OBJECTIVE: To evaluate the diagnostic role of combined electrocochleography and pure-tone audiometry monitoring during dehydrating test in Ménière\'s disease and consider its suitability as a diagnostic tool to differentiate those patients with unclear differential diagnosis and therefore identify those with clear endolymphatic hydrops responsive to dehydrating test. To study the efficacy of dehydrating therapy on vertiginous symptoms and hearing loss in patients with Ménière\'s disease.
METHODS: Prospective case series.
METHODS: University hospital, secondary referral center.
METHODS: Thirty patients, 20 women and 10 men, age range of 25 to 75 years, matching the criteria for definite Ménière\'s disease according to the Barany Society classification.
METHODS: Diagnostic. During an active phase of the disease, electrocochleography and pure-tone audiometry were performed, and repeated at 30th, 45th, and 60th minutes after intramuscular injection of 40 mg furosemide and 40 mg methylprednisolone.
METHODS: Data related to symptoms, electrocochleography, and pure-tone audiometry during the dehydrating test were collected at different times and statistically analyzed.
RESULTS: After the administration of dehydrating therapy, we observed that both summating potential and action potential ratio and summating potential and action potential area ratio were normalized in 21 of 30 subjects. Furthermore, pure-tone audiometry thresholds improved significantly. An improvement of ear fullness was also observed, whereas tinnitus unchangeably persisted.
CONCLUSIONS: The monitoring of the electrocochleography and pure-tone audiometry thresholds during dehydrating tests with furosemide and methylprednisolone could allow to detect an improvement of instrumental features and clinical symptoms related to endolymphatic hydrops, and therefore, it could be used as a diagnostic tool in the identification of those patients affected by Ménière\'s disease with unclear differential diagnosis.

To perform a matched cohort study to assess whether patients with Meniere\'s Disease (MD) require more intensive auditory rehabilitation following cochlear implantation (CI) and identify factors that may affect outcomes in patients with MD.
A retrospective case review was performed. MD and control patients were matched for age, biological sex, implant manufacturer and electrode design. Outcomes measured were speech scores, number of visits to audiology department following switch-on, and post-operative active MD.
Forty consecutive implanted MD patients were identified between May 1993 and May 2019. Patients with active MD following CI required significantly more visits to the audiology department compared to controls (P < 0.01) and patients who had inactive MD post-operatively (P < 0.01). However, in MD patients, active MD was less likely following CI (P = 0.03). In patients who continued to experience active MD post-operatively, further medical and surgical ablative intervention was required to control ongoing Meniere\'s attacks.
We present the largest case series of performance outcomes in CI patients with MD. Although speech outcomes in MD patients are comparable to controls, patients with active MD pre-operatively are more likely to experience variation in CI performance requiring a prolonged period of auditory rehabilitation compared to inactive preoperative MD.

暂无摘要。

Lateral semicircular canal (LSCC) malformations represent one of the most common types of inner ear malformation. As many cases of LSCC malformations are asymptomatic, detailed vestibular functions in such cases remain unclear. We present a case with bilateral LSCC malformations for whom the function of each vestibular organ was evaluated by caloric testing, video Head Impulse Test (vHIT) and vestibular evoked myogenic potentials (VEMP). Caloric testing showed canal paresis of the left side, whereas vHIT showed bilateral normal semicircular canal function. The results of VEMP indicated left saccular dysfunction. Discrepancies in caloric testing and vHIT results were observed and these discrepancies are thought to be due to endolymphatic hydrops rather than vestibular hypofunction, similar to that in Meniere disease.

暂无摘要。

Endolymphatic sac tumors are rare benign neoplasms with locally aggressive behavior located in the posterior petrous ridge of the temporal bone. They cause sensorineural hearing loss and may develop vestibular damage. A 24-year-old male patient arrived at our office with a history of acute vertiginous syndrome, left hearing loss, and tinnitus 1-year ago. His chief complaint was an increase in auditory symptoms. A CT scan and MRI showed an endolymphatic sac tumor. Complete resection of the lesion was achieved by a transmastoid and translabyrinthine approach. Low-grade adenocarcinoma was confirmed by histopathology. The patient remained without clinical vestibular symptoms. However, a small residual tumor was addressed by gamma-ray radiosurgery. Postoperative deep left sensorineural hearing loss was identified, without any vestibular sequelae. Radiologic imaging is the most useful tool for this diagnosis. Endolymphatic sac tumors should be in the differential diagnosis of recalcitrant audio-vestibular symptoms. Complete surgical resection is the most appropriate management.

