Modulation of Asymmetry in Auditory Perception through a Bilateral Auditory Intervention

The objective of this work was to analyze the modulating effect of an auditory intervention (AI) on the threshold and symmetry of auditory perception in people with different emotional states. The effects of AI were compared 3 months after using threshold audiometry (air conduction). The studied groups were emotional well-being (EWB) (n = 50, 14 with AI, 36 without AI); anxiety (ANX) (n = 31, 10 with AI, 21 without AI); and mixed group (MIX) (n = 45, 19 with AI, 26 without AI). The EWB group with AI lost the advantage of the left ear due to the hearing gain of the right ear, whereas in EWB without AI, no changes were observed. The ANX group with AI showed a non-significant improvement in both ears, maintaining the left interaural advantage. Interestingly, in the group without AI, the interaural difference was lost. The MIX group did not show interaural differences either with or without AI. However, the AI group showed a lower left ear threshold than that of the right ear, in contrast to the non-AI group. In conclusion, the application of this AI manages to decrease the prioritization of high frequencies, in addition to balance hearing between ears, which could decrease activation in states of anxiety.

Duration of symptom control following intratympanic dexamethasone injections in Meniere’s disease

Purpose

Intratympanic (IT) injections of corticosteroids have emerged as a non-ablative alternative to gentamicin in the management of refractory Meniere’s disease. However, currently, the duration of the symptom control achieved via intratympanic corticosteroids is under reported.

Methods

We retrospectively reviewed the notes of all patients who underwent IT injections of dexamethasone for the treatment of definite Meniere’s disease at a single tertiary referral university centre over a 6-year period. We included demographic information, the number of procedures patients required, duration of symptom-control achieved (time interval between repeat IT injections), and the presence of co-morbidities, with a focus on the presence of autoimmune disease.

Results

We identified 27 patients who underwent a total of 42 procedures; 23/27 (85.2%) patients demonstrated clinical response with a median period of symptom control of 14.5 months (range 1–64, IQR 10.25). The median longest asymptomatic period per patient was 19 months (range 11–64, IQR: 18). Interestingly, all patients with autoimmune disease (7/27) demonstrated a clinical response; autoimmune disease was found to be a statistically significant predictor of response to treatment (p = 0.002). In patients who received repeated treatment following disease relapse, there was no difference in duration of symptom-control achieved.

Conclusions

IT steroids can provide an effective alternative to gentamicin ablation. Symptom control is achieved for a median of 14.5 months, and treatment can be repeated with no loss of efficacy. Those patients who have an underlying autoimmune co-morbidity are more likely to demonstrate a clinical response to therapy, which may provide insight into the underlying pathophysiology of Meniere’s disease.

Anatomical variation of inner ear may be a predisposing factor for unilateral Ménière's disease rather than for ipsilateral delayed endolymphatic hydrops

Objective

Radiological anatomical variations, measured by magnetic resonance imaging (MRI), were evaluated in patients with ipsilateral delayed endolymphatic hydrops (DEH) and unilateral Ménière’s disease (MD). The role of anatomical variations in different subtypes of hydropic ear disease was investigated.

Methods

Twenty-eight patients with ipsilateral DEH, 76 patients with unilateral MD, and 59 control subjects were enrolled. The radiological indices included the distance between the vertical part of the posterior semicircular canal and the posterior fossa (MRI-PP distance) and the visibility of vestibular aqueduct (MRI-VA). These variations among patients with DEH, MD, and control subjects were compared. The correlation between radiological anatomical variations and clinical features or audio-vestibular findings was also examined.

Results

(1) MRI-PP distance in the affected side of unilateral MD was shorter than that in ipsilateral DEH (Z =  − 2.481, p = 0.013) and control subjects (Z =  − 2.983, p = 0.003), while the difference of MRI-PP distance between the affected side of ipsilateral DEH and control subjects was not statistically significant (Z =  − 0.859, p = 0.391). (2) There was no significant interaural difference of MRI-PP distance in patients with unilateral MD (Z =  − 0.041, p = 0.968) and ipsilateral DEH (t =  − 0.107, p = 0.915) respectively. (3) No significant interaural difference of MRI-VA visibility was observed in patients with unilateral MD (χ² = 0.742, p = 0.389) and ipsilateral DEH (χ² = 0.327, p = 0.567) respectively. (4) No correlation was found between these anatomical variables and clinical features or audio-vestibular findings in patients with unilateral MD and ipsilateral DEH respectively (p > 0.05).

Conclusions

Anatomical variations of inner ear may be a predisposing factor in the pathogenesis of unilateral MD rather than ipsilateral DEH.

Key Points

• Patients with ipsilateral delayed endolymphatic hydrops showed normal distance between the vertical part of the posterior semicircular canal and the posterior fossa.

• Compared to patients with ipsilateral delayed endolymphatic hydrops and control subjects, patients with unilateral Ménière’s disease exhibited shorter distance between the vertical part of the posterior semicircular canal and the posterior fossa.

• Anatomical variations of inner ear may be a predisposing factor in the pathogenesis of unilateral Ménière’s disease rather than ipsilateral delayed endolymphatic hydrops.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00330-021-08430-7.

