Long-term effects of middle ear pressure therapy with the EFET01 device in patients with Ménière's disease and delayed endolymphatic hydrops in Japan

BACKGROUND

Long-term efficacy of middle ear pressure therapy (MEPT) with the EFET01 device in patients in Japan with definitive Ménière's disease (MD) and delayed endolymphatic hydrops (DEH) was evaluated.

OBJECTIVE

To examine the effects of reducing vertigo attacks and improving hearing of MD and DEH patients by using MEPT with the EFET01 device for two years after treatment.

MATERIAL AND METHODS

A retrospective study was conducted of 32 MD patients and 2 DEH patients treated by MEPT with the EFET01 device from December 2018 to April 2021. According to Japan Society for Equilibrium Research (JSER) guidelines, patients were investigated for the frequency of vertigo attacks and change in hearing levels during a period of 6 months before to 18-24 months after start of treatment.

RESULTS

The frequency of vertigo attacks significantly decreased in both MD and DEH patients, and hearing level has remained stable in the majority of our patients after treatment.

CONCLUSION

Our study clarified that MEPT with the EFET01 device was effective in controlling vertigo symptoms of MD and DEH. It should be considered a safe option for patients failing medical treatment.

SIGNIFICANCE

The efficacy of MEPT with the EFET01 was shown over a 2-year follow-up period.

[A case report of middle ear cholesteatoma complicated with labyrinthine fistulaand delayed endolymphatic hydrops]

Delayed endolymphatic hydrops （DEH） is a rare disease that causes vertigo and is often misdiagnosed as other vertigo diseases. This article reports on a patient with vertigo who was easily misdiagnosed. The patient was a middle ear cholesteatoma complicated by labyrinthine fistula （LF）; however, his vertigo was episodic vertigo, which could not be explained solely by LF causing labyrinthitis. The possibility of endolymphatic hydrops was suspected, which was confirmed by inner ear magnetic resonance gadolinium imaging. This is the first reported case of middle ear cholesteatoma complicated by LF and DEH. The patient underwent surgical resection of the cholesteatoma and three semicircular canal obstructions at the same time. During two years postoperative follow-up, the patient did not experience a recurrence of vertigo. When diagnosing vertigo diseases, a careful history of vertigo is of utmost importance.

[Advances in the study of fluctuating sensorineural hearing loss]

Fluctuating sensorineural hearing loss（FSNHL） is a special type of sensorineural hearing loss, which can be manifested in many clinical diseases. In this paper, some clinical diseases associated with FSNHL are summarized, such as Meniere's disease, large vestibular aqueduct syndrome, acute low frequency sensorineural hearing loss, delayed endolymphatic hydrops, autoimmune inner ear disease and syndromes leading to FSNHL. The pathogenesis, diagnosis and treatment of FSNHL were summarized in order to improve clinicians' understanding of FSNHL, reduce the probability of misdiagnosis of related diseases and improve the prognosis of patients.

12-month effect of middle ear pressure therapy with the EFET01 device for intractable definite Meniere's disease and delayed endolymphatic hydrops after certification by the public health insurance system in Japan

BACKGROUND

Middle ear pressure therapy (MEPT) is effective for intractable vertigo in patients with definite Meniere's disease (MD) and treatment-refractory delayed endolymphatic hydrops (DEH). Four-month MEPT with the EFET01^®, an MEPT device developed in Japan and covered by national health insurance since September 2018, has shown efficacy. However, efficacy and safety after 12 months of treatment, which is appropriate for determining the therapeutic effect of MEPT devices, is unclear.

OBJECTIVES

Examine the therapeutic effect of 12-month MEPT using the ETET01^®.

MATERIAL AND METHODS

Patients underwent MEPT using the EFET01^® from September 2018 to July 2021. Thirty-three patients followed for >12 months were enrolled in this retrospective study. Clinical data were evaluated in the first and second 6-month treatment periods. Data from the second 6-month period were compared with data from an MEPT study using a different device.

RESULTS

MEPT with the EFET01^® significantly improved vertigo in the first period, with further improvement in the second period. The efficacy and safety were comparable to MEPT with other devices.

