1
|
Panda A, Carlson ML, Diehn FE, Lane JI. Beyond Tympanomastoidectomy: A Review of Less Common Postoperative Temporal Bone CT Findings. AJNR Am J Neuroradiol 2021; 42:12-21. [PMID: 33184072 PMCID: PMC7814786 DOI: 10.3174/ajnr.a6802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/18/2020] [Indexed: 11/07/2022]
Abstract
Postoperative temporal bone imaging after surgical procedures such as ossiculoplasty, tympanomastoidectomy, cochlear implantation, and vestibular schwannoma resection is often encountered in clinical neuroradiology practice. Less common otologic procedures can present diagnostic dilemmas, particularly if access to prior operative reports is not possible. Lack of familiarity with the less common surgical procedures and expected postoperative changes may render radiologic interpretation challenging. This review illustrates key imaging findings after surgery for Ménière disease, superior semicircular canal dehiscence, temporal encephalocele repairs, internal auditory canal decompression, active middle ear implants, jugular bulb and sigmoid sinus dehiscence repair, and petrous apicectomy.
Collapse
Affiliation(s)
- A Panda
- From the Departments of Radiology (A.P., J.I.L., F.E.D.)
| | - M L Carlson
- Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, Rochester, Minnesota
| | - F E Diehn
- From the Departments of Radiology (A.P., J.I.L., F.E.D.)
| | - J I Lane
- From the Departments of Radiology (A.P., J.I.L., F.E.D.)
| |
Collapse
|
2
|
Rego ÂR, Dias D, Pinto A, E Castro SS, Feliciano T, E Sousa CA. The cardiovascular aspects of a Ménière's disease population - A pilot study. J Otol 2019; 14:51-56. [PMID: 31223301 PMCID: PMC6570641 DOI: 10.1016/j.joto.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/15/2018] [Accepted: 01/22/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction MD is considered a rare disease. An adequate model that explains MD's pathophysiology is not well established. Recently, the vascular theory of the disease has been revived. Objectives To characterize a MD population according to its cardiovascular risk and correlate it to the MD clinical course. Methods In this retrospective chart study the data of 31 MD patients observed between January 2017 and April 2018 in a tertiary university hospital were reviewed. Patients included in the study were diagnosed according to the Bárány Society criteria. Lost follow-ups, patients with autoimmune disease, atopy or allergy, major psychiatric disease and migraine were excluded. Age, gender, cardiovascular risk factors, audiometric and vestibular parameters, occurrence of MD attacks in the previous 6 months, vestibular medication in course and time course of MD were recorded and compared between groups (with and without cardiovascular risk factors). Results 31 patients (61.3% females) mean aged 60.3 years (±9.7) were studied. 74% of the population had at least one risk factor and 51.6% of patients had attacks in the last 6 months. There was a statistically significant difference in the occurrence of MD attacks in the last 6 months (p = 0.014) between MD patients with and without risk factors. Mean PTA thresholds were higher and speech discrimination was lower in individuals with more cardiovascular risk factors. Conclusions Treatment of MD focusing on vascular risk factors may allow a better control of symptoms and result in a decreased need for ablative procedures in this disorder.
Collapse
Affiliation(s)
- Ângela Reis Rego
- ENT Department, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - David Dias
- ENT Department, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Ana Pinto
- ENT Department, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Sandra Sousa E Castro
- ENT Department, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Telma Feliciano
- ENT Department, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Cecília Almeida E Sousa
- ENT Department, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| |
Collapse
|
3
|
Long-term Vertigo Control and Vestibular Function After Low-dose On-demand Transtympanic Gentamicin for Refractory Menière's Disease. Otol Neurotol 2019; 40:218-225. [PMID: 30624404 DOI: 10.1097/mao.0000000000002101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the long-term clinical vertigo control along with measured lateral canal vestibular function in patients with unilateral refractory Menière's disease (MD) treated with gentamicin transtympanic injections (TTI). STUDY DESIGN Retrospective analytic study. SETTING Tertiary referral center. PATIENTS Thirty-eight patients treated by TTI for medically refractory unilateral MD, defined by the 1995 AAO-HNS criteria, between May 2006 and December 2012. INTERVENTION(S) One-year course of treatment with gentamicin TTI following a low dose on-demand protocol. TTI were repeated in new courses of treatment when MD recurrence occurred. MAIN OUTCOME MEASURE(S) AAO-HNS class of control, caloric tests (CalT), recurrence rate. RESULTS After an average clinical follow-up of 71 months, all patients entered a class of control A (78%) or B (22%), with an average of 2.3 TTI received. The mean maximal obtained deficit was 88.5%, and the mean long-term deficit was 85.5%. Ten (26%) patients had disease recurrence requiring a new course of treatment. A value of the first CalT in the 3 months following the first TTI strictly higher than 78% was significantly associated with disease control and the absence of symptom recurrence (p≤0.01). In the "recurrence" group, four patients had a significantly lower mean value of all CalT performed after the first TTI when compared with other patients (p≤0.001), indicating gentamicin resistance CONCLUSION:: Achieving a sustainable vestibular deficit on caloric testing is key for MD symptom control after gentamicin TTI. Gentamicin resistance must be diagnosed early to adapt therapeutic strategies.
