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Saccular otoconia as a cause of Ménière's disease: hypothesis based on two theories

Published online by Cambridge University Press:  28 August 2018

J Hornibrook
J Hornibrook*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Christchurch Hospital, University of Canterbury and University of Otago, Christchurch, New Zealand
*
Author for correspondence: Dr Jeremy Hornibrook, 2 Riccarton Avenue, Christchurch 8011, New Zealand E-mail: jeremy@jhornibrook.com Fax: +64 3 3640 273
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Abstract

Background

The cause of Ménière's disease remains enigmatic after 156 years. Schuknecht's rupture and potassium intoxication theory of attacks was based on histological studies.

Objectives

This paper aimed to: present the most contemporary evidence indicating that ruptures do not usually occur, and discuss the possibility that detached saccular otoconia are the main cause of Ménière's disease; and to establish an unequivocal definition of the age of Ménière's disease onset.

Method

The paper reviews the electrophysiological basis of the Gibson–Arenberg drainage theory used to explain vertigo attacks. The current, limited knowledge of the likely fate of detached saccular otoconia is discussed.

Results

Electrophysiological studies during attacks do not support endolymph ruptures, but rather endolymph flowing in one direction and then in the opposite direction. Age of onset for Ménière's disease parallels that for benign paroxysmal positional vertigo.

Conclusion

The similarity of age of onset spectrum for Ménière's disease and benign paroxysmal positional vertigo raises the possibility that the two conditions have the same fundamental cause.

Keywords

Meniere DiseaseOtolithic MembraneBenign Paroxysmal Positional Vertigo
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 9 , September 2018 , pp. 771 - 774
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Dr J Hornibrook takes responsibility for the integrity of the content of the paper

Presented at the Prosper Ménière Society Meeting, 12–18 March 2016, Zell im Zillertal, Austria, and at the Politzer Society Vertigo Academy International Meeting, 2–4 March 2017, Mumbai, India.

