Meniere disease

梅尼埃病
  • 文章类型: Journal Article
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  • 文章类型: English Abstract
    Endolymphatic hydrops(EH) is considered the histological hallmark of Meniere\'s disease. Visualization of EH has been achieved by special sequences of inner ear magnetic resonance imaging(MRI) with gadolinium-based contrast-agent via intravenous or intratympanic administration. Although it has been applied for more than ten years since 2007, a unified view on this technique has not yet been achieved. In 2022, Yang Jun and Duan Maoli et al led the organization to write the international expert consensus on MRI of EH. This article interprets the main contents and reports related progress.
    摘要: 梅尼埃病的病理特征是膜迷路积水。临床上通过静脉注射或鼓室内注射造影剂后行特殊序列MRI可观察到膜迷路积水。虽然这一技术自2007年已经开始应用,但目前尚未形成统一的观点。2022年杨军、段茂利等牵头组织撰写了内淋巴积水MRI造影国际专家共识,本文对主要内容进行解读并报道相关进展。.
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  • 文章类型: Journal Article
    Objective:Intratympanic(IT) drug delivery receives attention due to its effectivity in treatment for Menière\'s disease(MD). Due to the release of the consensuses and new evidence on IT drug delivery for MD have been published, the review with a view to supplementing the details of IT treatment of MD is indispensable. Methods:The literatures on IT injection for MD treatment over the last two decades are retrieved, International consensus(ICON) on treatment of Menière\'s disease(2018), Clinical Practice Guideline(2020) and European Position statement on Diagnosis and Treatment of Menière\'s disease(2018) are taken into account for reference, and follow advice from experts from Europe, USA and China. Results:Experts agree on the following: ①The effectiveness of IT methylprednisolone(ITM) on vertigo control seems to be somewhat better than that of IT dexamethasone(ITD), and ITM can restore hearing in some cases. ②Due to the ototoxicity of aminoglycosides, the application of intratympanic gentamicin(ITG) in MD patients with good hearing is conservative. However, some studies suggest that ITG with low doses has no significant effect on hearing, which needs to be further proved by clinical studies with high levels of evidence. ③Currently, generally accepted treatment endpoint of ITG is no vertigo attack in a 12-month period or a vestibular loss in objective tests in the affected ear. Conclusion:More studies with high level of evidence are needed to evaluate the drug type, efficacy, and therapeutic endpoint of IT therapy for MD.
    目的:鼓室内(intratympanic,IT)注射药物治疗梅尼埃病(MD)因其疗效显著而备受关注。由于IT注射药物治疗MD的共识和新证据的发布,对IT注射药物治疗MD进行细节上的补充具有重要意义。 方法:检索近二十年来有关IT注射药物治疗MD的文献,参考《梅尼埃病治疗国际共识(ICON)》(2018年),《美国梅尼埃病临床实践指南》(2020年)和《梅尼埃病诊断治疗的欧洲立场声明》(2018),并遵循来自欧洲、美国和中国的专家意见。 结果:专家一致认为:①鼓室内注射甲泼尼龙(ITM)对眩晕控制的疗效优于鼓室内注射地塞米松(ITD),ITM有恢复MD患者听力的可能性。②由于氨基糖甙类药物的耳毒性,鼓室内注射庆大霉素(ITG)在听力良好MD患者中的应用持谨慎态度。但也有研究表明,小剂量ITG对听力没有显著影响,还需要高水平证据的临床研究进一步证明。③目前普遍接受的ITG治疗终点是在12个月内无眩晕发作或受累耳客观检查提示前庭功能丧失。 结论:对IT注射药物治疗MD的药物类型、疗效和治疗终点还需要更多高证据水平的研究进行评价。.
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  • 文章类型: Journal Article
    目的:鼓室内(IT)药物递送因其在治疗梅尼埃病(MD)方面的有效性而受到关注。由于已经发布了关于MD的IT药物递送的共识和新证据,为了补充MD的IT治疗细节而进行的审查是必不可少的。
    方法:检索了过去二十年来用于MD治疗的IT注射文献,关于梅尼埃病治疗的国际共识(ICON)(2018年),临床实践指南(2020年)和欧洲关于梅尼埃病诊断和治疗的立场声明(2018年)被纳入参考。听从欧洲专家的建议,美国和中国。
    结果:专家同意以下几点:(1)IT甲基强的松龙(ITM)对眩晕控制的有效性似乎比IT地塞米松(ITD)要好一些,在某些情况下,ITM可以恢复听力。(2)由于氨基糖苷类的耳毒性,鼓室内庆大霉素(ITG)在听力良好的MD患者中的应用是保守的。然而,一些研究表明,低剂量的ITG对听力没有显著影响,这需要有高水平证据的临床研究进一步证明。(3)目前,ITG的普遍接受的治疗终点是12个月内无眩晕发作,或在受影响的耳朵的客观测试中无前庭丢失.