Collapse
|
4
|
Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Arch Physiother 2017; 7:12. [PMID: 29340206 PMCID: PMC5759906 DOI: 10.1186/s40945-017-0040-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/04/2017] [Indexed: 12/21/2022] Open
Abstract
Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain. There are no definitive clinical or laboratory tests for CGD and therefore CGD is a diagnosis of exclusion. It can be difficult for healthcare professionals to differentiate CGD from other vestibular, medical and vascular disorders that cause dizziness, requiring a high level of skill and a thorough understanding of the proper tests and measures to accurately rule in or rule out competing diagnoses. Consequently, the purpose of this paper is to provide a systematic diagnostic approach to enable healthcare providers to accurately diagnose CGD. This narrative will outline a stepwise process for evaluating patients who may have CGD and provide steps to exclude diagnoses that can present with symptoms similar to those seen in CGD, including central and peripheral vestibular disorders, vestibular migraine, labyrinthine concussion, cervical arterial dysfunction, and whiplash associated disorder.
Collapse
Affiliation(s)
- Alexander S. Reiley
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Frank M. Vickory
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Sarah E. Funderburg
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Rachel A. Cesario
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| | - Richard A. Clendaniel
- Doctor of Physical Therapy Division, Duke University, 2200 W Main St., Durham, NC 27705 USA
| |
Collapse
|
5
|
Long-term outcomes of endolymphatic sac shunting with local steroids for Meniere's disease. Am J Otolaryngol 2017; 38:285-290. [PMID: 28214024 DOI: 10.1016/j.amjoto.2017.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/17/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the long-term efficacy of endolymphatic sac shunt techniques with and without local steroid administration. STUDY DESIGN Retrospective case series and patient survey. SETTING Tertiary university hospital. PATIENTS Meniere's disease (MD) patients that failed medical therapy and subsequently underwent an endolymphatic sac shunt procedure. All patients had definitive or probable MD and at least 18-months of follow-up. INTERVENTIONS Three variations on endolymphatic sac decompression with shunt placement were performed: Group A received no local steroids, Group B received intratympanic dexamethasone prior to incision, and Group C received dexamethasone via both intratympanic injection and direct endolymphatic sac instillation. MAIN OUTCOME MEASURE(S) Vertigo control, hearing results, and survey responses. RESULTS Between 2002 and 2013, 124 patients with MD underwent endolymphatic sac decompression with shunt placement. 53 patients met inclusion criteria. Groups A, B, and C had 6 patients, 20 patients, and 27 patients, respectively. Mean follow-up was 56months. Vertigo control improved in 66%, 83%, and 93% of Groups A, B, and C. Functional level improved for Group B (-2.0) and Group C (-2.2) but was unchanged in Group A. Pure-tone average and speech discrimination scores changed by +22dB and -30%, +6dB and -13%, and +6dB and -5% in Groups A, B, and C. The long-term hearing results were significantly better with steroids (Groups B and C) according to the AAO-HNS 1995 criteria but did not meet significance on non-parametric testing. CONCLUSIONS Endolymphatic sac shunt procedures may benefit from steroid instillation at the time of shunt placement.
