Meniere's disease can happen at any age. Evidence and controversies. Mhatre AN, Jero J, Chiappini I, Bolasco G, Barbara M, Lalwani AK. Google Scholar. Teggi R, Lanzani C, Zagato L, et al. Schuknecht HF, Belal AA. Allergy and its relation to Menieres disease. Google Scholar. FOIA Acta Otolaryngol. Otolaryngol-- Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. Kitahara T, Okamoto H, Fukushima M, Sakagami M, Ito T, Yamashita A, et al. It seems clear that hydrops reflects the changes in the anatomy of the membranous labyrinth as a consequence of overaccumulation of endolymph.3 Thus, possible causes of hydrops include overproduction of endolymph and/or a decrease in the absorption of endolymph. 1982;90:25662. Hear Res. Park HJ, Migliaccio AA, Della Santina CC, Minor LB, Carey JP. 2009;30(7):100612. The membranous structures are filled with a potassium-rich extracellular fluid called endolymph; the space between them and the bone shell contains a completely separate fluid called perilymph, which ionic composition is similar to extracellular fluid found elsewhere in the body. Hebbar GK, Rask-Andersen H, Linthicum FH. Baloh RW, Jacobson K, Winder T. Drop attacks with Menires syndrome. 4 T MRI. As a service to our customers we are providing this early version of the manuscript. 2023 Mar 6;14(1):1249. doi: 10.1038/s41467-023-36949-4. 2017;131(8):65860. Otolaryngol Clin N Am. All Rights Reserved, 2022;148(4):360-368. doi:10.1001/jamaoto.2021.4282. [] The relapsing nature of the disease may significantly affect the patients' quality of life, especially during periods of acute symptomatology. Shinkawa H, Kimura RS. This site needs JavaScript to work properly. Arch Otolaryngol Head Neck Surg. 2019;84(2):70-77. doi: 10.17116/otorino20198402170. Otol Neurotol. Derebery MJ. 1956;64:11828. Many authors, in all patients with the disease, consistently observed dilation of the scala media of the cochlea, with displacement of Reissners membrane into the vestibular scala (endolymphatic hydrops) (Figs. None of the current theories remain tenable in view of recent findings concerning the physiology and pathophysiology of the cochlea and endolymphatic sac. Regarding the sensory elements of the inner ear, the reports in the literature conflict: the hair cells may or may not further degenerate in the organ of Corti and in the macula and crista ampullaris of the vestibular system (Fig. Eur Arch Otorhinolaryngol. Pathology of Meniere's Disease - Michael M. Paparella, 1984 - SAGE Journals PDF Mnire's Disease - NIDCD Pathology and pathophysiology of Meniere's disease Otolaryngol Clin North Am. Acta Otolaryngol Suppl 485:7154, Jahnke K (1994) Stage-appropriate therapy of Menires disease. Endolymphatic hydrops revealed by magnetic resonance imaging in patients with atypical Menieres disease. National Library of Medicine CrossRef Thus, through agents such as catecholamines, the sac might regulate the hydrostatic pressure in the endolymphatic system.38. In several studies in the 1970s and 1980s of temporal bones from deceased donors who had Menieres disease (as compared with nondiseased controls), the membranous labyrinth showed some marked changes, including perisaccular fibrosis,24 loss of epithelial integrity and atrophy of the endolymphatic sac,25 and narrowing or complete obstruction of the lumen in the endolymphatic duct (Figs. Mnire's disease usually affects only one ear. Two representative human temporal bone sections, showing the vestibular portion of the bony and membranous labyrinths, in a donor with Menieres disease (A) and a non-diseased bone (B) (hematoxylin and eosin, 2x). Menieres disease of syphilitic etiology. Corresponding author: Sebahattin Cureoglu, M.D., Otopathology Laboratory, Department of Otolaryngology, University of Minnesota, 2001 6th St SE, Lions, Research Building, Room 210, Minneapolis, MN 55455, USA. Mnire disease is a rare chronic benign disorder of the inner ear with a natural history of multiple clinical phenotypes of variable severity and a tendency to burnout with time. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA, Alexander L. Luryi,Elliot Morse&Elias Michaelides, You can also search for this author in Pathogenesis and Pathophysiology of Menieres Disease. Liu F, Huang W, Meng X, Wang Z, Liu X, Chen Q. 2023 Jul 19;13(4):528-545. doi: 10.3390/audiolres13040047. Rauch SD, Merchant SN, Thedinger BA. Audiol Neurotol. 2009;29(12):125966. Otol Neurotol. Two other tubular structures1 coming from the saccule (the saccular duct) and the other from the utricle (the utricular duct)join in a single fusiform membranous structure (the endolymphatic sinus) that lies in a groove on the posteriomedial surface of the vestibule. Types of Inheritance and Genes Associated with Familial Meniere Disease. Arch Otolaryngol Head Neck Surg 115(11):13551357, Committee on Hearing and Equilibrium (1995) Guidelines for the diagnosis and evaluation of therapy in Menires disease. Two representative horizontal sections of human temporal bones, showing the endolymphatic sinus and the Basts valve in bones from two donors who had Menieres disease (hematoxylin and eosin; 10x). Menieres disease and the peak audiogram. Otol Neurotol. PubMed Central Paparella MM. Genetic investigations of Menieres disease. Mnire's disease (idiopathic endolymphatic hydrops) is a rare inner ear disorder. 2012;121(10):6828. Springer, Berlin, Ruckenstein MJ (2010) Mnires disease. But it isn't clear what causes this fluid to build up in the inner ear. Autoimmunity has also been implicated in the pathophysiology of Menieres disease, mostly because of the high incidence of autoimmune diseases associated with Menieres disease. Arch Otolaryngol. Chiarella G, Petrolo C, Cassandro E. The genetics of Mnires disease. 2012;51(11):8415. High prevalence of systemic autoimmune diseases in patients with Menieres disease. Further observations on the role of the MHC genes and certain hearing disorders. Endolymph has a very high concentration of potassium (K+), which creates an environment that allows a high electric potential in the scala media of the cochlea (+80 to +110 mV). Google Scholar. General Approach Vertigo is a sensation of distorted self-motion when no self-motion is occurring. Eur Arch Otorhinolaryngol. 2002 Jun;35(3):565-80. doi: 10.1016/s0030-6665(02)00017-8. Google Scholar. Nadol JB Jr, Thornton AR. Hornibrook J, George P, Gourley J. Vasopressin in definite Menieres disease with positive electrocochleographic findings. 1982;217(4565):11535. Potential cause of positional vertigo in Menieres disease. Attacks of dizziness may come on suddenly or after a short period of tinnitus or muffled hearing. Acta Otolaryngol. Mnire disease is a rare chronic benign disorder of the inner ear with a natural history of multiple clinical phenotypes of variable severity and a tendency to burnout with time. The https:// ensures that you are connecting to the Brown DH, McClure JA, Downar-Zapolski Z. Audiol Res. 1987;31(3):2116. Acta Otolaryngol (Stockh). Colin D, Micheyl C, Girod A, Truy E, Gallgo S. Binaural diplacusis and its relationship with hearing-threshold asymmetry. Its composition is crucial in maintaining a constant, high endocochlear electric potential, which varies only slightly, from +80 to +110 mV.13,14 Evidence points toward the formation of endolymph from perilymph, rather than from plasma.15 The transepithelial K+ transportation from perilymph to endolymph through the sodium-potassium-adenosine triphosphate (Na+,K+-ATPase) ion pump is responsible for maintaining both the high endocochlear electric potential and the unique composition of endolymph.14, The stria vascularis is responsible for the secretion of endolymph, with small contributions from the planum semilunatum and from dark vestibular cells.16 The rate of endolymph secretion seems to be influenced by a number of factors and hormones, including aldosterone17 and vasopressin18; other substances such as cathecholamines, thyroid hormones, and somatostatin are also implicated in endolymph homeostasis.13 But the K+ in endolymph is absorbed by the sensory hair cells via apical transduction channels, from which it is transported back to perilymph.14. Otol Neurotol. ORL J Otorhinolaryngol Relat Spec. Sando