    结论:需要更多具有高水平证据的研究来评估药物类型,功效,和MD的IT治疗终点。
    OBJECTIVE: Intratympanic (IT) drug delivery receives attention due to its effectivity in treatment for Menière\'s disease (MD). Due to the release of the consensuses and new evidence on IT drug delivery for MD have been published, the review with a view to supplementing the details of IT treatment of MD is indispensable.
    METHODS: The literatures on IT injection for MD treatment over the last two decades are retrieved, International consensus (ICON) on treatment of Menière\'s disease (2018), Clinical Practice Guideline (2020) and European Position statement on Diagnosis and Treatment of Meniere\'s Disease (2018) are taken into account for reference, and follow advice from experts from Europe, USA and China.
    RESULTS: Experts agree on the following: (1) The effectiveness of IT methylprednisolone (ITM) on vertigo control seems to be somewhat better than that of IT dexamethasone (ITD), and ITM can restore hearing in some cases. (2) Due to the ototoxicity of aminoglycosides, the application of intratympanic gentamicin (ITG) in MD patients with good hearing is conservative. However, some studies suggest that ITG with low doses has no significant effect on hearing, which needs to be further proved by clinical studies with high levels of evidence. (3) Currently, generally accepted treatment endpoint of ITG is no vertigo attack in a 12-month period or a vestibular loss in objective tests in the affected ear.
    CONCLUSIONS: More studies with high level of evidence are needed to evaluate the drug type, efficacy, and therapeutic endpoint of IT therapy for MD.
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  • 文章类型: Journal Article
    本文回顾了梅尼埃病的最新进展,包括病因学,诊断,和治疗性调查改变了医疗服务提供者的前景。这些更新揭示了梅尼埃疾病的复杂性,并产生了为患者提供最佳护理的额外手段。
    鉴于梅尼埃病的多因素原因,最近提出了梅尼埃病的五种亚型。了解这些亚型将有助于开发适当的治疗算法。尽管尚未开发出更新的治疗方法,逐步治疗算法已经提出,可以改善病人的护理。新的MRI模式和血清检测有望作为临床线索和生物标志物。
    在使用这些更新的诊断标准时,梅尼埃的疾病可以被更精确地识别和治疗。这反过来将允许未来的随机对照研究,以提高可用治疗方案的质量。未来成像,前庭测试,血清生物标志物的潜力可以阐明其他诊断标准,只有进一步提高临床护理水平。
    This article reviews recent developments in Ménière\'s disease including etiologic, diagnostic, and therapeutic investigations that have changed the landscape for medical providers. These updates shed light onto the complex nature of Ménière\'s disease and generate additional means to provide optimal care to patients.
    Given the multifactorial cause of Ménière\'s disease, five subtypes of Ménière\'s disease have recently been proposed. A knowledge of these subtypes will aid in the development of an appropriate treatment algorithm. Although newer treatments have not been developed, stepwise treatment algorithms have been proposed and can improve patient care. New MRI modalities and serum testing hold promise as clinical clues and biomarkers.
    As these updated diagnostic criteria are used, Ménière\'s disease can be identified and treated more precisely. This will in turn allow for future randomized controlled studies to improve the quality of treatment options available. Future imaging, vestibular testing, and the potential for serum biomarkers may illuminate additional diagnostic criteria, only furthering the improvement in clinical care.
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  • 文章类型: Journal Article
    OBJECTIVE: To systematically appraise clinical practice guidelines for the diagnosis and treatment of Ménière\'s disease using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.
    METHODS: A systematic literature search was performed to identify guidelines pertaining to the diagnosis and treatment of Ménière\'s disease. Data were abstracted from guidelines that met inclusion criteria and appraised by four independent reviewers in the six domains of quality defined by the AGREE II. Domain scores reflecting quality in each domain were calculated. Intraclass correlation coefficients (ICC) were calculated across domains to qualify interrater reliability.
