ORIGINAL ARTICLES   

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

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

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.