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1.
Medicine (Baltimore) ; 99(52): e23706, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350750

RESUMO

ABSTRACT: Vestibular disorders can manifest several patterns of horizontal vestibulo-ocular reflex (VOR) impairment, which can be detected by caloric test and video head impulse test (vHIT). Several studies have examined the patterns of caloric-vHIT response in Ménière disease (MD). The purpose of this study was to investigate the diversity of caloric-vHIT response and its related factors in unilateral MD patients. We also explore the possibility of assessing the progression of unilateral MD by using the horizontal VOR tests.Ninety-eight patients with unilateral MD were enrolled and underwent a battery of audio-vestibular evaluations, including the pure tone audiogram, caloric test, and horizontal vHIT. Some patients received the electrocochleography and glycerol test. The combined results of caloric test and horizontal vHIT were categorized qualitatively into 4 patterns: Pattern I: normal caloric and vHIT responses; Pattern II: abnormal caloric and normal vHIT responses; Pattern III: normal caloric and abnormal vHIT response; and Pattern IV: abnormal caloric and vHIT responses. The abnormal caloric results were semi-quantitatively subdivided into sub-patterns as mild, moderate, and severe abnormality. The associations between these patterns/sub-patterns and related factors were analyzed.Pattern I was found in 35 cases (35.7%), Pattern II in 57 (58.2%), and Pattern IV in 6 (6.1%). No patient had Pattern III. No significant differences were found between the patterns/sub-pattern distribution and age, electrocochleography, and glycerol test results. Disease duration was not associated with the pattern distribution, while remained a relation with sub-pattern distribution. The pattern/sub-pattern distribution varied significantly across MD stages. The proportion of pattern II or pattern IV increased with the stage of unilateral MD.MD can manifest several patterns of horizontal VOR impairment, of which the impaired caloric response with normal vHIT is the most common pattern. With the progression of unilateral MD, the caloric-vHIT pattern tends to shift, which may reflect the deterioration of endolymphatic hydrops and vestibular hair cells impairments.


Assuntos
Doença de Meniere/diagnóstico , Reflexo Vestíbulo-Ocular , Testes Calóricos , Estudos Transversais , Progressão da Doença , Feminino , Teste do Impulso da Cabeça , Humanos , Masculino , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade
2.
Artigo em Chinês | MEDLINE | ID: mdl-33040507

RESUMO

Objective:To analyze the clinical characteristics of patients with Meniere's disease and vestibular migraine, improve the understanding of such diseases for accurate treatment. Method:Eighteen patients with MD and VM were reviewed and the clinical characteristics of the patients were evaluated. Result:There were 4 males and 14 females whose average age was 55.2 years old. The average onset age was 36.5 years meanwhile the headache occured 7.5 years earlier than the vertigo. The average time of vertigo attacks was 30 min-24 h; The mainly kind of headache was unilateral pulsatile headache with or without vertigo attacks; All patients showed the characteristics of photophobia or phonophobia, 7 of them showed visual aura and 9 of them experienced vertigo attacks with headache but without auditory symptoms; 11 patients experienced motion sickness and 10 patients had a related family history. Electrocochleogram abnormal was 11 ears; c-VEMP abnormal was 11 cases; Caloric test abnormal was 13 cases; Velocity step test abnormal was 4 cases. Conclusion:MD and VM shows recurrent vertigo, There are evidences of hearing loss and abnormal changes of electrocochleogram、c-VEMP and lateral semicircular canal function in MD; VM experienced migraine attacks with the characteristics of photophobia、phonophobia and visual aura; The patients can be diagnosed with overlap syndrome when they fulfill the diagnostic criteria of MD and VM at the same time and the two diseases should be treated at the same time.


