Influence of BPPV and Meniere's Disease on Cognitive Abilities: A Questionnaire-Based Study

The vestibular system connects the inner ear to the midbrain and subcortical structures and can affect cognition. Patients with vertigo often experience cognitive symptoms such as attention deficits, memory problems, and spatial perception difficulties. This study aimed to explore the cognitive impairments associated with Benign paroxysmal positional vertigo(BPPV) and Meniere's Disease(MD). A non-experimental group comparison design was used with 107 participants divided into three groups: Group I(clinically normal), Group II(BPPV), and Group III(MD). Participants completed a questionnaire with 10 cognition-related questions, and their responses were scored. The data were found to be non-normally distributed. The analysis revealed a significant difference in scores between Group I and both Group II and Group III. Chi-square tests showed that the responses to cognition-related questions varied among the groups, with Group II exhibiting more cognitive problems. Associated conditions like hypertension, diabetes, and hearing loss did not significantly influence the responses within each group. This study suggests a significant relationship between cognitive problems and patients with BPPV and MD. However, there was no association found between the cognitive problems experienced in BPPV and MD patients. These findings align with previous research indicating that vestibular disorders can lead to deficits in spatial memory, attention, and other cognitive functions. By understanding the link between cognition and vestibular disorders, we can improve diagnosis and rehabilitation services to enhance the quality of life for these patients.

Saccades of video head impulse test in Meniere's disease and Vestibular Migraine: What can we learn from?

Background:Saccades are often observed on video head impulse tests(vHIT)in patients with Meniere's Disease(MD)and Vestibular Migraine(VM).However,their saccadic features are not fully described.Objective:This study aims to identify the saccades characteristics of MD and VM.Methods:75 VM patients and 103 definite unilateral MD patients were enrolled in this study.First raw saccades were exported and analyzed.The VM patients were divided into left and right based on their ears,while the MD patients were separated into affected and unaffected subgroups based on their audiograms and symptoms.Results:The MD patients have more saccades on the affected side(85%vs.69%),and saccade velocity is more consistent than the contralateral side(shown by the coefficient of variation).The saccades occurrence rates on both sides are similar in VM(77%vs.76%),as are other saccadic parameters.The MD patients have more significant inter-aural differences than the VM patients,manifested in higher velocity(p-value 0.000),earlier arriving(p-value 0.010),and more time-domain gathered(p-value 0.003)on the affected side.Conclusions:Bilateral saccades are commonly observed in MD and VM.In contrast to MD,saccades on VM are subtle,scattered,and late-arrived.Furthermore,the MD patients showed inconsistent saccadic distribution with more velocity-uniform saccades on the affected side.

The role of cochlear implantation in alleviating Tumarkin drop attacks of Meniere's disease;a case report

Ménière’s disease(MD)patients may suffer episodes of sudden falls,named Tu markin drop attacks(DAs).This fall occurs abruptly and without warning or loss of consciousness.DAs usually aggravate the clinical picture of MD and are challenging to manage.The present report describes a case treated by cochlear implantation(CI)due to concomitant deafness and offers some clinical considerations for this condition.A male patient aged 48 years with a 10-year history of definite bilateral MD had profound SNHL on the right and severe SNHL on the left side.He suffered from intermittent attacks of vertigo,ear fullness,and tinnitus and,in the last year,had developed DAs and experienced 14 episodes in the previous six months.The preoperative category of acoustic performance was 3.The Dizziness Handicap Inventory(DHI)questionnaire showed a total score of 46,which indicated a moderate degree of disability.A CI was planned for the right side.The patient did not report any further DAs episode for two years since then.The postoperative category of acoustic performance became 11,and the postoperative DHI questionnaire showed a decrease in the total score(from 46 to 19),which indicated a mild disability.Unilateral CI effectively alleviated the DAs associated with bilateral MD.Our report proposes a new modality for managing vertiginous symptoms in cases of MD with hearing loss without the need for more aggressive surgical interventions with the need for clinical trials to confirm our results.

