On the Nature of Hearing Loss in Méniere’s Disease

Gacek, Richard R.

doi:10.1159/000511113

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…In line with our results suggesting a similarity of inner ear impairment in Menière's disease cCMV infection on vestibular assessment, Gacek suggested that the hydrops observed in Ménière's was due to virion particles and inflammation (herpes virus, amongst which CMV) leading to the increase in the osmolarity of the endolymph; this then generates passive liquid diffusion and the increase of the pressure in the endolymphatic structure (Gacek 2009;Gacek 2013;Dean et al 2019). This hypothesis was partly supported by the positive effect of antiviral treatment given by Gacek in few patients, on hearing threshold and vestibular disorders (Gacek 2009;Gacek 2021).…”

Section: Congenital CMV and Ménière's Disease: A Similar Physiopathol...mentioning

confidence: 89%

Audiovestibular Consequences of Congenital Cytomegalovirus Infection: Greater Vulnerability of the Vestibular Part of the Inner Ear

et al. 2022

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Objectives: To investigate the impact of congenital cytomegalovirus infection on cochlear and vestibular function.Design: This retrospective study conducted between March 2014 and March 2020 included children with confirmed congenital cytomegalovirus infection who underwent a complete audio-vestibular evaluation. It included a bithermal caloric test, a video head impulse test and a cervical vestibular evoked myogenic potential associated with a complete hearing assessment. Results:The cohort of 130 children included in the study had a median age of 21 months (interquartile range: 12 to 37 months). Eighty-three children (64%) showed an inner ear impairment (both cochlear and vestibular). The vestibular part of the inner ear was significantly more frequently impaired than the cochlear part (ρ = 0.003). Sixty-two children (48%) showed confirmed hearing impairment. The severity of hearing loss was variable, with a high proportion of profound hearing loss (30/62, 48%), which was often bilateral (47/62, 76%). The vestibular assessment showed a canal function disorder in 67 children (88%) and an otolith function disorder in 63 children (83%; ρ = 0.36). The video head impulse test was significantly less altered (64%) compared with the bithermal caloric test (80%; ρ = 0.02) and the cervical vestibular evoked myogenic potential (83%; ρ = 0.009). Only seven out of 83 children (8%) showed hearing loss without vestibular dysfunction, of which only one had a normal hearing screening test at birth. For the children who passed the hearing screening test at birth and presented an inner ear impairment [n = 36, median age: 16 (11 to 34) months], vestibular disorders were later found in 35 children (97%) and 17 of them (47%) developed hearing loss secondarily. This underlines the importance of assessing both vestibular and auditory parts of the inner ear. When comparing the agreement of cochlear and vestibular impairment, the severity and the laterality of the impairment were low [Cohen's kappa 0.31 (0.22 to 0.40) and 0.43 (0.32 to 0.55), respectively]. Conclusion:In our study, we demonstrated that although both cochlear and vestibular parts of the inner ear can be impaired by congenital cytomegalovirus infection, the vestibular part seems more often impaired compared with the cochlear part. This underlines the importance of vestibular evaluation in the follow-up of cytomegalovirus-infected children associated with hearing assessment.

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Section: Congenital CMV and Ménière's Disease: A Similar Physiopathol...mentioning

confidence: 89%

Audiovestibular Consequences of Congenital Cytomegalovirus Infection: Greater Vulnerability of the Vestibular Part of the Inner Ear

et al. 2022

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“…More recently, Gacek examined the nature of hearing loss in Meniere's disease and concluded that sensorineural hearing loss is due to dysfunction of the cochlear amplifier function of the outer hair cells caused by the toxicity of viral nucleic acids within the organ of Corti [29 ▪ ].…”

