[Round window microcatheter administered microdose of gentamycin: an alternative in the treatment of tinnitus in patients with Menière's disease].

Background: In this study, we review the results of Menière's disease treatment using microdose gentamycin delivered directly to the round window using a new microcatheter system.

Patients And Methods: 11 patients were treated by 1.25 mg gentamycin on the 3rd and 7th day after insertion of the new microcatheter at the niche of the round window membrane, while a second group of 7 patients was treated by a gentamycin dosage of 1 microliter/h continuously applied by a minipump over a period of 10 days.

Immune mechanisms in Meniere's syndrome.

Immune-mediated inner ear disease is a nonspecific term used to describe cochleovestibular dysfunction that results from immune-mediated injury. The ear may be involved directly or secondarily by the immune reaction, and evidence exists to implicate all four of the Gell and Coombs mechanisms of immune injury. The clinical presentation may be variable, with the diagnosis based on presentation, laboratory studies, and response to therapy.

Pathophysiologic theories in the etiology of Meniere's disease.

The etiology of the attacks of vertigo that occur in Meniere's disease is discussed in this article. None of the current theories remain tenable in view of recent findings concerning the physiology and pathophysiology of the cochlea and endolymphatic sac. A new theory suggests that a narrowed duct becomes obstructed by debris that is cleared by a combination of the secretion of hydrophillic proteins within the sac and a hormone, saccin, that increases the volume of endolymph within the cochlea.

Demonstration of autoantibodies to the endolymphatic sac in Meniere's disease.

Recent evidence suggests that immune mechanisms may underlie some cases of Meniere's disease. This study was conducted to determine whether an autoimmune mechanism is involved. Sera from 30 patients with Meniere's disease were reacted with human endolymphatic sacs and examined by indirect immunohistochemistry and fluorescence microscopy.

Pathophysiological mechanisms in immune inner ear disease.

Immune inner ear disease is a somewhat controversial entity which describes cochleovestibular dysfunction that is related to immune-mediated mechanisms. The diagnosis of this disease is based on clinical presentation and response to various treatment protocols. Unfortunately, the presentation is variable and the treatment empirical, and this has caused much confusion in the diagnosis and management of the condition.

Outbreak of vertigo in Wyoming: possible role of an enterovirus infection.

An epidemiologic investigation was conducted to characterize and evaluate the possibility of a viral aetiology of an outbreak of acute vertigo in Hot Springs Country, Wyoming, during autumn 1992. Case-finding identified Hot Springs County residents who sought medical attention for new onset vertigo during 1 August, 1992-31 January 1993. Thirty-five case-patients and 61 matched controls were interviewed and serum specimens were obtained during January 1993.

Normal evoked otoacoustic emissions with a profound hearing loss due to a juvenile pilocytic astrocytoma.

An interesting case is reported of an 11-year-old girl who experienced a sudden, profound right-sided hearing loss at the age of 5 years after hearing a "pop" and the sound of rushing water in her right ear. At that time the patient was thought to have Mondini's deformity, and a perilymphatic fistula of the oval window in the right ear. Six years later she was diagnosed with a juvenile pilocytic astrocytoma of the pons with an exophytic component extending into the cerebellopontine angle.

Fluorescein as an easy, low-cost, indirect, or reverse intraoperative marker to rule out perilymph versus local injection.

Clear fluid found in the dependent portions of the middle ear (round and oval windows) is generally assumed to be perilymph (PL). However, all clear fluid observed at middle ear exploration is not necessarily PL. PL should be distinguished from local injection.

CT imaging of radiopaque shunt catheter after endolymphatic duct surgery.

Until now, shunt catheters used in endolymphatic sac (ELS) and duct surgery have not been visible at computed tomography (CT) imaging. This report summarizes findings at postoperative CT in 50 patients who underwent endolymphatic system decompressive surgery with a new opaque shunt catheter placed at or into the endolymphatic duct (ELD). The catheter was visible in all 50 cases, and the best projection for visualization was the semicoronal view.

Immunoperoxidase study of the endolymphatic sac in Menière's disease.