A study of efficacy of Nigella sativa in treatment of Meniere's disease: A randomized, placebo controlled clinical trial

Purpose:Meniere's disease(MD),first introduced by Prosper Meniere,is characterized mainly by vertigo,tinnitus,aural fullness and sensorineural hearing loss.Though the exact pathophysiology of MD is unknown,immunologic and inflammatory interactions are possible underlying mechanisms involved in MD.This study is aimed to investigate the immunomodulatory and anti-inflammatory effect of Nigella sativa on MD as a therapeutic agent.Methods:We divided 40 patients with definite MD into two groups of 20 cases.The study group received 1 g of Nigella sativa oil daily for three months and the control group received a placebo.Changes in hearing,tinnitus and vertigo were estimated by pure tone audiometry,tinnitus handicap inventory questionnaire and dizziness handicap inventory questionnaire,respectively.Results:At the end of the study we did not observe any significant improvement in study's group hearing threshold,tinnitus and vertigo compared to the control group.Conclusions:In this study,statistical analysis showed that Nigella sativa failed to improve signs and symptoms of MD.However,further investigations with a larger study population are needed to ascertain the current conclusion.

穴位注射在Meniere's综合征的应用

目的:观察穴位注射治疗Meniere's的临床疗效。方法:将120例Meniere's患者随机分为对照组、针灸组、肌注组和治疗组,分别接受常规治疗、常规治疗加针灸、常规治疗加药物肌肉注射和常规治疗加穴位注射,比较各组的治疗效果。结果:治疗组完全控制率高于其他组,差异有统计学意义(P=0.028),基本控制以上率高于其他各组,差异有统计学意义(P=0.041),而各组部分控制以上率比较,差异无统计学意义(P=0.783)。结论:在常规治疗的基础上配合穴位注射能提高Meniere's综合征的完全控制率和基本控制率。

Dexamethasone does not affect endolymphatic hydrops(EH)in patients with Meniere's disease within 24 h,and intratympanic administration of gadolinium plus dexamethasone simplifies high-quality imaging of EH using a novel protocol of 7 min

Background:Intratympanic administration of gadolinium chelate allows for a better visualization of endolymphatic hydrops(EH)using MRI than intravenous injection and was recently further improved to facilitate high-quality imaging of EH in 7 min.The aim of the present study was to simplify the intratympanic administration protocol by mixing gadolinium chelate with therapeutic dexamethasone and to evaluate the effects of this mixture on the visualization of EH in MRI.Materials and methods:In an in vitro study,the potential impact of gadolinium-diethylenetriamine pentaacetic acid(Gd-DTPA)on the stability of dexamethasone was evaluated by analyzing dynamic changes in dexamethasone with high-performance liquid chromatography(HPLC)after mixing with GdDTPA.Ten patients with definite Meniere's disease(MD)were recruited to study the potential interference of dexamethasone on MRI visualization of EH,and 49 patients with MD were recruited to evaluate the effect of intratympanic injection of Gd-DTPA mixed with dexamethasone on MRI of EH using a 3T MR machine and a novel heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery reconstructed using a magnitude plus zero-filled interpolation(hT2FLAIR-MZFI)sequence.Results:The retention times and peak area of dexamethasone in HPLC were not modified by the addition of Gd-DTPA.EH grading in the cochlea and vestibule was not influenced in any ear by intratympanic injection of dexamethasone.Excellent inner ear images were obtained from all patients,and EHs with various grades were displayed.There were significant correlations between diagnosis and cochlear EH(p<0.01,Spearman's Rho),between diagnosis and vestibular EH(p<0.01,Spearman's Rho),and between cochlear and vestibular EH(p<0.01,Spearman's Rho).The distribution of Gd-DTPA plus dexamethasone negatively correlated with the grade of vestibular EH.Injury of the endolymph-perilymph barrier was detected in one cochlea and three vestibules of 59 inner ears with MD.Conclusions:Intratympanic administration of Gd-DTPA plus dexamethasone yielded high-quality MRI images of EH in patients with MD using a novel 7-min protocol and simplified the clinical application.Intratympanic administration of Gd-DTPA plus dexamethasone might be used to test its therapeutic effect in future work.

