Provocation of endolymphatic hydrops with a prick test in Meniere's disease.

This study was conducted to test the hypothesis that antigenic challenge is an important stimulative factor for an episode of endolymphatic hydrops. The study was held in a tertiary care center for patients with probable or definite Meniere's disease. The prick test, which included dietary and inhalant allergens, was applied to all patients with a Multi-Test Applicator (Lincoln Diagnostics, Decatur, Ill). Patients were tested with electrocochleography before and after the prick test. The positive allergen was diluted in 1/10 of a prick test dose, and patients were provoked and tested again. A negative summating potential/action potential (SP/AP) amplitude ratio greater than 0.5 was used as the main outcome measure. Pretest, posttest, and postprovocation SP/AP amplitude ratios were compared. A total of 80 diseased and 16 normal ears of 48 patients with Meniere's disease were assessed. All patients were found to be atopic, but none had allergic symptoms. No symptom like vertigo or fullness was seen after the prick test was performed. In all, 30 patients had tinnitus and fullness in the diseased ear, and 6 patients had vertigo after the provocation. The SP/AP ratio was greater than 0.50 in 23 diseased (29%) and 3 normal (19%) ears before the prick test. After the prick test, 62 diseased (78%) and 13 normal (81%) ears had endolymphatic hydrops. These numbers did not change much after the provocation. Results reported here support the role of antigenic stimulation for episodes of Meniere's disease. Endolymphatic hydrops was the atopic reaction that occurred in most study patients.

Efficacy of vestibular rehabilitation on chronic unilateral vestibular dysfunction.

OBJECTIVE: To assess the efficacy of vestibular rehabilitation exercises on patients with chronic unilateral vestibular dysfunction. DESIGN: Prospective study. SETTING: Physical Medicine and Rehabilitation Clinic and Otolaryngology Clinic of a tertiary referral hospital. SUBJECTS: One-hundred and twenty-five patients with unilateral chronic vestibular dysfunction were included in the study. INTERVENTIONS: Eight-week, two-staged (clinic and home) vestibular rehabilitation programme with components of Cawthorne-Cooksey and Norre exercises was applied. MAIN OUTCOME MEASURES: Dizziness Handicap Inventory (DHI) and visual analogue scale (VAS) were completed three times (at the beginning, end of the second week and end of the treatment). RESULTS: Data for 112 patients in the first stage and 93 patients in the second stage were evaluated because of insufficient compliance of the other patients. The mean DHI score was decreased from 50.42 +/- 24.12 points to 21.21 +/- 15.97 points (p < 0.001) at the end of first two weeks, and to 19.93 +/- 19.33 points at the end of the whole treatment. The mean VAS score was decreased from 5.87 +/- 2.27 to 2.02 +/- 1.75 (p < 0.001) at the end of second week, and to 1.51 +/- 1.29 at the end of eighth week. In respect to both VAS and DHI scores, improvement was noted in 67 patients (77.4%). Age, gender and disability level had no predictive value about therapy outcome. CONCLUSIONS: There was a fast recovery in the supervised exercise session, whereas there was no significant difference in the home exercise session. These findings suggest that either supervised exercise is better than home exercise or that 10 supervised sessions are sufficient to get the end result.