Assuntos
Doença de Meniere , Transtornos de Enxaqueca , Tontura , Feminino , Cefaleia , Humanos , Masculino , Doença de Meniere/complicações , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Vertigem/diagnóstico
3.
Neurology ; 95(17): e2409-e2417, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-32817190

RESUMO

OBJECTIVE: To determine the mechanism of ictal downbeat nystagmus in Ménière disease (MD), we compared the head impulse gain of the vestibulo-ocular reflex (VOR) for each semicircular canal between patients with (n = 7) and without (n = 70) downbeat nystagmus during attacks of MD. METHODS: We retrospectively analyzed the results of video-oculography, video head-impulse tests, and cervical vestibular-evoked myogenic potentials (VEMPs) in 77 patients with definite MD who were evaluated during an attack. RESULTS: Pure or predominant downbeat nystagmus was observed in 7 patients (9%) with unilateral MD during the attacks. All 7 patients showed spontaneous downbeat nystagmus without visual fixation with a slow phase velocity ranging from 1.5 to 11.2°/s (median 5.4, interquartile range 3.7-8.5). All showed a transient decrease of the head impulse VOR gains for the posterior canals (PCs) in both ears (n = 4) or in the affected ear (n = 3). Cervical VEMPs were decreased in the affected (n = 2) or both ears (n = 2) when evaluated during the attacks. Downbeat nystagmus disappeared along with normalization of the VOR gains for PCs after the attacks in all patients. During the attacks, the head impulse VOR gains for the PC on the affected side were lower in the patients with ictal downbeat nystagmus than in those without (Mann-Whitney U test, p < 0.001), while the gains for other semicircular canals did not differ between the groups. CONCLUSION: Downbeat nystagmus may be observed during attacks of MD due to an asymmetry in the vertical VOR or saccular dysfunction. MD should be considered in recurrent audiovestibulopathy and ictal downbeat nystagmus.


Assuntos
Doença de Meniere/fisiopatologia , Nistagmo Patológico/fisiopatologia , Adulto , Idoso , Estudos Transversais , Feminino , Teste do Impulso da Cabeça , Humanos , Imagem por Ressonância Magnética , Masculino , Doença de Meniere/complicações , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiologia , Reflexo Vestíbulo-Ocular , Estudos Retrospectivos , Canais Semicirculares/fisiopatologia , Potenciais Evocados Miogênicos Vestibulares
4.
Sci Rep ; 10(1): 12271, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32704101

RESUMO

The symptoms of Meniere's disease (MD) are generally considered to be related to endolymphatic hydrops (EH). There are many recent reports supporting the possibility that vasopressin (VP) is closely linked to the formation of EH in Meniere's disease. Based on this, we developed a clinically relevant animal model of Meniere's disease in which a VP type 2 receptor agonist was administered after electrocauterization of the endolymphatic sac. We report live imaging of the internal structure, and functional changes of the inner ear after electrocauterization of the endolymphatic sac and administration of a VP type 2 receptor agonist. In this model, the development of EH was visualized in vivo using optical coherence tomography, there was no rupture of Reissner's membrane, and low-tone hearing loss and vertiginous attacks were observed. This study suggested that acute attacks are caused by the abrupt development of EH. This is the first report of live imaging of the development of EH induced by the administration of a VP type 2 receptor agonist.


Assuntos
Doença de Meniere/diagnóstico , Doença de Meniere/fisiopatologia , Animais , Modelos Animais de Doenças , Hidropisia Endolinfática/diagnóstico por imagem , Hidropisia Endolinfática/etiologia , Hidropisia Endolinfática/fisiopatologia , Doença de Meniere/etiologia , Doença de Meniere/terapia , Tomografia de Coerência Óptica , Vasopressinas/farmacologia , Vasopressinas/uso terapêutico , Testes de Função Vestibular
5.
Expert Opin Pharmacother ; 21(14): 1753-1763, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32539493

RESUMO

INTRODUCTION: The term Meniere disease (MD) gathers a set of rare diseases involving the inner ear characterized by episodic vertigo associated with fluctuating auditory symptoms. Five clinical subgroups of patients have been defined, including familial MD, autoimmune MD, and MD with migraine. The diagnosis is based on clinical criteria as no biomarker is available, but genetic factors have a significant contribution in familial and non-familial MD. AREAS COVERED: In this review, the authors summarize the pharmacological treatment for vertigo in MD, providing evidence from preclinical and clinical studies. However, evidence supporting the efficacy for betahistine, diuretics, and intratympanic administration of corticosteroids or gentamicin is limited. EXPERT OPINION: Randomized clinical trials should consider stratification by MD clinical subgroups. The treatment plan should be personalized according to the clinical subgroup, hearing stage, duration of the disease, vertigo attack profile, and comorbidities. The treatment should include therapeutic counseling, sodium-free diet, high-water intake, and a diary of vertigo attacks with symptoms during the episodes to improve phenotyping. Migraine or autoimmune comorbidities will also require pharmacotherapy. Genetic testing by exome/genome sequencing should be discussed with the patient for familial MD and individuals with an early onset for genetic counseling and future gene therapies.


