Psychiatric disorders in patients with dizziness and Ménière’s disease

Conclusions: The Self-Rating Depression Score (SDS) is a useful metric for identifying patients with possible psychiatric disorders. Objective: A dilemma commonly encountered by otolaryngologists is how to diagnose and treat depression and anxiety disorders in patients who have dizziness or Ménière’s disease. Methods: We administered the SDS and Hospital Anxiety and Depression Scale (HADS) to patients with dizziness (n = 116) or Ménière’s disease (n = 22). Overall, 31 and 9 patients, respectively, had SDS ≥ 41. We investigated the correlation between the two questionnaire scores and the relationship between scores and a diagnosis of depression by a psychiatrist. Results: We referred 12 patients with dizziness and 4 with Ménière’s disease to a psychiatrist. The most common psychiatric comorbidities were anxiety disorder and major depression. Overall, 7 of the 12 patients who had dizziness and all 4 patients with Ménière’s disease were diagnosed with major depression. Patients with an SDS ≥ 41 and ≥ 11 on the D portion of HADS were likely to be diagnosed with major depression (9 of 11). No psychiatric disorders were diagnosed in patients with an SDS < 41. No specific characteristics were identified by HADS in patients with a psychiatric comorbidity.     

Imaging of the endolymphatic space in patients with Ménière’s disease

Objective

To examine endolymphatic hydrops (EH) using magnetic resonance imaging (MRI) in patients with definite Ménière’s disease (MD) and those with nonotological diseases.

Association between Ménière’s disease and vestibular migraine

ObjectiveThe aim of the present study was to evaluate complaints in people with Ménière’s disease (MD) with and without migraine and headache to study the association between MD and Vestibular Migraine (VM). We believe this will help us understand if these two disorders represent a disease continuum in that they may share a common aetiology.MethodsThe study used a retrospective design and included data of 911 patients with MD from the Finnish Ménière Federation database. The study participants had a mean age of 60.2 years, mean duration of disease of 12.6 years, and 78.7% of the participants were females. The questionnaire data comprised of both disease specific and impact related questions. The data were analyzed using the Mann–Whitney U test, the Kruskal Wallis H test, logistic regression analyses, and decision tree analysis.ResultsMigraine and headache was reported by 190 subjects (20.9%) and 391 subjects (42.9%) respectively. We found that patients that could be classified as VM in the study (i.e., those with frequent vertigo spells associated with migraine) more often reported complaints of severe MD symptoms, had reduced health-related quality of life, suffered more from anxiety, had more neurological complaints, and experienced a reduced sense of coherence than the non-migraneous patients with MD. However, neither the decision tree analysis nor the logistic regression analysis could reliably discriminate VM from MD patients.ConclusionOur study results confirm that MD is frequently associated with headache and migraine. In addition, results also indicate that migraine provokes the severity of MD. We suggest that MD and VM may share similar pathophysiological mechanisms. Hence, the future MD classification systems should include a category referred to as ‘MD with migraine’ that will include patients with VM.     

Meta-analysis of clinical studies with betahistine in Ménière’s disease and vestibular vertigo

We present a meta-analysis of 12 double-blind, randomized, placebo-controlled clinical studies with betahistine in patients suffering from vestibular vertigo or Ménière’s disease, based on both published and unpublished data. The clinical endpoint we used was the investigator’s overall opinion on the response to treatment of the vertigo symptoms, after at least 1 month of treatment. We introduce a new effect parameter, the odds of a favorable treatment outcome, with the odds ratio as measure to compare the responses of betahistine and placebo patients. For each study a separate odds ratio was estimated (the study-specific odds ratio). All but one of the study-specific odds ratios were >1.0, meaning that with the new effect parameter there was evidence of an effect of betahistine on vertigo symptoms in 11 of the 12 studies. Four of the 12 studies showed a statistically significant effect in favor of betahistine compared to placebo. The meta-analytical (i.e., average) odds ratio was 2.58 (95 % confidence interval 1.67–3.99), a statistically significant result. This means that on average, the likelihood of a favorable outcome is almost two times higher for patients treated with betahistine than for placebo-treated patients. Sub-analyses conducted for patients with Ménière’s disease on one hand and with vestibular vertigo on the other hand also yielded statistically significant results. For Ménière’s disease, the meta-analytical odds ratio was 3.37 (95 % CI 2.14–5.29); for vestibular vertigo, the odds ratio was 2.23 (95 % CI 1.20–4.14). Our meta-analysis supports the therapeutic benefit of betahistine on vertiginous symptoms in both Ménière’s disease and vestibular vertigo.     

