Delayed Effect of Active Pressure Treatment on Endolymphatic Hydrops

Abstract

Objective: To identify eventual correlations between the effect of low-pressure treatment and endolymphatic hydrops in Ménière patients. Material and Methods: The study group consisted of subjects affected by definite Ménière disease (2015) and a severe degree of disability, who received a ventilation tube with or without a low-pressure treatment before undergoing a surgical procedure (vestibular neurectomy). After the placement of the ventilation tube, the subjects were either left alone with the tube or received 1 month of self-administered low-pressure therapy with a portable device. In all subjects, an electrocochleography (ECochG) was performed and specific questionnaires - Dizziness Handicap Inventory (DHI) and Functional Scale Level (FSL) - were completed before starting either arm of treatment, at the end of treatment, and then 3 and 6 months later. Results: All selected subjects presented with an ECochG pattern that was indicative of endolymphatic hydrops before starting either treatment. At the end of pressure treatment, 80% showed symptomatic improvement while maintaining the hydropic ECochG pattern. At the 3-month control stage, the hydropic pattern resulted normalized (<0.5) in all the improved subjects. Conclusions: Although 1 month of low-pressure treatment provided a positive symptomatological outcome, normalization of the hydropic ECochG parameters occurred only at a later time. Therefore, it is possible to assume that endolymphatic hydrops could be concurrent with a non-symptomatic stage of Ménière disease, and that the anti-hydropic effect of the low-pressure treatment, if any, would present with a certain delay after its completion.

PET Visualized Stimulation of the Vestibular Organ in Menière's Disease

“…In the early stages of the Menière's disease, the vestibular function is rarely affected between vertigo spells. However, hearing loss and loss of vestibular function seem to gradually evolve over time despite various treatment modalities (6). Loss of sensory afferents leads to multisensory compensation in the brain, which is also believed to account for the clinical recovery in patients with vestibular disorders (7).…”

Intratympanic Steroid for Menière's Disease: A Systematic Review

“…Surgical treatment modalities include endolymphatic sac surgery, neurectomy of vestibular neurotomy or labyrinthectomy and are usually reserved as last resort treatments [6,7]. However, regardless of the treatment, the auditory and vestibular deficits generally progress over time [8]. An international consensus paper on the treatment of Menières disease was published in 2018 from six experts on Menières disease, which recommended intratympanic steroid as a second step treatment modality [7].…”