    RESULTS: Six guidelines were found to meet inclusion criteria after a systematic literature search. Of the six clinical practice guidelines appraised using the AGREE II, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline received the highest average score, with a mean of 90.7% spanning six quality domains. The guideline with the lowest average score across all domains was the European Position Statement on diagnosis and treatment of Ménière\'s disease, receiving an average score across domains of 34.6%. Overall quality scores of clinical practice guidelines for Ménière\'s disease had a standard deviation of 21.3%. Two guidelines met the quality threshold of > 60% in at least five domains, qualifying as \'high\': AAO-HNS and National Institute for Health and Care Excellence. Average ICC across all six domains was 0.87, suggesting near total agreement between reviewers.
    CONCLUSIONS: Ménière\'s disease remains a challenging entity to diagnose and treat; few existing clinical guidelines meet the standards of quality established by the AGREE II appraisal instrument.
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  • 文章类型: Journal Article
    1972年,美国耳鼻咽喉科学会(AAO)的听力和平衡委员会制定了第一个梅尼埃病诊断标准。随着对梅尼埃病认识的逐步深入,近年来,Barany协会、中华耳鼻咽喉头颈外科杂志编辑委员会和中华医学会耳鼻咽喉头颈外科学分会、欧洲梅尼埃病协会、国际耳鼻喉科学会联盟(IFOS)、美国耳鼻咽喉头颈外科学会(AAO-HNS)和日本平衡研究协会等分别于2015、2017、2018、2018、2020和2020年制定或修订梅尼埃病相关指南类文件。这些指南都是基于最新的循证医学和/或多国专家共识的基础上,反映了全球学者对梅尼埃病认知的改变和进步。本文对以上6版指南/声明/共识的整体框架和重点内容进行解读和比较,以供国内同道参考。.
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  • 文章类型: Journal Article
    1972年,美国耳鼻咽喉科学会听力与平衡委员会(AAO-CHE)制定了首个梅尼埃病诊断指南。美国耳鼻咽喉科学会-头颈外科基金会(AAO-HNS)于1985年、1995年和2015年对其进行了修改。然后,AAO-HNS根据最新的循证医学基础,于2020年制定了最新的《梅尼埃疾病指南》更新版本。在本文中,为国内同行解读2020年最新指南的总体框架和重点内容。
    In 1972, the Committee on Hearing and Equilibrium of the American Academy of Otoaryngology (AAO-CHE) produced the first diagnostic guidelines for Ménière\'s disease. The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNS) modified them in 1985, 1995 and 2015. Then, AAO-HNS developed the latest updated version of the Ménière\'s Disease Guidelines in 2020, based on the latest evidence-based medicine foundation. In this paper, the overall framework and key content of the latest guideline in 2020 are interpreted for domestic colleagues.
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  • 文章类型: Journal Article
    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.
    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.
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  • 文章类型: Journal Article
    梅尼埃病(MD)是一种由自发性眩晕发作(每次持续20分钟至12小时)定义的临床疾病,在受影响的耳朵之前有记录的低频至中频感音神经性听力损失,during,或者在眩晕发作之后.它还表现出波动的听觉症状(听力损失,耳鸣,或耳朵丰满)在受影响的耳朵中。MD的潜在病因尚不完全清楚,然而,它已经与内耳液(内淋巴)量增加有关,最终出现阵发性耳部症状(眩晕,波动性听力损失,耳鸣,和听觉丰满)。体格检查结果通常不明显,和听力测试可能会或可能不会显示低频到中频的感觉神经性听力损失。常规成像,如果执行,通常也是正常的。MD治疗的目标是预防或减少眩晕的严重程度和频率;缓解或预防听力损失,耳鸣,和听觉丰满;并提高生活质量。MD的治疗方法很多,通常包括生活方式因素的改变(例如,饮食)和医疗,外科,或多种疗法的组合。
    本临床实践指南的主要目的是提高MD的诊断检查质量和治疗结果。为了达到这个目的,本指南的目标是利用现有的最佳已发表的科学和/或临床证据来提高诊断准确性和适当的治疗性干预措施(内科和外科),同时减少未指明的诊断性检查和/或影像学检查.
    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.
    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.
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