References

1Meniere, P. On a form of severe deafness dependent on a lesion of the inner ear [in French]. Bulletin de l'Académie Impériale de Médecine 1861;16:55–7Google Scholar
2Woakes, E. Remarks on vertigo, and the group of symptoms sometimes called Menière's disease. Br Med J 1883;1:801–4Google Scholar
3Chiarella, Y, Petrolo, C, Cassandro, E. The genetics of Ménière's disease. Appl Clin Genet 2015;8:9–17Google Scholar
4Hallpike, CS, Cairns, H. Observations on the pathology of Meniere's syndrome. J Laryngol Otol 1938;53:625–55Google Scholar
5Schuknecht, HF. Pathology of the Ear. Cambridge: Harvard University Press, 1974;462Google Scholar
6Dohlman, GF. Further remarks on the mechanism producing the symptoms of Meniere's disease. J Otolaryngol 1980;9:285–90Google Scholar
7McClure, JA, Copp, JC, Lycett, P. Recovery nystagmus in Meniere's disease. Laryngoscope 1981;91:1727–37Google Scholar
8Brown, DH, McClure, JA, Downar-Zapolski, Z. The membrane rupture of Meniere's disease--is it valid? Laryngoscope 1968;98:599–601Google Scholar
9Tonndorf, J. Mechanical causes of fluctuant hearing loss. Otolaryngol Clin North Am 1975;8:303–11Google Scholar
10Gibson, WP. The role of electrocochleography in the understanding of the pathophysiology of Meniere's disease. Auris Nasis Larynx 1996;23:12–27Google Scholar
11McNeil, C, Cohen, MA, Gibson, WP. Changes in audiometric thresholds before, during attacks and after attacks of vertigo associated with Meniere's syndrome. Acta Otolaryngol 2009;129:1404–7Google Scholar
12Brown, DJ, Chihara, Y, Curthoys, IS, Wang, Y, Bos, M. Changes in cochlear function during acute endolymphatic hydrops. Hear Res 2013;296:96–106Google Scholar
13Brown, DJ, Chihara, Y, Wang, Y. Changes in utricular function during artificial endolymph injections in guinea pigs. Hear Res 2013;304:70–6Google Scholar
14Johnson, SA, O'Beirne, GA, Lin, E, Gourley, J, Hornibrook, J. oVEMPs and cVEMPs in patients with “clinically certain” Meniere's disease. Acta Otolaryngol 2016;136:1029–34Google Scholar
15Manzari, L, Tedesco, AR, Burgess, AM, Curthoys, IS. Ocular and cervical vestibular-evoked myogenic potentials to bone-conducted vibration in Meniere's disease during quiescence vs during attacks. Clin Neurophysiol 2010;212:1092–101Google Scholar
16Manzari, Burgess AM, Curthoys, IS. Does unilateral utricular dysfunction cause horizontal canal spontaneous nystagmus? Eur Arch Otorhinolaryngol 2012;269:2441–5Google Scholar
17Manzari, L, Burgess, AM, MacDougall, HG, Bradshaw, AP, Curthoys, IS. Rapid fluctuations in dynamic semicircular canal function in early Meniere's disease. Eur Arch Otorhinolaryngol 2011;268:637–9Google Scholar
18Yacovino, DA, Hain, TC, Musazzi, M. Fluctuating vestibulo-ocular reflex in Meniere's disease. Otol Neurotol 2017;38:244–7Google Scholar
19Salt, AN, DeMott, J. Longitudinal flow associated with acute volume increase in the guinea pig cochlea. Hear Res 1997;107:29–40Google Scholar
20Rask-Andersen, H, Danckwardt-Lilliestrom, N. Ultrastructural evidence of a merocrine secretion in the human endolymphatic sac. Ann Otol Rhinol Laryngol 1991;100:29–40Google Scholar
21Moller, MN, Kirkeby, S, Vikesa, J, Nielsen, FC, Caye-Thomasen, P. The human endolymphatic sac excretes natriuretic peptides. Laryngoscope 2017;127:E201–8Google Scholar
22Gibson, WP, Arenberg, IK. Pathophysiologic theories in the etiology of Meniere's disease. Otolaryngol Clin North Am 1997;30:961–7Google Scholar
23Gibson, WP. Hypothetical mechanism for vertigo in Meniere's disease. Otolaryngol Clin North Am 2010;43:1019–27Google Scholar
24Gurkov, R, Flatz, W, Ertl-Wagner, B, Krause, E. Endolymphatic hydrops in the horizontal semicircular canal: a morphologic correlate for canal paresis in Meniere's disease. Laryngoscope 2013;123:503–6Google Scholar
25Zucca, G, Valli, S, Valli, P, Perin, P, Mira, E. Why do benign paroxysmal vertigo episodes recover spontaneously? J Vestib Res 1998;8:325–9Google Scholar
26Parnes, LS, McClure, JA. Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992;102:988–92Google Scholar
27Lundquist, PG. Aspects of endolymphatic sac morphology and function. Arch Otorhinolaryngol 1976;212:231–40Google Scholar
28Friberg, U, Rask-Andersen, H, Bagger-Sjöbäck, D. Human endolymphatic sac: an ultrastructural study. Arch Otolaryngol 1984;110:421–8Google Scholar
29Rask-Andersen, H, Friberg, U, Bagger-Sjöbäck, D. The ultrastructure of the human endolymphatic duct. Acta Otolaryngol 1994;406:61–6Google Scholar
30Imoto, T, Rask-Andersen, H, Bagger-Sjöbäck, D. The role of the endolymphatic sac in statoconial formation and degradation. Acta Otolaryngol 1983;96:227–35Google Scholar
31Yamane, H, Imoto, T, Nakaio, Y, Igarashi, M, Rask-Andersen, H. Otoconia degradation. Acta Otolaryngol 1984;406:263–70Google Scholar
32Ohashi, K, Igarashi, M. Statoconial displacement in squirrel monkey ears. ORL Otorhinolaryngol Relat Spec 1985;47:242–8Google Scholar
33Kao, WT, Parnes, LS, Chole, RA. Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo. Laryngoscope 2017;127:709–14Google Scholar
34Pender, DJ. Endolymphatic hydrops and Meniere's disease: a lesion meta-analysis. J Laryngol Otol 2014;128:859–65Google Scholar
35Kumara, RS, Schuknecht, HF, Ota, C, Jones, DD. Obliteration of the ductus reuniens. Acta Otolaryngol 1980:89:295–309Google Scholar
36Yamame, H, Takayama, M, Sunami, K, Sakamoto, H, Imoto, T. Blockage of reuniting duct in Meniere's disease. Acta Otolaryngol 2010;130:233–9Google Scholar
37Yamane, H, Sunami, K, Iguchi, H, Sakamoto, H, Imoto, T, Rask-Andersen, H. Assessment of Meniere's disease from a radiological aspect--saccular otoconia as a cause for Meniere's disease? Acta Otolaryngol 2012;132:1054–60Google Scholar
38Yamane, H, Konsihi, K, Sakamaoto, H, Yamamoto, H, Matsuhita, N, Oishi, M et al. Practical 3DCT imaging of the vestibular aqueduct for Meniere's disease. Acta Otolaryngol 2015;135:799–806Google Scholar
39Calzada, AP, Lopez, IA, Ishiyhama, G, Ishiyama, A. Otolithic damage in patients with endolymphatic hydrops and drop attacks. Otol Neurotol 2012;33:1593–8Google Scholar
40Hornibrook, J, Bird, P. A new theory for Meniere's disease: detached saccular otoconia. Otolaryngol Head Neck Surg 2016;156:350–2Google Scholar
41Hornibrook, J. Tone burst electrocochleography for the diagnosis of clinically certain Meniere's disease. Front Neurosci 2017;11:301Google Scholar
42Phillips, JS, Prinsley, PR. A unified hypothesis for vestibular dysfunction. Otolaryngol Head Neck Surg 2009;140:477–9Google Scholar
43Jahn, AF. Benign positional vertigo and endolymphatic hydrops: what is the connection? J Laryngol Otol 2017;131:658–60Google Scholar