I, Ikeda M. Pneumatization and thickness of the petrous bone in patients with Menieres disease. Since Meniere's disease can be seen only in humans, assessing its natural history is important. It's caused by an abnormality in part the inner ear called the labyrinth. Otolaryngol Head Neck Surg. Merchant SN, Adams JC, Nadol JB. Arch Otorhinolaryngol 1:166, CAS Lawrence M, McCabe BF. 2016;263(Suppl 1):S7181. Three-dimensional analysis of 61 human endolymphatic ducts and sacs in ears with and without Menires disease. Kawaguchi S, Hagiwara A, Suzuki M. Polymorphic analysis of the heat-shock protein 70 gene (HSPA1A) in Mnires disease. AJNR Am J Neuroradiol. Two representative human temporal bone sections showing the stria vascularis (arrow) in the basal turn of the cochlea (20x; hematoxylin and eosin). PubMed Familial cases seem to involve an autosomal dominant inheritance with an incomplete penetrance (60%), plus evidence of the possibility of more severe clinical symptoms in offspring.57 Early investigations analyzed the possible association between human leukocyte antigens (HLAs)and susceptibility to Menieres disease, but conflicting evidence was found.58 However, in a specific population in Europe, Lpez-Escmez et al.59 found a possible association between the HLA-DRB1*1101 allele and bilateral Menieres disease. Bernstein JM, Shanahan TC, Schaffer FM. Progression of hearing loss in bilateral menieres disease. Michel O, Hess A, Su J, Bloch W, Stennert E, Addicks K. Expression of inducible nitric oxide synthase (iNOS/NOS II) in the hydropic cochlea of guinea pigs. Hearing loss and caloric response in Menires disease. Meniere's disease - Symptoms and causes - Mayo Clinic Correspondence to A systematic review of diuretics in the medical management of Menieres disease. Auris Nasus Larynx. Evaluation and Management of Mnire's Disease - ASHA 1997;30(6):101726. The only known gene in that region encodes phosphatidylinositol 3-kinase class 2 gamma (PIK3C2G), whose activation was demonstrated to regenerate cells in the utricular macula of rats.60 Two other studies showed an association between Menieres disease and single-nucleotide polymorphisms. Two representative horizontal sections of human temporal bones, showing the vestibular aqueduct and endolymphatic duct (hematoxylin and eosin; 2x). In the cochlea, the scala media is filled with endolymph, whereas the scala tympani and the scala vestibuli contain perilymph. History of Menieres disease and its clinical presentation. (A) otosclerotic foci involving the bony areas around the cochlea and vestibule (2x); squared area: blockage of the vestibular aqueduct by an otosclerotic foci. Disclaimer. Laryngoscope. 2017;39(1):427. Hear Res. Eur Arch Otorhinolaryngol. DEFINITION Disease of inner ear Distention of endolymphatic system Vertigo Sensorineural hearing loss Tinnitus. Hirai C, Yamamoto Y, Takeda T, Tasaki A, Inaba Y, Kiyokawa Y, et al. 2017;11:301. 1981;91:172737. Hietikko E, Kotimaki J, Okuloff A, Sorri M, Mannikko M. A replication study on proposed candidate genes in Menieres disease, and a review of the current status of genetic studies. Dissertation, University of Hamburg, Salt AN, Hartsock JJ, Gill RM, Piu F, Plontke SK (2012) Perilymph pharmacokinetics of markers and dexamethasone applied and sampled at the lateral semi-circular canal. Otolaryngol Clin N Am. Otol Neurotol. Acta Otolaryngol (Stockh). Hallpike CS, Cairns H. Observations on the Pathology of Mnires Syndrome. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Cochlear hydrops (or cochlear Meniere's or cochlear endolymphatic hydrops) is a condition of the inner ear involving a pathological increase of fluid affecting the cochlea. 2010;130(3):33843. Chin Med J. Ear Nose Throat J. Careers, Unable to load your collection due to an error. Bilateral aspects of Menieres disease: an underestimated clinical entity. 