Assuntos
Doença de Meniere/tratamento farmacológico , Transtornos de Enxaqueca/tratamento farmacológico , Vertigem/tratamento farmacológico , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , beta-Histina/administração & dosagem , beta-Histina/uso terapêutico , Ensaios Clínicos como Assunto , Diuréticos/administração & dosagem , Diuréticos/uso terapêutico , Feminino , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Humanos , Doença de Meniere/complicações , Doença de Meniere/diagnóstico , Transtornos de Enxaqueca/complicações , Resultado do Tratamento , Vertigem/complicações , Vertigem/diagnóstico
6.
Am J Otolaryngol ; 41(4): 102498, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32354483

RESUMO

PURPOSE: Osmotic diuretics such as glycerol are used for diagnostic purposes in patients with a suspect of Meniere's disease (MD). Scientific evidence in the animal model and in humans has shown that glycerol can induce a reduction in endolymphatic hydrops; however, its use for therapeutic purposes in MD has never been reported. The aim of this study was to evaluate the effectiveness on symptom control of intravenous glycerol in a sample of patients with definite unilateral MD not responsive to dietary restrictions. MATERIALS AND METHODS: Forty patients with unilateral intractable MD were included in the study. After audio-vestibular evaluation, patients were treated with intravenous 10% glycerol with 0.9% sodium chloride, 0.5 g/kg ml once a day for 2 consecutive days every fifteen days for six months. Vertigo attacks were evaluated before and after therapy and categorized into classes A-F according to the 2015 Equilibrium Committee criteria. Tinnitus and quality of life were evaluated through the Tinnitus Handicap Inventory and the Functionality Level Scale questionnaires. RESULTS: Before treatment, patients had an average of 3.2 vertigo attacks/month; during the six months after treatment the average number of attacks/month decreased to 1.2 (p < 0.0001). At the end of the study period, 25 patients (62.5%) were in Class B vertigo control; 10 patients (25%) in Class C; and 5 patients (12.5%) in Class D. No patients were in Class A, E and F. No hearing deterioration was found in all treated patients. Quality of life according to administered questionnaires improved after treatment. CONCLUSIONS: In our sample, intravenous infusion of glycerol for two consecutive days every fifteen days for six months based on the patient's weight improved vertigo attacks and reduced the discomfort generated by tinnitus raising quality of life in patients with unilateral MD unresponsive to dietary restrictions.


Assuntos
Glicerol/administração & dosagem , Doença de Meniere/tratamento farmacológico , Diuréticos Osmóticos , Esquema de Medicação , Humanos , Infusões Intravenosas , Doença de Meniere/diagnóstico , Resultado do Tratamento
7.
Otolaryngol Head Neck Surg ; 162(2_suppl): S1-S55, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32267799

RESUMO

OBJECTIVE: Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. PURPOSE: The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.


Assuntos
Doença de Meniere/diagnóstico , Doença de Meniere/terapia , Audiometria , Aconselhamento , Diagnóstico Diferencial , Diuréticos/uso terapêutico , Orelha Interna/cirurgia , Gentamicinas/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Doença de Meniere/epidemiologia , Transtornos de Enxaqueca/diagnóstico , Educação de Pacientes como Assunto , Qualidade de Vida , Vertigem/diagnóstico , Doenças Vestibulares/diagnóstico
8.
Otolaryngol Head Neck Surg ; 162(4): 435-445, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32267819

RESUMO

This plain language summary explains Ménière's (pronounced men-yerz) disease (MD) to patients. The summary applies to patients aged 18 years and older with a suspected diagnosis of definite or probable MD. It is based on the 2020 "Clinical Practice Guideline: Ménière's Disease." This guideline uses published research to best advise health care providers and patients on the history and physical examination of patients with MD and how to diagnose and treat them. The guideline includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to facilitate shared decision making between patients and their health care providers.