ELECTROACUPUNCTURE TREATMENT OF MENIERE'S DISEASE

Objective: To observe the effect of electroacupuncture (EA) on Meniere's disease. Methods: A total of 114 cases (38 males and 76 females) of Meniere's disease were treated with EA of Ermen(耳门 TE 21), Tinggong (听宫 SI 19), Tinghui (听会 GB 2), Yifeng (医风 TE 17), Fengchi (风池 GB 20) and Baihui (百会 GV 20). The treatment was given 3 times a week,9 times altogether. Follow-up was made at the end of the 3rd, 6th and 12th months after treatment. Results; Follow-up in 114 patients showed that after EA treatment, 63 cases (55.26%) were cured, 30 (26.31%) had remarkable improvement in their symptoms, 10 (8. 77%) responded with improvement and 11 (9.65%) failed in the treatment, with a total effective rate of 90.35%. Conclusion: EA treatment was effective in controlling Meniere's disease patients' symptoms and reducing attack.

MEFV,IRF8,ADA,PEPD,and NBAS gene variants and elevated serum cytokines in a patient with unilateral sporadic Meniere's disease and vascular congestion over the endolymphatic sac

The etiology and underlying mechanism of Meniere's disease(MD)development are still unknown,although inflammation and autoimmunity have been implicated as underlying mechanisms.The human endolymphatic sac(ES)has been reported to have innate and adaptive immune capacity in local immune reactions.In vivo demonstration of inflammation of the ES in patients with MD is missing in the literature.We report the case of a 47-year-old female patient diagnosed with unilateral MD with genetic variants and cytokine markers indicating inflammation and vascular congestion of the ES.Endolymphatic hydrops in the right cochlea(grade 2)and vestibulum(grade 3)were detected using MRI.She carried heterozygous variants in MEFV(c.442G>C),IRF8(c.1157G>T),ADA(c.445C>T),PEPD(c.151G>A),NBAS(c.4049T>C),CSF2RB(c.2222C>T),HPS6(c.277G>T),IL2RB(c.1109C>T),IL12RB1(c.1384G>T),IL17RC(c.260_271del GCAAGAGC TGGG),LIG1(c.746G>A),RAG1(c.650C>A),and SLX4(c.1258G>C,c.5072A>G).In the serum,the levels of granulocyte colony-stimulating factor(G-CSF),macrophage inflammatory protein 1a,and IL7 were significantly elevated,and the level of IL2Ra was reduced.Intratympanic administration of dexamethasone temporarily alleviated her hearing loss.Her vertigo was significantly relieved but remained slight after ES administration of corticosteroids.

Study on medication rules of traditional Chinese medicine for Meniere's disease based on data analysis

Objective:Study on medication rules of traditional Chinese medicine in treating Meniere's disease based on data mining technology.Methods:Computer retrieval with since establishment of the“CNKI”,“WF”,“VIP”,there have been literatures on the treatment of Meniere syndrome with Traditional Chinses medicine.Memory preprocessing in accordance with inclusion criteria.Then,EXCLE 2010,SPSS Statistics(ver.25)and SPSS Modeler(ver.18.0)were adopted respectively for frequency analysis,cluster analysis and association rules analysis.Result:A total of 133 references were included in this study,146 prescriptions,192 kinds of drugs,and the total frequency of drugs was 1702.The high frequency Meniere syndrome types were spleen deficiency and phlegm dampness syndrome,wind phlegm syndrome,gallbladder depression and phlegm disturbance syndrome,hyperactivity of liver yang syndrome,phlegm and blood stasis syndrome.The efficacy of drug frequency≥25 were summarized as follows,antiasthmatic drugs for relieving phlegm and relieving cough,diuresis-removing dampness,Tonic drugs,etc.High frequency meridian of drugs are:lung,liver,spleen,etc.High frequency drug properties are:temperature,cold,flat etc.High frequency drug taste:bitter,sweet,pungent,etc.Core drugs:Pinellia,Atractylodes,Poria,Gastrodia,etc.The main prescriptions werealisma soup,Banxia Baizhu Tianma Decoction,Zhengan Xifeng Decoction and Xiaochaihu Decoction.Conclusion:In this study,data mining was used to sort out the treatment of Meniere's disease by traditional Chinese medicine.It was found that the treatment of Meniere's disease was mainly to calm the liver and strengthen the spleen,supplemented by regulating qi and activating blood,clearing heat and opening orifices,tonifying deficiency and tranquilizing mind.