Application of autogenic training in patients with Ménière disease

Data are limited on the role of psychotherapy in the treatment of Ménière disease. We sought to document the effect of a psychotherapeutic technique known as autogenic training on clinical outcome in Ménière disease. Six patients with Ménière disease were studied. Retrospective chart review was conducted. All patients were refractory to conventional therapy and completed a course of autogenic training, which was offered as a complementary treatment. Autogenic training with initial psychological counseling was conducted by a clinical psychologist during 45-min sessions. Outcome measures assessed were the frequency of vertigo and functional levels 2 years after initiation of autogenic training. Functional levels were evaluated according to the 1995 guidelines of the American Academy of Otolaryngology-Head Neck Surgery (AAO-HNS). As a personality measure, we used the Maudsley Personality Inventory (MPI), devised by Eysenck, which measures neuroticism (N), extraversion (E), and propensity to lie (L). Five of six patients showed improved functional level after three to eight sessions of psychotherapy; hearing level did not change. The score of the N scale of the MPI was closely related to the number of psychotherapy sessions. Prognosis was evaluated based on the AAO-HNS reporting guidelines, as follows: A = 3, B = 1, C = 1, F = 1. The value of N in MPI was closely related to the number of psychological counseling sessions (R = 0.97, P < 0.05). In conclusion, autogenic training may enhance the mental well-being of patients with Ménière disease and improve clinical outcome.     

Vestibular syncope: A disorder associated with drop attack in Ménière’s disease

Objective

Experiments in humans and animals indicate that vestibular influx through vestibular sympathetic reflex is an important and vital part of the regulatory system of circulation. The otolith organ adjusts the circulatory responses through the vestibular sympathetic reflex during an upright stance and may trigger a vasovagal attack of syncope. The aim of the present study was to evaluate the prevalence and association of syncope attacks among patients with Ménière’s disease (MD). Vestibular syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously in people with vestibular disorders and without localizing neurological deficit.

Ozone therapy and pressure-pulse therapy in Ménière's disease

The aim of this study was to evaluate the usefulness of ozone and pressure-pulse therapies in treating Ménière's disease. Using objective otoacoustic emissions and short-increment sensitivity index (SISI) tests together with subjective anamnesis, we tested 15 patients (8 men, 7 women) who had suffered from Ménière's disease for 1-3 years and had permanent sensorineural hypoacusis; we compared results before and after treatment. We performed ozone therapy and pressure-pulse treatments simultaneously for one 10-minute session each day for 10 consecutive days. After treatment, both otoacoustic-spontaneous and transiently evoked emissions and SISI test results exhibited no statistically significant changes. However, the subjective state of the patients was clearly improved. The frequency, severity of attacks, and tinnitus decreased. The mechanism of such an improvement is discussed.     

Glycerol affects vestibular-evoked myogenic potentials and pure-tone hearing in patients with Ménière’s disease

Conclusion: The pure-tone audiometry results following glycerol administration indicated a positive effect on cochlear endolymphatic hydrops. Glycerol cervical vestibular-evoked myogenic potential (cVEMP) tests are a useful means of diagnosing saccular hydrops. There was no correlation between cVEMP and audiological results. Objective: To document the changes in pure-tone hearing outcomes and cVEMPs in patients with Ménière’s disease (MD) and 10 healthy volunteers before and after oral administration of glycerol. Methods: Twenty-nine study group subjects were chosen with complaints of vertigo. cVEMP testing and pure-tone hearing level testing were performed before and at 1, 2, and 3 h after administration of glycerol. Results: The means of the latencies, amplitudes, and difference ratio in 20 normal subject ears were determined. Based on these values, 9/29 MD-affected (MDA) ears (31%) had a unilaterally absent cVEMP. Compared with difference ratio values of the control groups there were significant differences in both latencies and amplitudes in MDA ears after glycerol administration. Before glycerol administration, there were significant differences between control and MDA ears on mean values of pure-tone hearing outcomes. Twenty patients in the MDA group showed significant pure-tone hearing outcomes after glycerol administration.     