Collapse
|
6
|
Wick CC, Lin SJ, Yu H, Megerian CA, Zheng QY. Treatment of ear and bone disease in the Phex mouse mutant with dietary supplementation. Am J Otolaryngol 2017; 38:44-51. [PMID: 27733274 PMCID: PMC6221453 DOI: 10.1016/j.amjoto.2016.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 09/25/2016] [Indexed: 01/25/2023]
Abstract
HYPOTHESIS Phosphorus and vitamin D (calcitriol) supplementation in the Phex mouse, a murine model for endolymphatic hydrops (ELH), will improve otic capsule mineralization and secondarily ameliorate the postnatal development of ELH and sensorineural hearing loss (SNHL). BACKGROUND Male Phex mice have X-linked hypophosphatemic rickets (XLH), which includes osteomalacia of the otic capsule. The treatment for XLH is supplementation with phosphorus and calcitriol. The effect of this treatment has never been studied on otic capsule bone and it is unclear if improving the otic capsule bone could impact the mice's postnatal development of ELH and SNHL. METHODS Four cohorts were studied: 1) wild-type control, 2) Phex control, 3) Phex prevention, and 4) Phex rescue. The control groups were not given any dietary supplementation. The Phex prevention group was supplemented with phosphorus added to its drinking water and intraperitoneal calcitriol from postnatal day (P) 7-P40. The Phex rescue group was also supplemented with phosphorus and calcium but only from P20 to P40. At P40, all mice underwent auditory brainstem response (ABR) testing, serum analysis, and temporal bone histologic analysis. Primary outcome was otic capsule mineralization. Secondary outcomes were degree of SNHL and presence ELH. RESULTS Both treatment groups had markedly improved otic capsule mineralization with less osteoid deposition. The improved otic capsule mineralized did not prevent the development of ELH or SNHL. CONCLUSION Supplementation with phosphorus and calcitriol improves otic capsule bone morphology in the Phex male mouse but does not alter development of ELH or SNHL.
Collapse
MESH Headings
- Analysis of Variance
- Animals
- Biopsy, Needle
- Bone Diseases/diagnosis
- Bone Diseases/therapy
- Calcitriol/pharmacology
- Dietary Supplements
- Disease Models, Animal
- Ear Diseases/diagnosis
- Ear Diseases/therapy
- Endolymphatic Hydrops/diagnosis
- Endolymphatic Hydrops/therapy
- Evoked Potentials, Auditory, Brain Stem
- Hearing Loss, Sensorineural/diagnosis
- Hearing Loss, Sensorineural/therapy
- Humans
- Hypophosphatemia, Familial/diagnosis
- Hypophosphatemia, Familial/therapy
- Immunohistochemistry
- Male
- Mice
- Mice, Inbred BALB C
- Mice, Mutant Strains
- Phosphorus/pharmacology
- Random Allocation
- Treatment Outcome
Collapse
Affiliation(s)
- Cameron C Wick
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A..
| | - Sharon J Lin
- Department of Otolaryngology, Head and Neck Surgery, University of California - Davis, Sacramento, CA, U.S.A
| | - Heping Yu
- Ear, Nose, and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, U.S.A
| | - Cliff A Megerian
- Ear, Nose, and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, U.S.A
| | - Qing Yin Zheng
- Ear, Nose, and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, U.S.A
| |
Collapse
|
7
|
Canzi P, Manfrin M, Perotti M, Aprile F, Quaglieri S, Rebecchi E, Locatelli G, Benazzo M. Translabyrinthine vestibular neurectomy and simultaneous cochlear implant for Ménière's disease. Acta Neurochir (Wien) 2017; 159:123-130. [PMID: 27812817 DOI: 10.1007/s00701-016-2996-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgical management of Ménière's disease (MD) is recommended in case of medical and intratympanic treatment failures. Translabyrinthine vestibular nerve section has been considered the gold standard for denervation procedures in order to control vertigo attacks, although at the cost of sacrificing residual hearing. To the best of our knowledge, no work has been published with regard to a group of patients submitted to translabyrinthine vestibular neurectomy and simultaneous cochlear implant for MD. The aim of the present study was to assess the effectiveness of translabyrinthine vestibular nerve section and simultaneous cochlear implant in a prospective study. METHODS All adult patients (over 18 years of age) with a diagnosis of intractable unilateral definite MD and useless residual hearing function were enrolled after medical and intratympanic treatment failures. Pre- and postoperative otoneurological evaluation concerned: frequency of vertigo attacks, head impulse test and caloric testing, pure tone average and speech perception audiometry in quiet conditions, tinnitus handicap inventory test, functional level scale and rate of vertigo control, dizziness handicap inventory test, and MD patient-oriented severity index. At least 6 months of follow-up were needed to be enrolled in the study. RESULTS Four patients were included in the study. Translabyrinthine vestibular nerve section and simultaneous cochlear implant seemed to considerably improve the disabling effects of MD, achieving a good control of vestibular symptoms (mean pre/postoperative vertigo attacks per month: 16.5/0), resolving hearing loss (mean pre/postoperative pure tone average in the affected ear: 86.2/32.5 dB), improving the tinnitus (mean pre/postoperative tinnitus handicap inventory test: 77.2/6), and finally increasing the overall quality-of-life parameters. CONCLUSIONS In our preliminary report, translabyrinthine vestibular nerve section and simultaneous cochlear implant showed encouraging results in order to definitively control both vestibular and cochlear symptoms during the same therapeutic procedure.