Assuntos
Doença de Meniere/diagnóstico , Doença de Meniere/terapia , Humanos
9.
Otolaryngol Head Neck Surg ; 162(4): 415-434, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32267820

RESUMO

OBJECTIVE: Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many, and approaches typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. PURPOSE: The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.


Assuntos
Doença de Meniere/diagnóstico , Doença de Meniere/terapia , Humanos , Doença de Meniere/complicações
10.
J Laryngol Otol ; 134(4): 302-310, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32241307

RESUMO

BACKGROUND: Recent developments in magnetic resonance imaging have enabled demonstration of endolymphatic hydrops, and the clinical application of these imaging studies in Ménière's disease is being explored. OBJECTIVE: To evaluate our centre's experience to date of hydrops magnetic resonance imaging in patients with episodic vertigo. METHODS: Magnetic resonance imaging was performed using a high-resolution three-dimensional fluid-attenuated inversion recovery sequence on a 3 Tesla scanner at 4 hours following double-dose gadolinium administration. RESULTS: The study included 31 patients, 28 of whom had a clinical diagnosis of Ménière's disease. In unilateral Ménière's disease, magnetic resonance imaging was able to lateralise endolymphatic hydrops to the clinically symptomatic ear in all cases. Mild hydrops was often seen in clinically asymptomatic ears. CONCLUSION: There is a good correlation between the clinical symptoms and lateralisation of hydropic changes on magnetic resonance imaging. Further refinements of imaging techniques and grading system will likely improve the diagnostic accuracy and clinical utilisation of hydrops magnetic resonance imaging.


Assuntos
Hidropisia Endolinfática/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Doença de Meniere/diagnóstico , Adulto , Idoso , Feminino , Gadolínio/administração & dosagem , Humanos , Imageamento Tridimensional/métodos , Masculino , Doença de Meniere/classificação , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Reino Unido/epidemiologia , Vertigem/diagnóstico , Vertigem/epidemiologia
12.
Wien Klin Wochenschr ; 132(17-18): 521-525, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31997063

RESUMO

BACKGROUND: Menière's disease (MD) is a symptom complex which is characterized by episodes of vertigo, tinnitus and fluctuating sensorineural hearing loss, which worsens during the course of the disease. OBJECTIVE: Vertigo attacks (MD functional level scale) before compared to after cochlear implantation in patients with end-stage MD. DESIGN AND PATIENTS: In this questionnaire-based cross-sectional study eight patients with end-stage MD, who received a cochlear implant (CI) were analyzed. MAIN OUTCOME MEASURE: The effect of the CI on vertigo was measured preoperatively and postoperatively with the Menière's disease functional level scale and the Menière's disease outcome questionnaire. The primary outcome parameter influence of vertigo attacks on daily living was analyzed using the non-parametric Wilcoxon signed rank test before and after CI. SETTING: Department of otolaryngology of a medical university. RESULTS: The primary outcome measure influence of vertigo attacks on daily living as measured by the MD functional level scale improved significantly after CI. CONCLUSION: A CI can be an adequate treatment for vertigo attacks in patients with end-stage MD; however, due to the small sample size additional (multicenter) trials are necessary to confirm the findings.


Assuntos
Implante Coclear , Doença de Meniere , Vertigem , Idoso , Estudos Transversais , Humanos , Doença de Meniere/diagnóstico , Doença de Meniere/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Vertigem/diagnóstico
13.
Eur Arch Otorhinolaryngol ; 277(1): 77-83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605188

