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Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-188X
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
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.