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)

Hypersensitivity to inhalants and food in balance disturbances.

INTRODUCTION: The prevalence of allergy in patients with Menière's disease was established as approximately 41.6% for inhalants and 26.6% for food. These are elevated values in relation to the prevalence of allergy in the general population, which varies from 9% to 30% for inhalants (in Brazil) and from 1% to 3% for food. OBJECTIVES: To evaluate the prevalence of type I hypersensitivity reactions to inhalants and food in the patients of the Neurotology Sector of the "Hospital das Clinicas" of the University of São Paulo Medical School and to describe vestibular symptoms of these patients. METHOD: Seventy-five patients with imbalance due to peripheral origin were evaluated by a questionnaire for the clinical characterization of the cochleo-vestibular symptoms and underwent the prick test for 13 inhalants and 5 food stuffs. RESULTS: Twenty-five (33.3%) patients presented positive prick tests and, at least, one food allergen. Four patients presented positive prick tests without allergy symptoms. The prevalence of the complaint of rotatory dizziness was similar among the patients with positive and negative prick tests. CONCLUSION: The prevalence of Type I hypersensitivity reactions to inhalants and food in the population evaluated was greater than in the general population. The vestibular symptoms did not differ among the patients with either positive or negative prick tests. However, a larger sample size should be obtained for the data to be more reliable and compared to a control group.

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.

Meniere's disease: overview, epidemiology, and natural history.

Meniere's disease is a disease of the inner ear characterized by a triad of symptoms: vestibular symptoms, auditory symptoms, and pressure. The pathologic correlate of Meniere's disease is endolymphatic hydrops and the etiopathogenesis involves a deficiency in the absorption of endolymph. The pathophysiology of the symptoms is still disputed: membranous ruptures, pressure and mechanical displacement of the end organs, or obstruction followed by an abrupt clearance of the endolymphatic duct. The course of the disease may be progressive or nonprogressive and, in addition to the typical presentation of Meniere's disease, two variations of the disorder have been identified: cochlear Meniere's disease, and vestibular Meniere's disease. It can be further broken into two subsets: Meniere's syndrome, with a known and well-established cause, and Meniere's disease, in which the cause seems to be idiopathic. It is likely that there are racial (genetic) as well as environmental factors that influence differences in incidence among countries and among various sections of countries. The disease is much more common in adults, with an average age of onset in the fourth decade, the symptoms beginning usually between ages 20 and 60 years. Meniere's disease is (grossly) equally common in each sex, and right and left ears are affected with fairly equal frequency. The diagnosis of Meniere's disease is by exclusion, and a careful history is the most important guide to a correct diagnosis. Its medical treatment is largely empiric. Surgery can be considered when, even after medical therapy, the disease progresses and the symptoms become intractable. Surgery may be either conservative or destructive. Bilaterality must be considered when deciding the best surgical option for a patient with Meniere's disease. It is the authors' opinion that endolymphatic sac surgery is an extension of conservative treatment.

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

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