End-point indicators of low-dose intra-tympanic gentamicin in management of Ménière’s disease

Conclusions: One-shot, low-dose intra-tympanic gentamicin (ITG) treatment was effective and safe for Ménière’s disease (MD) patients. Head thrust test (HTT) and vestibular evoked myogenic potentials (VEMPs) test could be used as endpoint indicators for vertigo control in MD patients.

Objectives: The present study is to explore end-point indicators of ITG injection in MD.

Methods: Patients with MD were reviewed from June 2012 to March 2014. Single-shot ITG at a concentration of 30?mg/ml was administered to patients. The sensitivity and specificity of HTT and VEMPs for vertigo control were measured.

Results: All 37 patients with a median follow-up of 26 months were included. Of those 37 patients, 24 patients (64.9%) obtained class A vertigo control and seven patients (18.9%) obtained class B vertigo control. Only six patients had class C control (16.2%). The sensitivity and specificity of HTT for vertigo control were 74.2% and 50.0%. Meanwhile, the sensitivity and specificity of VEMPs threshold were 83.9% and 33.3%. When combined HTT and VEMPs, sensitivity and specificity were 93.5% and 66.7%. Based on the four-tone average thresholds at 0.5, 1, 2, 3?kHz, 78.4% patients had no significant change in PTA and 16.2% patients experienced significant improvement.     

Intratympanically administered steroid for progressive sensorineural hearing loss in Ménière’s disease

Abstract

Background: Ménière’s disease is characterised by episodic rotational vertigo, sensorineural hearing loss, tinnitus, and vegetative symptoms.

Objectives: The aim of our study is to follow-up the effects of the intratympanic steroid treatment of hearing loss in MD.

Material and methods: A group of 105 clinically diagnosed MD patients were enrolled in this investigation. Long-term follow-up was carried out, and pure tone speech audiometry results of the subjects before and after application of steroid were contrasted. Statistical analysis was carried out using the IBM SPSS V24 software.

Results: Based on the audiograms in this population, all stages of hearing loss were presented (from slight to profound). In most of the cases (68.6%), after intratympanic dexamethasone treatment, stagnation in the hearing profile was achieved. Moreover, there was a smaller group demonstrating hearing improvement after the treatment (12.4%). According to logistic regression [p?=?.001; Odds ratio: 2.75 (95% CI 1.068–4.442,)], there was a strong correlation between hearing improvement and dexamethasone treatment (all patients were treated with intratympanic dexamethasone, while improvement without steroid treatment could never be attained).

Conclusions and significance: Intratympanically administered dexamethasone is a potent agent to prevent the progression of hearing loss in MD.     

Mitochondrial ribosome and Ménière’s disease: a pilot study

Ménière’s disease patients experience vestibular disability. When most of medical treatments fail, a chemical labyrinthectomy using aminoglycosides is indicated. However, this process frequently causes hearing damage. Aminoglycosides, interacting with mitochondrial rRNAs, alter mitochondrial protein synthesis and the oxidative phosphorylation system, which provide most of the energy in sensory hair cells. For this reason, we hypothesized that genetic variation in mitochondrial rRNA genes and in two nuclear genes coding for proteins that also modify the susceptibility to aminoglycosides might affect the risk of hearing loss in Ménière’s disease patients suffering chemical labyrinthectomy. However, there were no differences in mitochondrial rRNA, TFB1M or MRPS12 genetic variation between those patients that experienced or did not experience hearing loss. This is only a pilot study and larger studies are required to use this therapeutic approach in a rational way and decrease the risk of hearing damage.     