RESUMO

PURPOSE: Specially processed cereals (SPC) that increase endogenous antisecretory factor (AF) synthesis have been proposed to improve symptoms of Meniere's disease (MD) with controversial results. The aim of this study was to evaluate the effects of SPC in patients with definite unilateral MD and compare the results to a treatment protocol with intravenous glycerol and dexamethasone. METHODS: Thirteen patients with unilateral MD were treated with SPC and 13 patients were treated with intravenous glycerol and dexamethasone for 12 months. Audio-vestibular evaluation was performed before (T0) and at the end of the treatments (T12). The number of vertigo spells were evaluated before and after therapy and the Efficacy Index (EI) was calculated. Questionnaires for hearing loss (HHIA), tinnitus (THI) and quality of life (TFL) were administered. RESULTS: EI decreased in the SPC group in the second semester compared to the first although not significantly (p = 0.6323). There was a significant reduction for THI score in the SPC group at T12 (p = 0.0325). No significant differences were found between the two groups at T0 (p = 0.4723), while a significant difference was found at T12 (p = 0.0041). Quality of life showed an improvement in daily activities in the SPC group compared to infusion therapy group. CONCLUSION: Our study shows a reduced number of vertigo attacks and a positive effect on the discomfort generated by tinnitus and quality of life in patients with unilateral MD treated with SPC and when compared to patients treated with intravenous glycerol and dexamethasone. No effects on hearing thresholds were noted in both groups.


Assuntos
Grão Comestível/metabolismo , Doença de Meniere/metabolismo , Neuropeptídeos/metabolismo , Fármacos do Sistema Nervoso Periférico/metabolismo , Vertigem/metabolismo , Adulto , Idoso , Dexametasona/administração & dosagem , Feminino , Glicerol/administração & dosagem , Humanos , Masculino , Doença de Meniere/diagnóstico , Doença de Meniere/tratamento farmacológico , Pessoa de Meia-Idade , Fármacos do Sistema Nervoso Periférico/administração & dosagem , Qualidade de Vida , Inquéritos e Questionários , Zumbido/diagnóstico , Zumbido/tratamento farmacológico , Vertigem/tratamento farmacológico , Vertigem/etiologia
14.
HNO ; 68(5): 352-358, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31428809

RESUMO

Reliable confirmation of the presence or absence of endolymphatic hydrops is essential to avoid confusing vestibular migraine with Meniere's disease. MRI inner ear imaging is a promising new method to confirm hydrops, avoiding both unnecessary invasive or destructive inner ear treatments, but it is not universally available. Tone burst electrocochleography is an older simple, quick, safe, and sensitive test that is potentially available, with existing (or minorly upgraded) equipment at most tertiary medical centers. In Meniere's disease hydrops remains after intratympanic treatments. A case is presented of a 45 year-old man with a long history of recurrent vertigo attacks who, due to an erroneous diagnosis of Meniere's disease, was given five intratympanic treatments with no effect. He was subsequently found by tone burst electrocochleography to have no hydrops and was differentially diagnosed with probable vestibular migraine. Response to treatment confirms this diagnosis. This patient's electrocochleographic findings are compared with two other patients with definite Meniere's disease, one of whom had demonstrable hydrops despite intratympanic gentamycin treatments.


Assuntos
Orelha Interna , Hidropisia Endolinfática , Doença de Meniere , Audiometria de Resposta Evocada , Humanos , Masculino , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Vertigem
15.
J Int Adv Otol ; 15(3): 442-446, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31846926

RESUMO

OBJECTIVES: The aim of the present study was to improve the instrumental diagnosis of assessing Menière's disease (MD) if the frequency and slow-phase velocity (SPV) of the thermally induced nystagmus analyzed through the caloric vestibular test (CVT) showed different alterations in relationship with an increasing severity of the cochlear involvement. MATERIALS AND METHODS: The study retrospectively analyzed the CVT results of 72 patients affected by unilateral "definite MD" according to the 2015 Barany Society Diagnostic Criteria and treated only conservatively. RESULTS: There were 7 (9.72%) patients in stage 1, 27 (37.50%) in stage 2, 35 (48.61%) in stage 3, and 3 (4.16%) in stage 4. The canal paresis (CP) calculated through the frequency of the thermally induced nystagmus on the affected side increased in more severe stages (p=0.033). Conversely, the CP calculated through the SPV was not significantly different among the stages showing abnormal values even in the early phases of the disease (71% in stage 1, 81% in stage 2, 91% in stage 3, and 100% in stage 4), exclusively on the affected side. CONCLUSION: Abnormalities of the thermally induced nystagmus on the affected side characterize most patients with MD, but only "SPV" alterations are common in the early stages. An increasing severity of the cochlear involvement progressively reflects also on the "frequency" parameter. Detecting a dissociation between these two parameters could represent an instrumental marker of the early forms of MD. Cite this article as: Cerchiai N, Navari E, Miccoli M, Casani AP. Menière's Disease and Caloric Stimulation: Some News from an Old Test. J Int Adv Otol 2019; 15(3): 442-6.