The role of selective serotonin reuptake inhibitors and tricyclic antidepressants in addressing reduction of Meniere's disease burden:A scoping review

Objective:To assess the effect of selective serotonin reuptake inhibitors(SSRIs)and tricyclic antidepressants(TCAs)in reducing vertigo,tinnitus,and hearing loss among patients with Meniere's disease(MD).Data Sources:The following databases were utilized in this scoping review:Ovid Medline,PubMed-NCBI,CINAHL,Cochrane Library,Web of Science,and Clinicaltrials.gov.Method:Studies were identified through the following search phrases:"serotonin specific reuptake inhibitors"OR"tricyclic antidepressants"AND"Meniere's disease."References from included manuscripts were examined for possible inclusion of additional studies.Results:The literature search yielded 23 results,which were screened by three independent reviewers.Seventeen studies and three duplicates were excluded.An examination of references from the included studies yielded two additional publications.A total of four published studies assessing SSRIs and TCAs among 147 patients with MD were ultimately included.Four studies described significant reductions in vertigo attack frequency among patients treated with either SSRIs or TCAs compared to their pretreatment baseline.Three studies assessed the drugs'effects on hearing,of which none found a significant difference among patients treated with SSRIs or TCAs.One study found a significant decrease in patient-reported tinnitus following treatment with TCAs or SSRIs compared to their pretreatment baseline.Conclusions:Data exploring SSRIs and TCAs among patients with MD suggests that these medications may reduce the frequency of tinnitus and vertigo,although there was significant heterogeneity in outcome reporting.There remains a need for larger-scale prospective studies that emphasize objective data to evaluate their effective-ness in reducing common MD symptoms.

Controlled release of dexamethasone from fibrin sealant for intratympanic administration in inner ear therapy

The aim of the present work was to show the sustainability of fibrin sealant in releasing dexamethasone and adjust the protocol for clinical application of the novel method in the treatment of Meniere’s disease (MD) and sudden sensorineural hearing loss (SSHL).Gelation occurred shortly after mixing dexamethasone-containing fibrinogen with thrombin.Dexamethasone was constantly released for at least 16 d at a stable level after 7d in protocol 1 (low-dose),while it was robustly released within 4 d and slowed afterward until 10 d in protocol 2(high-dose).There were significant differences among the time points in Protocol 2 (p<0.01,ANOVA),and the exponential model with the formula y=15.299*e~(-0.483*t) fits the association.The estimated concentration of dexamethasone released on 7 d in protocol 2 was slightly lower than that observed in protocol 1.The fibrin sealant is capable of constantly releasing dexamethasone with adjustable dynamics.Targeted and minimally invasive administration of the material can be achieved in the clinic by sequential injections of the fluids using a soft-tipped catheter.

MRI detection of endolymphatic hydrops in Meniere's disease in 8 minutes using MIIRMR and a 20-channel coil after targeted gadolinium delivery

Background:Endolymphatic hydrops(EH)become visible in vertigo patients,particularly in those with Meniere's disease(MD),in vivo using gadolinium-enhanced MRI.However,the image quality is not satisfying after intravenous injection of gadolinium chelate(GdC),and occasional failure in GdC uptake has been noticed after traditional intratympanic injection.In the present report,targeted delivery of GdC and using a cost-effective MRI system to obtain high quality images of EH in only 8 min will be fntroduced.Methods:39 MD patients were recruited in the study.First,0.1 ml of 20-fold diluted gadolinium-diethylenetriamine acid(Gd-DTPA)was delivered onto the posterior upper part of the tympanic medial wall using a soft-tipped micro-irrigation catheter through an artificially perforated tympanic membrane.Inner ear MRI was performed 24 h after Gd-DTPA administration using a 3T MR machine and a 20-channel head/neck coil with an 8 min sequence of medium inversion time inversion recovery imaging with magnitude reconstruction(MIIRMR).The parameters were as follows:TR 16000 ms,TE 663 ms,inversion time 2700 ms,flip angle 180°,slices per slab 60.Results:Efficient inner ear uptake of Gd-DTPA was detected 24 h after delivery and it created excellent contrast in the inner ear of all cases.High quality images demonstrating EH in the vestibule and cochlea were obtained.Conclusion:Targeted delivery of minimum Gd-DTPA(0.1 ml,20-fold dilution)onto the posterior upper portion of the tympanic medial wall and MRI with MIIRMR in a 3T machine and 20-channel head/neck coil are clinically practical to obtain high quality images displaying EH.