A growing body of evidence suggests that some cases of Menière's disease may be mediated by immune mechanisms. Because endolymphatic sac dysfunction is believed to be an underlying cause of Menière's disease, this study used immunohistochemical techniques to demonstrate the presence of immune complex deposition in the sacs of patients with Menière's disease. Positive immunoglobulin G (IgG) staining was noted in 10 of 23 sac biopsies from Menière's patients, with 2 specimens showing perivascular deposition.

Diagnosis of vestibular Menière's disease with electrocochleography.

The existence of vestibular Menière's disease, once considered a variant of classic Menière's disease, but without hearing loss, has been questioned because of lack of objective evidence that endolymphatic hydrops is involved with the disease process. Transtympanic electrocochleography (TT ECoG) has emerged as a useful tool for electrophysiologic monitoring of the inner ear, and is especially valuable in assessing endolymphatic hydrops. A retrospective chart review was performed to identify those patients with a diagnosis consistent with vestibular Menière's disease in order to determine the presence or absence of endolymphatic hydrops using TT ECoG.

Delayed endolymphatic hydrops following acoustic tumor removal with intraoperative and postoperative auditory brainstem response improvements.

A 36-year-old female with delayed endolymphatic hydrops (ELH) after acoustic tumor removal of the same ear is reported. She presented at our clinic with pressure, fullness, and tinnitus involving her right ear. She had an abnormal auditory brainstem response (ABR), and a computed tomography showed a right acoustic tumor.

Intraoperative electrocochleography of endolymphatic hydrops surgery using clicks and tone bursts.

Seventy-seven ears of patients with Menière's disease (n = 69) and other ears with secondary endolymphatic hydrops (n = 8) underwent valved shunt surgery, and were monitored with intraoperative electrocochleography (ECoG) using clicks stimuli (n = 77), and both clicks and tone bursts (n = 37). Of the 41 ears in which the "baseline" measurement was > 35% summating potential to action potential (SP/AP) amplitude click ratio, 23 ears (56%) showed a significant ratio decrease (improvement). Twenty-six ears out of the 37 that were monitored by both clicks and tone bursts had abnormal absolute SP tone bursts amplitudes at "baseline" and 8 ears (31%) changed to normal at "closing".

Vincent's violent vertigo. An analysis of the original diagnosis of epilepsy vs. the current diagnosis of Meniére's disease.

The authors propose to correct the historical misimpression that Vincent van Gogh's medical problems resulted from epilepsy. Rather, the authors propose his main medical problem was Meniére's disease. The authors have reviewed the 796 personal letters written by van Gogh.

Intraoperative electrocochleographic monitoring of inner ear surgery for endolymphatic hydrops. A review of cases.

The purpose of this review of cases was to determine whether or not the SP/AP amplitude ratio changes during unidirectional inner ear valved shunt surgery for the decompression of the hydropic labyrinth in Meniere's disease. A series of 62 patients underwent shunt surgery over a 20 month period. In 43 cases (43 ears), ECoG responses were successfully recorded throughout the duration of surgery.

Electrocochleographic effects of ear canal pressure change.

A series of Swedish studies has shown that the application of middle ear over-pressure may be effective in ameliorating the symptoms associated with Meniere's disease. Other studies have shown that electrocochleography (ECochG) is an effective tool in the identification of Meniere's disease, especially in the presence of active symptoms. Based on the therapeutic potential of middle ear overpressure as a treatment for Meniere's symptoms and on the relationship between these symptoms and ECochG, we investigated the effects of ear canal pressure change on human electrocochleographic components in normally hearing subjects.

Low frequency air-bone gap in Menière's disease without middle ear pathology. A preliminary report.

The audiograms of some patients suffering from Meniere's disease show an unexplained conductive component, or air-bone gap (ABG), predominantly in the low frequencies. Neither the history nor physical findings support poor eustachian tube function, ossicular chain abnormalities, chronic ear disease, physical trauma, or otosclerosis as a cause of this audiometric finding. In the present study, 40 patients diagnosed as suffering from classical Meniere's disease were evaluated audiometrically.