Otolith Membrane Herniation, not Semicircular Canal Duct Dilation, Is Associated with Decreased Caloric Responses in Ménière’s Disease

Abstract Ménière’s disease (MD) is a debilitating disorder with unclear pathophysiology whose diagnosis often relies on clinical judgment rather than objective testing. To complicate matters further, a dissociation has emerged between two vestibular function tests commonly used in patients with MD to examine the same end-organ (the semicircular canals): the caloric test and video head impulse testing (vHIT). Caloric responses are often abnormal, while vHIT results remain normal. Explaining this dissociation could reveal novel insights into MD pathophysiology. Here, we conduct a histopathological study using temporal bone specimens (N = 58, 21 MD-affected ears and 37 age-matched controls) and their clinical testing data to examine current hypotheses aimed at this dissociation. We find otolith membrane herniation into the horizontal semicircular canal in 69% of MD ears, with 90% of these ears demonstrating a diminished caloric response. No ears with a normal response had this herniation. Moreover, we evaluated the semicircular canals for endolymphatic hydrops, which had been hypothesized to contribute to the dissociation, and found no evidence of duct dilation/hydrops. We did, however, note a potentially novel morphologic finding—smaller bony labyrinth cross-sectional diameters/areas in some MD ear canals compared to controls, suggesting relative size of the membranous duct to the bony canal rather than absolute size may be of importance. Taken together, this study refines hypotheses on the vestibular test dissociation in MD, holding diagnostic implications and expanding our understanding of the mechanisms underlying this enigmatic disease..

Medienart:

E-Artikel

Erscheinungsjahr:

2022

Erschienen:

2022

Enthalten in:

Zur Gesamtaufnahme - volume:24

Enthalten in:

Journal of the Association for Research in Otolaryngology - 24(2022), 1 vom: 20. Dez., Seite 95-106

Sprache:

Englisch

Beteiligte Personen:

Shen, Leo L. [VerfasserIn]
Andresen, Nicholas S. [VerfasserIn]
Chari, Divya A. [VerfasserIn]
Pogson, Jacob M. [VerfasserIn]
Lauer, Amanda M. [VerfasserIn]
Rabbitt, Richard D. [VerfasserIn]
Carey, John P. [VerfasserIn]
Santos, Felipe [VerfasserIn]
Ward, Bryan K. [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.94$jHals-Nasen-Ohrenheilkunde

Themen:

Caloric
Herniation
Ménière
Ménière’s disease
Otolith
Semicircular canal

Anmerkungen:

© The Author(s) under exclusive licence to Association for Research in Otolaryngology 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:

10.1007/s10162-022-00883-x

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2134185244

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