Changes in endolymphatic hydrops in patients with Ménière’s disease treated conservatively for more than 1 year

Conclusion: This study revealed that endolymphatic hydrops (EH) reduced in some cases with Ménière’s disease (MD) treated conservatively. It appears that the EH reduction was associated with improvement of the clinical symptoms. Objectives: The relationship between the degree of EH and clinical symptoms is not clear at present. The purpose of the present study was to investigate the time course of the relationship in patients with MD treated conservatively. Patients: Twelve patients with MD treated conservatively for more than 1 year in a university hospital. Methods: Twenty ears of 12 patients with MD treated conservatively were evaluated. The presence or absence of vertigo, tinnitus and ear fullness was confirmed when magnetic resonance imaging (MRI) was performed. Using a 3 T MRI scanner, three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) MRI was performed 2 or 3 times 24 hours after intra-tympanic gadolinium injection or 4 hours after intravenous gadolinium injection. Results: In the three ears in which the symptoms alleviated, EH was reduced in two ears, but EH was reduced in only one of 17 ears in which the symptoms did not alleviate. The Fisher exact test revealed that EH reduction occurred more frequently in ears with alleviation of the symptoms (p < 0.05).     

A systematic review and meta-analysis of extratympanic electrocochleography in Ménière’s disease diagnosis

Objective: Determine whether a combination of electrocochleography determined summating/action potential (SP/AP) ratio and other audiological measurements has greater sensitivity and specificity than that achieved with electrocochleography SP/AP ratio alone in diagnosing definite Ménière’s Disease.

Design: Systematic review and meta-analysis.

Study sample: Pubmed, Cochrane Library, and Web of Science were searched using search terms “electrocochleography”, “ECochG, ,“ECoG”, “Ménière’s Disease”, and “Idiopathic Endolymphatic Hydrops”. Inclusion criteria were extratympanic electrocochleography methodology, English language publication between January 2002 and December 2017, and the 1995 American Academy of Otolaryngology and Head and Neck Surgery Ménière’s disease diagnostic criteria. Five articles satisfied inclusion criteria and were sufficiently detailed for aggregate quantitative analysis of SP/AP ratio (315 subjects) and combination audiological measures (113 subjects).

Results: The diagnostic sensitivity and specificity of the SP/AP amplitude ratio was 47.6% and 83.8% and of combination diagnostic measures 63.5% and 89.3%, respectively. Point estimates of sensitivity (p?=?0.248) and specificity (p?=?0.969) and the summary Receiver Operator Characteristic Curve (p?=?0.407) were not statistically significant.

Conclusion: Statistically, combination diagnostic measures do not result in greater accuracy of definite Ménière’s disease diagnosis compared to the SP/AP amplitude ratio alone. However, given the small sample size further studies are recommended to arrive at a definitive conclusion.     

Ménière disease: diagnostic instrumental support

The current guidelines of the American Academy of Otolaryngology-Head and Neck Surgery entrust the diagnosis of Ménière disease (MD) only to the clinical presentation and the pure tone audiometry. However, most otolaryngologists request a widened instrumental evaluation of the patients suspected of MD. The effective reliability of the further instrumental support for the diagnosis of MD is still debated in the literature because of nonstandardized procedures and sometimes incoherence among authors. New and more sophisticated diagnostic tests have been developed both in audiovestibology and in imaging in the last few years. A review of the recent literature on this controversial subject is provided.     

Relational quality,illness interference,and partner support in Ménière’s disease

Objective: The current study aimed to better understand how patients and their significant others (SOs) cope with Menière’s disease (MD). Design: The study used a cross-sectional design and the data were collected using questionnaires. Study sample: Seventy-five dyads in which one person had MD. Results: SOs of patients with MD not only experienced activity and participation restrictions but also had positive experiences. In relational quality, the SOs reported uncertainty of their future, limited visits in noisy places, limited activities as walking, watching TV, and participating in social life. The illness interference correlated with the patients' complaints, and most significant was the problem of imbalance. The quality of life was significantly reduced in patients with MD, and the illness interference in terms of quality of life was correlated with the SOs in items related to mood and anxiety. The stress related conditions of the SOs were correlated with two positive items (e.g. alleviating the stress factor). The SOs could also identify one positive item (i.e., improved relationship). Conclusions: Perceptions of MD as interfering in couples’ lives influence dyadic coping in unique ways. The current study identified that dyadic coping has both positive aspects and limitations as a consequence of their partner’s MD.