Assuntos
Testes Calóricos/estatística & dados numéricos , Doença de Meniere/diagnóstico , Índice de Gravidade de Doença , Testes de Função Vestibular/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Testes Calóricos/métodos , Cóclea/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Fisiológico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Testes de Função Vestibular/métodos
16.
PLoS One ; 14(11): e0225650, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31756230

RESUMO

Despite considerable research, it remains controversial as to whether viral-infections are associated with Meniere's Disease (MD), a clinically heterogeneous set of chronic inner-ear disorders strongly associated with endolymphatic hydrops. Here, we investigated whether viral-infections are associated with MD through a systematic review and meta-analysis of observational clinical studies using molecular-diagnostics. Eligible for inclusion were case-controlled studies which ascertained molecular-determinants of past or present viral-infection through either viral nucleic acids or host serological marker in MD cases and non-MD controls. Across online databases and grey literature, we identified 210 potentially relevant articles in the English language, from which a total of 14 articles fully satisfied our eligibility criteria such that meta-groups of 611 MD-cases and 373 controls resulted. The aggregate quality of the modest-sized (14 studies) body of evidence was limited and varied considerably with regards to participant selection, matching, and ascertainment(s) and determinant(s) of viral-infection. Most data identified concerned the human cytomegalovirus (CMV), and meta-analysis of eligible studies revealed that evidence of CMV-infection was associated approximately three-fold with MD compared to controls, however the timing of the infections was indeterminate as the pooled analyses combined antiviral serological markers with viral nucleic acid markers. No association was found for any of HSV-1, -2, VZV, or EBV. Associative analyses of any viral species not aforementioned were precluded by limited data, and thus potential associations between other viral species and MD, especially other than Herpesviridae, are yet to be characterised. Overall, we have found a small association between CMV-infection and MD, however it is to be determined for what sub-groups of MD this finding may be relevant, and ideally the reported association remains would be reproduced by a greater volume of higher quality evidence.


Assuntos
Doença de Meniere/diagnóstico , Viroses/complicações , Anticorpos Antivirais/sangue , Citomegalovirus/genética , Citomegalovirus/isolamento & purificação , DNA Viral/metabolismo , Bases de Dados Factuais , Humanos , Doença de Meniere/etiologia , Estudos Observacionais como Assunto , Razão de Chances , Viroses/virologia
18.
Audiol Neurootol ; 24(6): 285-292, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31715604

RESUMO

OBJECTIVE: To evaluate resonance frequency (RF) values via dehydration effects in the inner ear caused by the glycerol test, which is used as a diagnostic method for Ménière's disease (MD). METHODS: Twenty adult patients with unilateral MD were included in the study. Before, and then at 1, 2, and 3 h after administration of glycerol (1 g/kg), pure-tone hearing levels (125-8,000 kHz) and multifrequency tympanometry tests were performed. As a control, the RF values of the ears of 25 healthy subjects (i.e., 50 ears) were compared to the affected and unaffected ears in the 20 MD patients. RESULTS: There was a significant difference between the RF values of affected and healthy ears before glycerol administration (p = 0.047). The RF values before and after glycerol administration into affected ears were compared. The average RF values decreased significantly from 748.0 ± 402.1 to 808.0 ± 410.1 Hz at 1 h after glycerol intake, and this value increased during the subsequent hours. There were no statistically significant differences between the pure-tone levels before and 1 h after glycerol administration, but a significant decrease was observed at 3 h. CONCLUSION: We suggest that MD has different inner-ear dynamics and normal RF values when compared to healthy ears. Furthermore, decreased inner ear pressure causes reduction of the mass effect and a stiffening of the annular ligament. We conclude that pre- and post-RF tests should be added to the test battery for diagnosis of MD.