OBJECTIVE: Ménière\'s disease is an inner ear disorder classically characterized by fluctuating hearing loss, tinnitus, and aural fullness accompanied by episodic vertigo. While the pathogenesis of Ménière\'s remains under debate, histopathological analyses implicate endolymphatic sac dysfunction with inner ear fluid homeostatic dysregulation. Little is known about whether external impingement of the endolymphatic sac by tumors may present with Ménière\'s-like symptoms. The authors present a case series of 7 patients with posterior fossa meningiomas that involved the endolymphatic sac and new onset of Ménière\'s-like symptoms and review the literature on this rare clinical entity.
METHODS: A retrospective review of patients undergoing resection of a posterior petrous meningioma was performed at the authors\' institution. Inclusion criteria were age older than 18 years; patients presenting with Ménière\'s-like symptoms, including episodic vertigo, aural fullness, tinnitus, and/or hearing loss; and tumor location overlying the endolymphatic sac.
RESULTS: There were 7 cases of posterior petrous face meningiomas involving the vestibular aperture presenting with Ménière\'s-like symptoms. Imaging and intraoperative examination confirmed no cranial nerve VIII compression or labyrinthine artery involvement accounting for audiovestibular symptoms. Of the 7 patients in the series, 6 experienced significant improvement or resolution of their vertigo, and all 7 had improvement or resolution of their tinnitus after resection. Of the 5 patients who had preoperative hearing loss, 2 experienced improvement or resolution of their ipsilateral preoperative hearing deficit, whereas the other 3 had unchanged hearing loss compared to preoperative evaluation.
CONCLUSIONS: Petrous face meningiomas overlying the endolymphatic sac can present with a Ménière\'s syndrome. Early recognition and microsurgical excision of these tumors is critical for resolution of most symptoms and stabilization of hearing loss.

Enhancement of the subarachnoid space after intravenous administration of gadolinium contrast agent is not common. Enhancement usually occurs in pathological conditions that increase the permeability of the blood-cerebrospinal fluid barrier, most notably in meningitis. We herein describe possible subarachnoid enhancement in patients with no apparent effect on the meninges. These patients had clinical signs of Meniere\'s disease and underwent specific magnetic resonance imaging of the inner ear to possibly visualize endolymphatic hydrops. The endolymphatic space can be noninvasively imaged by intravenous administration of contrast agent, usually at a double dose, 4 hours before the scanning process. During this time, the contrast agent penetrates not only the perilymph but also the subarachnoid space, where the highest concentration occurs after 4 hours according to some studies.

OBJECTIVE: The main purpose of this study was to investigate the usefulness of wide band tympanometry (WBT) as a diagnostic tool for Ménière\'s disease (MD) by comparing differences in absorbance measures between normal hearing ears and patient diagnosed with MD.
METHODS: We conducted a retrospective case-control study. From a cohort of 116 patients diagnosed with Ménière disease, 52 MD patients and 99 normal hearing adults with no history of otological disease served as subjects. Wideband tympanometry was conducted using at Titan Impedance module and audiometry was performed with a MADSEN Astera2. Mean energy absorbance curves with 95% confidence intervals were computed across cases with MD and controls in the frequency range 226-8000 Hz. An overall test for difference between curves of cases and controls was calculated by multivariate analysis of variance.
RESULTS: The MD group and the subpopulations of MD patients who fulfilled the International criteria for MD showed a statistically significant lower absorbance at tympanic peak pressure compared to the control group (p < 0.001). No overlap of confidence intervals between mean curves was found within the frequency range of 2000-4000 Hz.
CONCLUSIONS: Absorbance measures obtained by WBT were able to distinguish between MD ears and normal ears within the frequency range of 2000-4000 Hz. The results indicate that WBT potentially could be a useful and simple non-invasive diagnostic tool for MD. However, more research on the association between absorbance measures and inner ear pathologies is needed.

This study explored the relation between Ménière\'s disease and chronic obstructive pulmonary disease (COPD). The ≥40-year-old population of the Korean National Health Insurance Service-Health Screening Cohort was included. In total, 7734 Ménière\'s disease patients and 30,936 control participants were enrolled. Control participants were matched for age, sex, income, and region of residence with Ménière\'s disease participants. The odds of having Ménière\'s disease given a history of COPD were analyzed using conditional logistic regression. Subgroup analyses were conducted according to age, sex, income, and region of residence. The odds of having Ménière\'s disease were found to be 1.18-fold higher with a history of COPD than with no history of COPD (95% confidence intervals (CI) = 1.06-1.32, E-value (CI) = 1.64 (1.31)). The ≥60 years old, male, low-income, and rural subgroups showed increased odds of developing Ménière\'s disease when a history of COPD was reported. A history of COPD was associated with an increased risk of Ménière\'s disease in the adult population.