Article

Middle ear pressure and dysfunction of the labyrinth: is there a relationship?

Department of Otorhinolaryngology, University of Freiburg, Germany.
The Annals of otology, rhinology, and laryngology (Impact Factor: 1.21). 07/1997; 106(6):478-82.
Source: PubMed

ABSTRACT Relationships between middle ear pressure and non-infection-related cochleovestibular dysfunction have been suggested by several authors. According to some data, vertiginous attacks can be prevented by the insertion of a ventilation tube in patients suffering from Meniere's syndrome. The aim of our study was to investigate if the incidence of eustachian tube malfunction and pathologic middle ear pressure is frequent, and if routine implantation of ventilation tubes is reasonable in ears with dysfunctions of the labyrinth, including clinical Meniere's syndrome. So, we determined in our pressure chamber all active and passive parameters of eustachian tube function in 40 patients suffering from Meniere's syndrome, sudden sensory hearing impairment (SSHI), or vestibular neuronitis. Our results disclosed no nonrandom incidence of impaired tubal function among our patients compared to healthy control subjects. Pressure equalization was sufficient in most patients suffering from clinical Meniere's syndrome, and only one patient with vestibular neuronitis presented with a patulous tube. Our results show that impairment of vestibular or cochlear function is not regularly accompanied by eustachian tube dysfunction. Furthermore, no patient reported symptoms while pressure variation was performed. We conclude that variation of middle ear pressure does not usually play a role in the genesis of Meniere's syndrome, vestibular neuronitis, or SSHI. Thus, from our data, we cannot recommend routine implantation of tympanic ventilation tubes in patients suffering from Meniere's syndrome, vestibular neuronitis, or sudden hearing loss.

0 Bookmarks
 · 
57 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The influence of Eustachian tube (ET) dysfunction on the inner ear fluid pressure and thus on the inner ear function in Meniere's disease has been discussed controversially. So far, most of the studies examining ET function in inner ear disorders indirectly analyzed ET function by tympanometric methods. The present study directly studied ET function in inner ear disorders by sonotubometry. Healthy subjects and patients with Meniere's disease, sudden sensorineural hearing loss, cholesteatoma and chronic suppurative otitis media were examined by sonotubometry. Mean increase of sound pressure intensity (dB) and mean duration of sound pressure increase (s) were analyzed. Highest mean increase of sound pressure intensity was seen in healthy subjects when using >5 dB peaks (11.6 ± 0.7 dB) and >0 dB peaks (9.6 ± 0.6 dB). Comparative analysis including bilateral ears showed decreased ET function in patients with cholesteatoma (p = 0.002) and in patients with Meniere's disease (p = 0.003) when using >0 dB peaks. Examination of each specific ET opening maneuver showed impaired ET function in pathological ears of patients with cholesteatoma and with Meniere's disease, during yawning (p = 0.001; p < 0.001), dry swallowing (p = 0.010; p = 0.049), Toynbee maneuver (p = 0.033; p = 0.032) and drinking (p = 0.044; p = 0.027). Mild ET dysfunction is detected in patients with Meniere's disease by direct sonotubometric assessment of ET function.
    Archives of Oto-Rhino-Laryngology 09/2012; · 1.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The indications for surgical treatment of labyrinthine vertigo associated with severe impairment and a lack of response to medication are heterogeneous. Due to different therapeutic goals and success parameters, the results of treatments can only be compared to a limited extent. This overview of the current literature and procedures performed by the author contains recommendations for indications and outlines the risks associated with operative therapy of vestibular vertigo. Results of function-preserving and ablative therapies are compared. Surgical treatment of Menière's syndrome (non-idiopathic) using tympanostomy tubes is indicated in cases of increased middle ear pressure; Meniere's disease (idiopathic) in its early stages can be treated with the endolymphatic shunt operation to preserve hearing and balance functions and where these techniques fail, with vestibular neurectomy for preservation of hearing or with cochleosacculotomy in the case of deafness. Rare indications are intractable benign paroxysmal positional vertigo and superior semicircular canal dehiscence syndrome (SCDS). The function preservation success rate in cases of Meniere's syndrome and disease is 70-88 %, ablative procedures are effective in > 90 % of cases and occlusion of the superior or posterior canals is successful in > 95 % of patients.
    HNO 09/2013; 61(9):752-61. · 0.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this physiological study subjects with Meniere's disease (MD) had high resistance to opening of the eustachian tube (ET) in three of four provocation tests. These subjects can be exposed to pressure deviations in the middle ear (ME) above their equalizing capacity. Transmission of the pressure deviations to the inner ear fluids and influence of the symptoms of MD are feasible. The aim of the study was to reveal potential inadequacy in the ET equilibration capacity and deviations in ME pressure in patients with MD. Direct ME pressure measurements were made during provocation tests of the ET, and continuously during the daytime and night-time in 21 patients with unilateral, definite and active MD. Twenty subjects with healthy ears (HEs) were used for comparison. In all, 15/21 subjects could not equilibrate an induced positive and/or negative pressure in the ME by deglutition; 9/21 subjects were not able to perform Valsalva's manoeuvre. All the controls could effectively perform these manoeuvres. However, the continuous measurements showed a similar pressure pattern in patients with MD and the controls, i.e. a slightly negative mean ME pressure during the daytime and positive pressure during sleep.
    Acta oto-laryngologica 12/2011; 132(3):255-60. · 0.98 Impact Factor