Intratympanic steroid versus gentamicin for treatment of refractory Meniere's disease: A meta-analysis

PURPOSE

Intratympanic steroid injections (ITSI) have become a promising treatment for refractory Meniere's disease due to less cochleovestibular damage. However, whether ITSI would be a good alternative to intratympanic gentamicin injections (ITGI) for refractory Meniere's disease still remains controversial. Here we intended to compare the therapeutic effect of ITSI and ITGI in patients with Meniere's disease refractory to conservative treatments, in terms of vertigo control and hearing outcomes, via a meta-analysis.

METHODS

Using MEDLINE, PubMed, and EMBASE databases, we calculated pooled odds ratio (OR) estimates of vertigo control rate (i.e., class A according to AAO-HNS guideline) and standardized mean differences (SMD) of spell count, pure tone audiometry (PTA) threshold and speech discrimination score (SDS) with a 95% confidence interval (CI). The trim-and-fill method and sensitivity analysis were used as post-hoc analyses to verify the integrity of the quantitative analysis results. Furthermore, subgroup analyses were performed according to steroid type (methylprednisolone versus dexamethasone) and follow-up period (>1-year versus <1-year).

RESULTS

Five studies involving 332 patients with refractory unilateral Meniere's disease were included. In the pooled analysis, those treated with ITGI showed higher ORs than those treated with ITSI in terms of vertigo control rate (OR: 2.39, 95% CI: 0.84-6.79, P = 0.102) and spell counts (SMD: 0.24, 95% CI: -0.12-0.59, P = 0.195), but it did not reach statistical significance. However, a substantial amount of heterogeneity (I² = 71.0%, Q = 13.79, P = 0.008) and publication bias was found, suggesting a significant small-study effect. Additionally, ITSI elicited better hearing outcomes of the mean PTA threshold (SMD: 3.08, 95% CI: -1.18-7.35) and mean SDS (SMD: 11.15, 95% CI: -23.21-0.90) compared with ITGI, although no statistical significance. In subgroup analysis, the difference in vertigo control rate between ITGI and ITSI was not significant, regardless of the follow-up period and steroid type. Further, methylprednisolone appeared to be superior to dexamethasone for vertigo control. No significant complications from either treatment were reported in the literature.

CONCLUSION

The results of this study further refine the recently proposed efficacy of ITSI for the treatment of refractory Meniere's disease, demonstrating the comparable value of ITGI on vertigo control as well as better hearing preservation. Collectively, ITSI could be a safe and the effective treatment for refractory Meniere's disease. However, the current evidence on efficacy of ITSI for refractory Meniere's disease needs to be further clarified, given the substantial heterogeneity and potential biases.

[Various types of vertigo and balance disorders in patients with Meniere's disease]

Vertigo and balance disorders in Meniere's disease (MD) may have various etiology. The aim of the review is discussing pathogenetic mechanisms of the typical vertiginous paroxysms in MD, resulting from endolymphatic hydrops as well as analysis of etiology, pathogenesis, clinical course and basic treatment of paroxysmal and permanent forms of vertigo and balance disorders, caused by other conditions, associated with MD. We discussed the course of MD complicated by vestibular migraine, benign positional paroxysmal vertigo, functional dizziness, bilateral vestibulopathy and vestibular drop-attacks.

Pharmacologic and surgical therapies for patients with Meniere's disease: a protocol for a systematic review and meta-analysis

BACKGROUND

Hearing loss is one of the leading causes of disability in Canada and worldwide, with more than one million Canadians enduring a hearing-related disability. Meniere's disease (MD) is a chronic condition of the inner ear, manifesting as a triad of disabling symptoms, including attacks of vertigo, fluctuating sensorineural hearing loss (SNHL), and tinnitus. Impacts on quality of life are severe, particularly with respect to restrictions in social participation and physical activity, fatigue, and reduced capacity to work. Anxiety and other psychological disorders may result from the restrictions imposed on life, the constant uncertainty of vertigo attacks, and fluctuating SNHL, with neuroses and depression affecting 40 to 60% of sufferers of intractable MD. There is a need to establish the benefits of previously studied interventions with greater certainty. The planned systematic review and meta-analyses/network meta-analyses (NMAs) will assess the relative effects of competing pharmacologic and surgical interventions for management of MD in adults.

METHODS

An experienced medical information specialist in consultation with the review team will develop the electronic search strategies. We will search various databases including MEDLINE, Embase, and the Cochrane Library with no date or language restrictions for published literature, and key clinical trial registries for in-progress and completed trials. Screening of the literature will be performed by two reviewers independently using pre-specified eligibility criteria, and quality of the included studies will be assessed using the Cochrane Risk of Bias tool. We will resolve disagreements through consensus or third-party adjudication. When applicable, meta-analyses and NMAs will be pursued to compare interventions in terms of their effects on outcomes, including frequency and severity of vertigo, occurrence and intensity of tinnitus, changes in hearing and speech recognition, quality of life, and harms. Separate analyses exploring the effects of pharmacologic and surgical approaches will be performed.

DISCUSSION

Our planned systematic review will provide informative evaluations of existing treatments for management of Meniere's disease. The findings will inform practitioners as to the relative benefits and harms of the existing competing interventions for MD, offer optimal clinical treatment strategies, identify evidence gaps, and determine promising therapies for evaluation in future trials.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019119129.