from the vestibular end organ and not from the cochlea of the inner ear. OBJECTIVE: Studies in animals of the sound evoked vestibular myogenic potentials on the SM should aid in elucidating the pathway of the vestibular-evoked myogenic potential (VEMP). However, details of the pathway of the VEMP remain to be elucidated. This study aimed to clarify aspects of this pathway. MATERIALS AND METHODS: In the present study, short latency biphasic myogenic potentials on the SM in guinea pigs were induced by an intense brief sound. RESULTS: The thresholds of the potentials were 67 dB SPL above those of the auditory brainstem response (ABR). The potentials were eliminated by a vestibular deafferentation, but were observed after selective cochlea toxicity using an amikacin injection.

Sound-evoked myogenic potentials on the sternocleidomastoid muscle in monkeys.

CONCLUSION: We recorded sound-evoked myogenic potentials of the sternocleidomastoid (SCM) muscle using awake monkeys. The characteristics of these potentials are similar to those of vestibular evoked myogenic potentials (VEMPs) in humans, suggesting that the sound-evoked myogenic potentials of the SCM muscle in monkeys may be utilized as an animal model of VEMPs. OBJECTIVE: The pathway of the VEMPs remains uncertain as no animal model has yet been used to record sound-evoked myogenic potentials in the SCM muscle. Therefore, the present study aimed to establish an animal model of VEMPs using macaque monkeys. MATERIALS AND METHODS: Four macaque monkeys were used. A pair of electrodes was attached on the SCM muscle ipsilateral side to the intense sound stimulation. RESULTS: The sound-evoked myogenic potentials of the SCM muscle exhibited a biphasic waveform. When a click at 125 dBSPL was applied, the peak latency of the first positive wave was 12.5 ms and was not delayed when the stimulating sound intensity was reduced. The thresholds of the myogenic potentials were 103 dBSPL, which were 43 dB higher than those of the auditory brainstem response (ABR). When a short tone burst was applied, the reactive optimal frequency of the myogenic potentials was relatively low (500-1000 Hz).