Collapse
|
8
|
Martin-Sanz E, Esteban J, Vaduva C, Sanz R, Lopez-Escamez J. High-frequency sensorineural hearing loss associated with vestibular episodic syndrome. Clin Otolaryngol 2016; 42:856-859. [DOI: 10.1111/coa.12710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2016] [Indexed: 12/01/2022]
Affiliation(s)
- E. Martin-Sanz
- Department of Otolaryngology; University Hospital of Getafe; Madrid Spain
| | - J. Esteban
- Department of Otolaryngology; University Hospital of Getafe; Madrid Spain
| | - C. Vaduva
- Department of Otolaryngology; University Hospital of Getafe; Madrid Spain
| | - R. Sanz
- Department of Otolaryngology; University Hospital of Getafe; Madrid Spain
| | - J.A. Lopez-Escamez
- Otology and Neurotology Group CTS495; Department of Genomic Medicine; GENYO - Centre for Genomics and Oncological Research - Pfizer/University of Granada/ Junta de Andalucía, PTS; Granada Spain
- Department of Otolaryngology; Complejo Hospitalario Universitario; University of Granada; Granada Spain
| |
Collapse
|
9
|
Acupuncture Points Stimulation for Meniere's Disease/Syndrome: A Promising Therapeutic Approach. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:6404197. [PMID: 27547229 PMCID: PMC4980515 DOI: 10.1155/2016/6404197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/22/2016] [Accepted: 06/05/2016] [Indexed: 12/28/2022]
Abstract
Objective. This study aims to explore evidence for acupuncture points stimulation (APS) in treatment of Meniere's disease (MD). Method. A literature search was conducted in seven databases including EMBASE, Medline, Cochrane Library, Web of Science, CBM, CNKI, and WangFang database and the data analysis was performed by using the RevMan version 5.3. Results. 12 RCTs with 993 participants were acquired after the search. The quality of most eligible studies was very low which limited the value of the meta-analysis. Compared with western medicine comprehensive treatment (WMCT), the APS alone or in combination with WMCT had a significant positive effect in controlling vertigo; however, the result was negative in hearing improvement and DHI. No adverse events were reported in the studies. Conclusion. The APS might be a promising therapeutic approach for MD. However, the currently available evidence is insufficient to make a definitive conclusion for the poor quality of included studies. More high-quality researches with larger sample size are urgently needed to assess the effectiveness and safety.