Assuntos
Testes de Impedância Acústica , Audiometria de Tons Puros , Orelha Interna/fisiopatologia , Glicerol , Doença de Meniere/fisiopatologia , Solventes , Adulto , Idoso , Desidratação , Feminino , Voluntários Saudáveis , Humanos , Masculino , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade
19.
Orv Hetil ; 160(48): 1915-1920, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31760777

RESUMO

Introduction: Ménière's disease (MD) is a disorder that affects the inner ear, characterized by vertigo, tinnitus, hearing loss and vegetative symptoms. One of the main points of the management of the patients is the analysis of the vertigo diaries. Aim: To identify the typical characteristics of the symptoms and to highlight the importance of multidisciplinary approach. Material and method: 58 (12 male and 46 females, mean age 56.97 ± 10.45 SD) definite MD patients were enrolled in this investigation. The vertigo diaries filled out by the patients were analysed. The statistical analysis was performed using IBM SPSS V24 software. Since the parameters did not show normal distribution, non parametric test (Mann-Whitney U test) was used. Results: Based on the diaries, the most tormenting symptom is vertigo (mean power: 5.38 ± 2.06 SD), the second one is tinnitus (4.54 ± 2.81 SD), and last one is headache (2.77 ± 3.1 SD). Despite the frequent prevalence of associated headache, vestibular migraine could be ruled out in all of the cases. Another important outcome was that the attacks associated with headache were significantly stronger (p = 0.001). In the case of the vegetative symptoms, the association was even much stronger (p<0.01). According to the narrative analysis, the most frequent provocation factors of the attacks were the cold front and stress. Conclusion: Along with the treatment of vertigo, the management of the associated symptoms (headache, vegetative symptoms) is also of great importance. Monitoring the quality of life and psychiatric disorders suggests the importance of multidisciplinary approach. Orv Hetil. 2019; 160(48): 1915-1920.


Assuntos
Doença de Meniere/diagnóstico , Transtornos de Enxaqueca , Qualidade de Vida , Vertigem , Idoso , Feminino , Cefaleia , Perda Auditiva , Humanos , Masculino , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade , Zumbido
20.
Otol Neurotol ; 40(10): 1346-1352, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31568134

RESUMO

OBJECTIVE: To investigate if the cervical vestibular evoked myogenic potential (cVEMP) is predictive for developing bilateral Menière's disease (MD). STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care center. PATIENTS: Records of 71 patients previously diagnosed with unilateral MD at our institution who underwent cVEMP testing between 2002 and 2011 were screened. INTERVENTION: Patients were contacted to answer a questionnaire to identify which patients had developed bilateral disease. Based on questionnaires and medical charts, 49 patients with a follow-up time of at least 5 years were included. The 49 originally asymptomatic ears are referred to as "study ears." Previously reported cVEMP criteria (original criteria) applied to study-ear cVEMPs separated them into Menière-like and normal-like groups. MAIN OUTCOME MEASURE: The main purpose was to determine if previously obtained cVEMP thresholds and tuning ratios of unilateral MD patients could predict who develops bilateral disease. RESULTS: From the 49 included patients, 12 developed bilateral disease (24.5%). The study ears characterized by original cVEMP criteria as Menière-like were significantly more likely to develop bilateral disease compared with the normal-like study ears. The original criteria predicted development of bilateral disease with a positive predictive value (PPV) and negative predictive value (NPV) of 58.3% and 86.5% respectively. ROC curves were used to revise cVEMP criteria for predicting the progression to bilateral disease. A revised criterion combining three cVEMP metrics, reached a PPV and NPV of 85.7% and 93.7%. CONCLUSION: cVEMP threshold and tuning in unilateral MD patients are predictive of which patients will develop bilateral disease.


Assuntos
Doença de Meniere/diagnóstico , Potenciais Evocados Miogênicos Vestibulares , Vestíbulo do Labirinto/fisiopatologia , Adulto , Idoso , Audiometria , Limiar Auditivo , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Inquéritos e Questionários
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