中耳压力治疗梅尼埃病的有关研究进展

梅尼埃病是一种以膜迷路积水为基本病理特征的内耳疾病,目前临床上药物、手术等治疗方法效果有限,而中耳压力治疗近年来新兴的一种无创、效果显著的治疗方法,本文就梅尼埃病的中耳压力治疗有关进展进行综述。

Intratympanic corticosteroids in Ménière's disease:A mini-review

This article reviews the effectiveness of intratympanic corticosteroids for vertigo control in Meniere's disease at 2-years follow-up according to the guidelines expressed by the American Academy of Otolaryngology-Head & Neck Surgery. Despite the increased use of intratympanic corticosteroids for vertigo control in Meniere's disease there is debate as to their effectiveness, particularly compared to gentamicin. Even so,after just a single course of injections, corticosteroids can reliably provide complete vertigo control(Class A) at 2-years in about 50% of cases as indicated in a recent double-blind randomized controlled clinical trial(Patel et al., 2016). But the effectiveness of intratympanic corticosteroids truly increases when treatment is provided 'as-needed', whereby complete vertigo control is established in up to 91% of cases. On the basis of available literature, there is good evidence to recommend the use of intratympanic steroid treatment for vertigo control in Meniere's disease, but patients must be monitored for non-response. The rationale for treating patients as-needed and the possible reasons for corticosteroid nonresponse are discussed.

Electrocochleographic recording in Asian adults: Preliminary normative data and demographic analyses

Objective: Electrocochleography(ECochG) is valuable to diagnose Meniere's disease objectively. The aim of the present study was to provide preliminary normative data for ECochG among Asian adults. The influences of ethnicity(Malay versus Chinese) and gender on ECoch G results were also studied.Methods: Twenty-two Malay adults(10 men and 12 women) and twenty Chinese participants(10 men and 10 women) aged between 20 and 49 years participated in this study. Extratympanic ECoch G(ET-ECochG) was recorded according to standard non-invasive procedure. Summating potential(SP) amplitude, action potential(AP) amplitude and SP/AP ratio were analyzed accordingly.Results: ET-ECoch G results were found to be comparable between left and right ears(p > 0.05). No notable differences in ET-ECochG results were found between Malay and Chinese groups(p > 0.05). No significant influence of gender on ET-ECochG outcomes was also noted(p > 0.05). The derived normative data for Asian adults(84 ears) are consistent with previous reports.Conclusion: The present study provides preliminary normative data for ET-ECochG among Asian adults. The ECoch G components do not appear to be influenced by either ethnicity or gender. The derived normative data can be used for clinical applications and as the reference for future studies involving Asian population.

ILLUSTRATIVE CASES TREATED BY THE APPLICATION OF THE EXTRA POINT SISHENCONG

The president of our hospital, Dr. Chen Daoyi, has rich experience in the clinical us age of Sishencong (Extra 6). Having learnt from him, now Ⅰ present a few cases, in which the patients have been treated with this extra point.

前庭神经切断术及其术式选择

前庭神经切断术是保守治疗无效的难治性梅尼埃病的有效治疗手段之一,现对其历史现状,相关解剖,术式选择及优缺点进行综述。

耳源性眩晕病毒学研究

关于耳源性眩晕的病因学假说很多，其中病毒感染学说占据重要地位。本文综述了耳源性眩晕病毒学研究进展，提供了包括病原学、流行病学、血清学、组织形态学、临床观察和抗病毒治疗效果以及动物实验等方面的研究证据。目前的研究未能完全满足病毒作为直接病因的感染性疾病的科赫法则。本文对此进行解释，并对进一步的研究进行综述。

鼓室注入庆大霉素治疗梅尼埃病的再思考

自从“化学性迷路切除术”的概念引入临床，鼓室注入庆大霉素治疗梅尼埃病一度成为临床热点。但近十年过去了，其临床推广受限。本文从医学伦理，合理的临床研究设计的角度出发，对治疗过程中畿需解决的关键问题进行综述。