Collapse
|
10
|
Early Diagnosis and Management of Acute Vertigo from Vestibular Migraine and Ménière's Disease. Neurol Clin 2015; 33:619-28, ix. [DOI: 10.1016/j.ncl.2015.04.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
11
|
Vasopressin induces endolymphatic hydrops in mouse inner ear, as evaluated with repeated 9.4 T MRI. Hear Res 2015; 330:119-24. [PMID: 26048336 DOI: 10.1016/j.heares.2015.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/09/2015] [Accepted: 05/25/2015] [Indexed: 11/24/2022]
Abstract
From histopathological specimens, endolymphatic hydrops has been demonstrated in association with inner ear disorders. Recent studies have observed findings suggestive of hydrops using MRI in humans. Previous studies suggest that vasopressin may play a critical role in endolymph homeostasis and may be involved in the development of Ménière's disease. In this study we evaluate the effect of vasopressin administration in vivo in longitudinal studies using two mouse strains. High resolution MRI at 9.4 T in combination with intraperitoneally delivered Gadolinium contrast, was performed before and after chronic subcutaneous administration of vasopressin via mini-osmotic pumps in the same mouse. A development of endolymphatic hydrops over time could be demonstrated in C57BL6 mice (5 mice, 2 and 4 weeks of administration) as well as in CBA/J mice (4 mice, 2 weeks of administration; 6 mice, 3 and 4 weeks of administration). In most C57BL6 mice hydrops developed first after more than 2 weeks while CBA/J mice had an earlier response. These results may suggest an in vivo model for studying endolymphatic hydrops and corroborates the future use of MRI as a tool in the diagnosis and treatment of inner ear diseases, such as Ménière's disease. MRI may also be developed as a critical tool in evaluating inner ear homeostasis in genetically modified mice, to augment the understanding of human disease.
Collapse
|
12
|
Abstract
Dizziness is a common and challenging condition seen in the primary care office. Because dizziness is a vague term that can include a wide array of medical disorders, it is important to use a stepwise approach to differentiate between causes. This article focuses on vertigo and its four most common causes: benign paroxysmal peripheral vertigo, vestibular neuritis, vestibular migraine, and Meniere's disease.
Collapse
Affiliation(s)
- Jennifer Wipperman
- Department of Family and Community Medicine, University of Kansas School of Medicine - Wichita, 1010 North Kansas, Wichita, KS 67214, USA.
| |
Collapse
|
13
|
Wick CC, Semaan MT, Zheng QY, Megerian CA. A Genetic Murine Model of Endolymphatic Hydrops: The Phex Mouse. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014; 2:144-151. [PMID: 25309828 PMCID: PMC4193546 DOI: 10.1007/s40136-014-0048-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Animal models of endolymphatic hydrops (ELH) provide critical insight into the pathophysiology of Meniere's disease (MD). A new genetic murine model, called the Phex mouse, circumvents prior need for a time and cost-intensive surgical procedure to create ELH. The Phex mouse model of ELH, which also has X-linked hypophosphatemic rickets, creates a postnatal, spontaneous, and progressive ELH whose phenotype has a predictable decline of vestibular and hearing function reminiscent of human MD. The Phex mouse enables real-time histopathologic analysis to assess diagnostic and therapeutic interventions as well as further our understanding of ELH's adverse effects. Already the model has validated electrocochleography and cervical vestibular evoked myogenic potential as useful diagnostic tools. New data on caspase activity in apoptosis of the spiral ganglion neurons may help target future therapeutic interventions. This paper highlights the development of the Phex mouse model and highlights its role in characterizing ELH.
Collapse
Affiliation(s)
- Cameron C Wick
- Ear, Nose, and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Maroun T Semaan
- Ear, Nose, and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Qing Yin Zheng
- Ear, Nose, and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Cliff A Megerian
- Ear, Nose, and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| |
Collapse
|
14
|
Ahsan SF, Standring R, Wang Y. Systematic review and meta-analysis of Meniett therapy for Meniere's disease. Laryngoscope 2014; 125:203-8. [PMID: 24913022 DOI: 10.1002/lary.24773] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS To perform a systematic review and meta-analysis of micropressure treatment for Meniere's disease (MD). DATA SOURCES Medline, Ovid, Web of Science, and Cochrane Library search of the literature from January 1996 to December 2012. REVIEW METHODS Systematic literature review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria required definitive diagnosis of unilateral MD, treatment with Meniett device, vertigo control results, and hearing results before and after treatment. Randomized controlled trials and other types of case-control studies were included. Improvements in vertigo, American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) functional score, and pure tone average (PTA) were assessed. Funnel plots were used to detect bias and Q test was used to assess for heterogeneity. Random effects model was used for meta-analysis. T test was used to assess for significance. RESULTS Of 113 abstracts screened, 18 studies met criteria for review and 12 were used for meta-analysis. Eight studies reported hearing evaluation and the improvement in PTA after Meniett treatment was significant (P = 0.0085). Data could not be combined for AAO-HNS functional score due to heterogeneity. However, there was a trend toward improvement. Of six studies reporting frequency of vertigo, Meniett treatment significantly reduced frequency of vertigo (P = < .0001). LIMITATIONS Much of the data used in the analysis was derived from retrospective or level 4 studies. The average follow-up was only 5 months, and there were low number of patients in the treatment and control groups. CONCLUSION The Meniett device is a safe, nondestructive treatment for patients' refractory to medical therapy for MD.
