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OTORINOLARINGOLOGIA

A Journal on Otorhinolaryngology, Head and Neck Surgery,
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Otorinolaringologia 2010 June;60(2):35-52

language: English

Meniere’s disease: state-of-the-art

Mancini F. 1, Sacchi M. 1, Monti B. 1, Paparella M. M. 2

1 Otorinolaringoiatri Associati, Turin, Italy
2 Minnesota Ear Head and Neck Clinic, Minneapolis, MN, USA


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Meniere’s disease is a chronic illness that causes a triad of vestibular symptoms, cochlear symptoms and aural pressure or fullness. Studying the natural history of the disease in patients facilitates the understanding of the disease and contributes to better treatment. It is almost universally accepted that the pathological correlate of Meniere’s disease is endolymphatic hydrops. Manifestations of Meniere’s disease may be atypical, cochlear and vestibular types, for many years before aquiring the full blown picture of the disease but in some cases atypical forms never develop it. Hydrops may develops for defective reabsorption or for overproduction of endolymph along the longitudinal flow toward the endolympatic duct and sac. The sac seems to contribute to the production of endolymph directly or producing substances and hormones that stimulate the secretion. The fundamental and most important etiopathogenetic basis is “multifactorial inheritance” that include intrinsic or genetic factors like anatomical malformations, familiarity, race, chromosomal and molecular biologic modifications, autoimmunity and otosclerosis. Extrisic contributing factors, among other, include trauma, otitis media, syphilis, viral infections. All of them may cause malabsorption of endolymph and, subsequently, hydrops. Pathogenesis of symptoms lean on mechanical and biochemical disfunctions. Medical therapy is well known but does not cure the disease. In unresponsive cases intratympanic perfusion of steroids (conservative) or gentamicin (destructive) may be used. Conservative surgery is only achieved by endolymphatic sac enhancement procedures. New medications like vasopressin antagonists and better comprehension of the role of aquaporins in the homeostasis of inner ear fluids will probably help tomorrow in better treating patients.

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