Section: Evidence In Support Of a Viral Etiology Of Meniere's Diseasementioning

confidence: 99%

Infectious causes and mimickers of meniere's disease

Kurtzman

Sioshansi

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review To review the evidence of a possible viral etiology of Meniere's disease, the role of antiviral therapy, as well as other infectious disease processes that may mimic Meniere's disease. Better understanding of the etiology of Meniere's disease and the role of various infectious disease processes may allow for more effective diagnosis and management. Recent findings There is evidence that viral infections – to Herpes simplex virus, cytomegalovirus, Epstein Barr virus, influenza, adenovirus, Coxsackie virus B, and Varicella Zoster Virus – may be involved in the development of Meniere's disease, however the evidence is inconsistent and the underlying mechanism remains theoretical. Nevertheless, antiviral therapy may be effective for a subset of patients with Meniere's disease. Lastly, other infectious diseases including Lyme disease and syphilis can present with symptoms similar to Meniere's disease. It is important to discern these from Meniere's disease to determine the appropriate treatment. Summary There is a paucity of high-quality evidence to support a viral etiology of Meniere's disease, and the current evidence appears circumstantial and inconsistent. Additional research is necessary to establish the mechanism and causative pathogens. Antiviral therapy may provide therapeutic benefit for a subset of patients with Meniere's disease. Furthermore, clinicians should be aware of other infectious mimics of Meniere's disease and include them in the differential diagnosis of patients presenting with Meniere's-like symptoms. Research on this subject continues to evolve, and data from these studies represent a growing repository of evidence that can be used to guide clinical decision-making.

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“…The cochlea is an organ dedicated to hearing that transfers mechanical stimuli as electrical signals and then transduces them to the brain, where they can be processed to cause auditory sensation (Brownell, 1997 ; Fettiplace, 2017 ; Sohmer, 1997 ). Any damage to the sensory hair cells or auditory nerves of the cochlea caused by external stimuli (such as excessive noise (Yang & Chung, 2016 ), infection (Cohen et al., 2014 ) or ototoxic drugs (Rizk et al., 2020 )) or intrinsic causes such as genetic mutations (Vona & Haaf, 2016 ), aging (Cardin, 2016 ) and Meniere’s disease (Gacek, 2021 ) gives rise to sensorineural hearing loss (SNHL), the most frequent inner ear impairment in humans. However, the treatment of SNHL has been challenging, as it is difficult to achieve therapeutic drug concentrations in the inner ear due to anatomical and physiological barriers.…”

Section: Introductionmentioning

confidence: 99%

Sustained delivery of triamcinolone acetonide from a thermosensitive microemulsion gel system for the treatment of sensorineural hearing loss

et al. 2023

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Intratympanic administration for the delivery of steroids has been extensively studied but limited because of low permeability of the drug through the row window membrane. Here, to effectively deliver poorly soluble triamcinolone acetonide (TA), microemulsions (ME) were prepared from Capmul MCM (oil), Cremophor RH40 (surfactant), and tetraglycol (cosurfactant) based on solubility studies, emulsifying ability test, and pseudoternary phase diagrams. Microemulsion gel (MEG) was prepared by mixing TA-ME with a poloxamer hydrogel base. The physicochemical properties of ME and MEG formulations were characterized, and the toxicity and oto-protective effectiveness were evaluated in vitro and in vivo. The ME-3 formulation showed a small droplet size (16.5 ± 0.2 nm), narrow PDI (0.067 ± 0.041), and enhanced TA solubility (2619.7 ± 57.6 μg/g). The optimized MEG demonstrated temperature-dependent gelation with a gelation time of 208 ± 10 sec at 37 °C. Slow degradation of the gel matrix sustained release of TA from MEG compared to the ME formulation. Both TA-ME and TA-MEG were found to be nontoxic to NIH3T3 cells at the test concentrations (0 to 5 µg/mL), and biocompatible after intratympanic administration to mice. The incorporation of ME into thermosensitive hydrogels prolonged retention of TA at the site of administration until 6 days. As a consequence, the enhanced drug absorption into the cochlea in TA-MEG group (approximately 2 times higher than other groups) protected hair cells, spiral ganglion neurons, and stria vascular cells from cisplatin-induced damage. Therefore, this injectable TA-loaded MEG is an effective and safe vehicle for the sustained delivery of triamcinolone acetonide into the inner ear.

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On the Nature of Hearing Loss in Méniere’s Disease

Cited by 5 publications

References 14 publications

Audiovestibular Consequences of Congenital Cytomegalovirus Infection: Greater Vulnerability of the Vestibular Part of the Inner Ear

Audiovestibular Consequences of Congenital Cytomegalovirus Infection: Greater Vulnerability of the Vestibular Part of the Inner Ear

Infectious causes and mimickers of meniere's disease

Sustained delivery of triamcinolone acetonide from a thermosensitive microemulsion gel system for the treatment of sensorineural hearing loss

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