Collapse
Affiliation(s)
- Syed F Ahsan
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital; Henry Ford Health System, Detroit, Michigan, U.S.A
| | | | | |
Collapse
|
15
|
Choi JW, Kang SI, Rhee JH, Choi BY, Kim JS, Koo JW. Clinical implication of ocular torsion in peripheral vestibulopathy. Eur Arch Otorhinolaryngol 2014; 272:1613-7. [DOI: 10.1007/s00405-014-2952-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
|
16
|
A mouse model validates the utility of electrocochleography in verifying endolymphatic hydrops. J Assoc Res Otolaryngol 2014; 15:413-21. [PMID: 24509791 DOI: 10.1007/s10162-014-0445-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 01/20/2014] [Indexed: 10/25/2022] Open
Abstract
Endolymphatic hydrops (ELH) is a disorder of the inner ear that causes tinnitus, vertigo, and hearing loss. An elevated ratio of the summating potential (SP) to the action potential (AP) measured by electrocochleography has long been considered to be the electrophysiological correlate of ELH-related clinical conditions, such as Meniere's disease, but in vivo confirmation and correlation between an elevated SP/AP ratio and ELH has not yet been possible. Confirming this relationship will be important to show that elevated SP/AP ratio is indeed diagnostic of ELH. Here, we sought to confirm that an elevated SP/AP ratio is associated with ELH and test the hypothesis that severity of ELH and hearing loss would also correlate with the SP/AP ratio in vivo using the Phex(Hyp-Duk)/Y mouse model of postnatal ELH. In addition, we describe a minimally invasive approach for electrocochleography in mice. Auditory brainstem responses and electrocochleography data were collected from controls and Phex(Hyp-Duk)/Y mutants at postnatal day 21 and the mice (all male) were euthanized immediately for cochlear histology. Our results show that (1) the SP/AP ratio was significantly elevated in mice with histological ELH compared to controls, (2) the SP/AP ratio was not correlated with the severity of histological ELH or hearing loss, and (3) the severity of hearing loss correlated with the severity of histological ELH. Our study demonstrates that an elevated SP/AP ratio is diagnostic of ELH and that the severity of hearing loss is a better predictor of the severity of ELH than is the SP/AP ratio.
Collapse
|
17
|
Marques PS, Perez-Fernandez N. Bedside vestibular examination in patients with unilateral definite Ménière's disease. Acta Otolaryngol 2012; 132:498-504. [PMID: 22264068 DOI: 10.3109/00016489.2011.646357] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Although vestibular clinical examinations are quite variable in Ménière's disease (MD), when used in a grouped fashion they attach valuable information to the understanding of MD. OBJECTIVE Evaluation of unilateral MD vestibular bedside examination. METHODS This was a retrospective study of patients with definite unilateral MD at a tertiary care facility. Assessment of spontaneous nystagmus (SN), head-shaking nystagmus (HSN), head impulse test (HIT) and vibration-induced nystagmus (VIN) was carried out. Clinical manifestations and auditory and vestibular function were studied. RESULTS The study included 97 patients: 47 presented SN, 75 a positive HSN (biphasic in 14) and in 73 a VIN was observed. After excluding patients with biphasic HSN, a homogeneous response was observed in 43.4%: no nystagmus in 15.7%; nystagmus of similar direction in 27.8% (paretic, 14.5%; irritative, 13.3%). There were no significant differences in duration of the disease, functional level and vertigo index, although a trend towards a shorter time since last crisis was observed in patients with an irritative nystagmus. In 36.1% nystagmus was revealed with a consistent direction in at least one of the tests and in 20.5% it was non-coherent, something more frequently observed closer to the crisis. Independently only in VIN an irritative response was associated with a higher functional level and a shorter time from last attack.
Collapse
|