CONCLUSIONS

MEPT with the EFET01^® is effective for intractable vertigo in patients with definite MD and DEH, and 12-month follow-up is recommended.

SIGNIFICANCE

The efficacy of 12-month MEPT with the EFET01^® was demonstrated.

Efficiency of a novel middle ear pressure device for intractable definite Meniere's disease and delayed endolymphatic hydrops after certification by the public health insurance system in Japan

BACKGROUND

Middle ear pressure therapy (MEPT) is effective in treating intractable vertigo in patients with definite Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) refractory to conservative treatment. A novel middle ear pressure device, the EFET01^®, which requires no transtympanic ventilation tubes, was developed in Japan, approved by the Japanese Ministry of Health, Labour and Welfare, and has been used under Japanese national health insurance since September 2018.

OBJECTIVES

To examine short-term therapeutic effect of MEPT using the ETET01^® compared with previous clinical trial results.

METHODS

Patients selected according to Japan Society for Equilibrium Research (JSER) guidelines underwent MEPT using the EFET01 from September 2018 to July 2021, and 44 patients were enrolled in this retrospective study. Clinical data analysed at 4 months after the start of MEPT were compared with those of the previous clinical trial for the EFET01.

RESULTS

MEPT using the EFET01 showed the same therapeutic efficacy as that of the previous clinical trial, i.e. improvement in the intensity and frequency of vertigo with no effect on hearing, even under JSER guidelines for proper use of MEPT.

CONCLUSION

MEPT using the EFET01 provided an effective treatment option for intractable vertigo in patients with definite MD and DEH.

Long-term effect of transtympanic intermittent pressure therapy using a tympanic membrane massage device for intractable meniere's disease and delayed endolymphatic hydrops

BACKGROUND

A 12-month follow-up study showed that middle ear pressure treatment with a transtympanic membrane massage (TMM) device had a similar effect to a Meniett device.

OBJECTIVES

The effects of pressure treatment with a TMM device were retrospectively compared to the effects of treatment with a Meniett device in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) who were followed for a minimum of 24 months.

MATERIALS AND METHODS

Twenty-seven patients were treated with the TMM device and 14 patients were treated with a Meniett device. The insertion of a transtympanic ventilation tube was necessary for the Meniett device but not for the TMM device.

RESULTS

In patients treated with the TMM and Meniett devices, the frequency of vertigo significantly improved at 19-24 months after treatment. The distribution of vertigo at 19-24 months after treatment did not differ between the patients treated with the two types of devices. Pressure treatment for 8 months or more was suitable to achieve remission.

CONCLUSIONS AND SIGNIFICANCE

Middle ear pressure treatment for 8 months or more with a TMM or Meniett device was equally effective and provided minimally invasive treatment options for intractable MD and DEH.

Effects of transtympanic intermittent pressure therapy using a new tympanic membrane massage device for intractable Meniere's disease and delayed endolymphatic hydrops: a prospective study

BACKGROUND

The retrospective study showed that the effect of the middle ear pressure treatment by the tramstympanic membrane massage (TMM) device was similar to that of the Meniett device.

OBJECTIVES

The new TMM device named EFET device was prospectively evaluated in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) and we compared the effects to the Meniett device.

MATERIALS AND METHODS

23 ears of 19 patients were treated with an EFET device, and 17 ears of 15 patients were treated with the Meniett device. All patients suffering from intractable MD and DEH were treated for 4 months. The insertion of a transtympanic ventilation tube was necessary for the Meniett device, but not the EFET device.

RESULTS

In patients treated by the EFET and Meniett devices, the frequency of vertigo significantly improved after treatment. The distribution of vertigo outcomes at 4 months after treatment did not differ between patients treated with the both devices.

CONCLUSIONS AND SIGNIFICANCE

Middle ear pressure treatment by the EFET device is effective and provides minimally invasive options for intractable MD and DEH like the Meniett device.

The transcriptome characteristics of vestibular organs from delayed endolymphatic hydrops patients (Meniere's disease)

OBJECTIVES

To identify genes that are related to delayed endolymphatic hydrops (DEH) in patients by RNA-Seq analysis.

