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Otorinolaringologia 2004 December;54(4):193-8

language: Italian

Assessment of the neuroautonomic function in Ménière’s disease

Giuliano D. A. 1, Costanza G. 2, Di Gregoli A. 2, Barone G. 2, Carella S. 2, Galioto A. 2, Gallina S. 1, Gargano R. 1, Speciale R. 1, Restivo S. 1

1 Clinica Otorinolaringoiatrica Università degli Studi di Palermo, Palermo
2 Divisione di Medicina Interna II Università degli Studi di Palermo, Palermo


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Aim. Neuroautonomic dys­func­tion is one of the ­main pre­dis­pos­ing fac­tors for the ­onset of ver­ti­go ­attacks in Ménière’s dis­ease (MD). The pur­pose of the ­present ­paper is to inves­ti­gate the prev­a­lence of ­this con­di­tion in ­patients suf­fer­ing ­from MD ­while ­also attempt­ing to clar­i­fy the ­role of ­this lab­y­rin­thop­a­thy in the aetio­path­o­gen­e­sis.
Methods. Twenty ­patients (10 ­male, 10 ­female; aver­age age±SD: 40.4±8.1; ­range 34-54 ­years old) suf­fer­ing ­from MD ­were recruit­ed. After assess­ment of the ­patients’ gen­er­al con­di­tion ­using rou­tine hae­mat­o­chem­i­cal, car­di­oan­gio­log­i­cal and oto­neu­ro­log­i­cal exam­ina­tions, the ­patients ­were sub­ject­ed to the ­study of the sym­pa­tho-­vagal bal­ance by tra­di­tion­al ­tests (­deep breath­ing, ­lying to stand­ing, Valsalva ­ratio, ­hand ­grip, ­study of orthos­tat­ic hypo­ten­sion) and by ­short-­term ECG Holter record­ing. Following dig­i­tal ­data pro­cess­ing, the lat­ter ­makes it pos­sible to ana­lyse the pow­er spec­trum of spon­ta­ne­ous var­i­abil­ity of ­heart fre­quen­cy, the com­po­nents of ­which are: LF (low fre­quen­cy), ­which ­reflects ortho­sym­pa­thet­ic mod­ula­tion, and HF (­high fre­quen­cy), out­come of ­vagal activ­ity. An LF/HF ­ratio ­close to one ­denotes a reg­u­lar bal­ance ­between the 2 com­po­nents of the neu­ro­au­to­nom­ic ­system, ­while val­ues high­er or low­er ­than one indi­cate respec­tive­ly con­di­tions of sym­pa­thet­ic or ­vagal hyper­tone. This eval­u­a­tion was car­ried out in eve­ry ­patient in two dis­tinct stag­es: sub­acute ­stage (with­in 4 ­days of the ver­ti­go ­attack) and in the ­basal res­to­ral ­stage (10 ­days ­after ces­sa­tion of the ves­tib­u­lar symp­toms).
Results. In the sub­acute ­stage, 100% (20/20) of the sub­jects ­under exam­ina­tion pre­sent­ed an LF/HF ­ratio of ­more ­than 2. In the ­basal res­to­ral ­stage ­only in 10% (2/20) was ­this rela­tion­ship ­close to one. The tra­di­tion­al car­di­o­vas­cu­lar ­tests, in sub­acute ­stage, ­showed path­o­log­i­cal val­ues in 95% (19/20) of cas­es ­while in 5% (1/20) val­ues ­were nor­mal. In the ­basal res­to­ral ­stage the val­ues ­were path­o­log­i­cal in 75% (15/20) of cas­es, nor­mal in 25% (5/20).
Conclusion. The prev­a­lence of neu­ro­au­to­nom­ic dis­tur­banc­es in sub­jects affect­ed by MD is ­high ­both a ­short ­time ­after the ­attack and in the inter­crit­i­cal ­stage, con­firm­ing the impor­tance ­they ­have in the aetio­lo­gy of ­this lab­y­rin­thop­a­thy, ­although the phys­io­path­o­log­i­cal mech­a­nisms ­with ­which neu­ro­veg­e­ta­tive dys­to­nia ­favours the ­onset of ver­ti­go ­have not yet ­been ade­quate­ly clar­i­fied.

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