DESIGN

Observational study.

SETTING

Eye & ENT Hospital, Fudan University (Shanghai, China).

PARTICIPANTS

We collected the entire vestibular system from four patients with DEH who underwent labyrinthectomy. Three control samples were collected from patients with acoustic neuroma or facial neuroma treated via the translabyrinthine approach. High-throughput RNA-Seq analysis was performed to investigate gene expression in the pathological vestibular system.

MAIN OUTCOME MEASURES

Our bioinformatic analysis identified 17 genes that were upregulated and eight genes that were downregulated in patients with DEH compared with the controls.

RESULTS

The altered gene expression profile suggested that DEH is closely related to neuropathy and autoimmune disease. In addition, many of the differentially regulated genes were involved in cell adhesion, suggesting a role of cell adhesion in DEH. Immunofluorescence analysis confirmed the expression of PMP2 and CLDN19 in the cytoplasm of hair cells and scattered expression of MPZ at cell junctions. The protein expression levels were higher in specimens from patients with Ménière's disease and DEH compared with controls.

CONCLUSIONS

The protein expression profile of vestibular organs in patients with endolymphatic hydrops exhibited a degree of similarity to that of Ménière's disease. Endolymphatic hydrops is characterised by autoimmune abnormalities. DEH and Ménière's disease are likely to be different manifestations of the same disease, with disparate clinical symptoms. RNA-Seq is a useful analytical tool to characterise the vestibular pathology based on its transcriptome.

Dissociation of Caloric and Video Head Impulse Tests in Patients With Delayed Endolymphatic Hydrops

Delayed endolymphatic hydrops (DEH) represents a rare clinical entity characterized by intermittent vertigo attacks mimicking those of Ménière's disease (MD) in a patient with a prior sensorineural hearing loss. Some vestibular tests have been employed in patients with DEH. These tests provide useful diagnostic information and facilitate clinical decision-making. Here, we retrospectively studied the features of video head impulse test (vHIT) and examined its relationship with caloric test used in DEH patients. Included in this study were 17 patients with ipsilateral DEH and 2 with contralateral DEH. Among them, 73.7% (14/19) showed abnormal caloric test response (76.5% in ipsilateral DEH and 50% in contralateral DEH). Meanwhile, only 15.8% (3/19) of patients yielded abnormal horizontal vHIT results (11.8% in ipsilateral DEH and 50% in contralateral DEH). Abnormal caloric response in the presence of a preserved vHIT was common in DEH patients, especially those with ipsilateral DEH. This dissociation might be a distinctive pattern of vestibular deficit in DEH.

[Advance in research of delayed endolymphatic hydrops]

Delayed endolymphatic hydrops (DEH) is a disease entity first described by Kamei and named by Schuknecht, defined as profound sensorineural deafness at early stage and after several years started to appear clinical feature of endolymphatic hydrops such as vertigo, aural fullness like Meniere's disease or fluctuating hearing loss in the contralateral ear . DEH can be classified into ipsilateral type, contralateral type and bilateral type. Although DEH has low incident rate, there are many kinds of etiology and audiology and vestibular tests. Up to now, a lot of literatures about etiology, diagnose, clinical manifestation, relevant examination and therapy of DEH were published abroad. In this review, we will make a summary of research status of DEH.

[Triple semicircular canal occlusion with cochlear implantation for delayed endolymphatic hydrops: a case report]

A 46-year-old female with profound sensorineural hearing loss in her left ear from childhood developed tinnitus and fluctuating hearing loss on the right side 8 years ago. Four years later, paroxysmal episodes of rotatory vertigo occurred with gradually increased frequency, lasting from half an hour to 2 hours and accompanied with nausea and vomiting. Audiometric test revealed severe sensorineural hearing loss in both of her ears. The tympanograms showed type A on both sides. The threshold of auditory brainstem response was 97 dBnHL in her right ear while no waves could be educed on her left side. Weakened right-sided vestibular function was confirmed on caloric testing and vestibular-evoked myogenic potential. A normal cochlear morphology and clearness cerebellopontine angle were shown in the MR imaging scan. She was diagnosed with Delayed Endolymphatic Hydrops.