1959;171:192732. Effects of cholera toxin on cochlear endolymph production: model for endolymphatic hydrops. Ann Otol Rhinol Laryngol 114(12):927933, Paparella MM, Djalilian HR (2002) Etiology, pathophysiology of symptoms, and pathogenesis of Menires disease. Vrabec JT. Hear Res. 2014;134:123944. PubMed Central Ann Otol Rhinol Laryngol. Paparella MM, McDermott JC, de Sousa LC. Otol Neurotol. Tokyo: Springer Science & Business Media; 2013. ORL J Otorhinolaryngol Relat Spec. Profil. J Psychosom Res 43(6):595603, CrossRef 2012;32:21325. 2015;24(4):111926. Hum Mol Genet. 2006;126(10):10305. PubMedGoogle Scholar. Laryngoscope. 1986;112(5):53640. Meniere's Disease - PowerPoint PPT Presentation - PowerShow.com 1 and and22).69 Also a common, though less frequent, finding was saccular hydrops (Fig. Hofman R, Segenhout JM, Buytaert JAN, Dirckx JJJ, Wit HP. Plural Publishing, San Diego, Oxford, Brisbane, p S162, Rudack C (1995) Immunology of the inner ear. Salvinelli F, Greco F, Trivelli M, Linthicum FH. Mizukoshi K, Shojaku H, Aso S, Watanabe Y. Bance M, Mai M, Tomlinson D, Rutka J. The Correlation Between Endolymphatic Hydrops and Clinical Features of Meniere Disease. Introduction. 2005 Jan;26(1):74-81. doi: 10.1097/00129492-200501000-00013. Megerian CA, Semaan MT, Aftab S, Kisley LB, Zheng QY, Pawlowski KS, et al. A three-dimensional analysis of the endolymph drainage system in Meniere disease. Bartoli E, Satta A, Melis F, et al. 2015;135:85965. Otolaryngol Head Neck Surg. Tone burst electrocochleography for the diagnosis of clinically certain Menieres disease. Aoki M, Asai M, Nishihori T, Mizuta K, Ito Y, Ando K. The relevance of an elevation in the plasma vasopressin levels to the pathogenesis of Menieres attack. Pathophysiology of Menieres syndrome: are symptoms caused by endolymphatic hydrops? Absence of COCH mutations in patients with Meniere disease. The episodic vertigo typically resolves over time; however, hearing loss usually becomes permanent with disease progression. 2023 Jun;24(3):269-279. doi: 10.1007/s10162-023-00896-0. 2009;123(1):2937. Large heterogeneity among studies may be explained by historical differences in the clinical understanding of the disease, as well as evolving intervention methodologies and practitioner expertise. What is Mnire disease? The composition of endolymph is different from that of every other fluid in the human body. Causes. Terms of Use| Mnire's disease - Wikipedia Meniere's disease (MD) consists of a tetrad of episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Janzen VD, Russell RD. Polymorphisms in KCNE1 or KCNE3 are not associated with Meniere disease in the Caucasian population. Intractable benign paroxysmal positional vertigo in patients with Menieres disease. Federal government websites often end in .gov or .mil. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Menires disease: an immune complex-mediated illness? Diagnosis and Treatment of Vestibular Disorders pp 165188Cite as. [2,3] Vertigo mainly influences the physical dimension, while tinnitus . Otol Neurotol. Marshall AF, Jewells VL, Kranz P, Lee YZ, Lin W, Zdanski CJ. Nomura Y. Morphological aspects of inner ear disease. Front Neurol. Kariya S, Cureoglu S, Fukushima H, et al. He was able to make clear, that the triage of vertigo, hearing loss and tinnitus is an independent disease of the inner ear. This scoping review found that Mnire disease is a multifactorial disease with lifelong comorbidities and loss of quality-associated life-years whose most commonly reported causes were structural dysfunction, immunologic damage, and genetic susceptibility. An official website of the United States government. PLoS One. Mater Psychoanal 11:104147, Levo H, Stephens D, Poe D (2010) Use of ICF in assessing the effects of Menieres disorder on life. Vrabec JT. Would you like email updates of new search results? Can vestibular-evoked myogenic potentials help differentiate Mnire disease from vestibular migraine? New York: Springer Science & Business Media; 2013. Hearing loss proved by a hearing test. Acta Otolaryngol. Gazquez et al.63 found a higher prevalence (as compared with what is expected in the general population) of rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis in patients with Menieres disease. 3); however, utricular hydrops was rarely observed.3. 2017;38:2447. Otol Neurotol. Zuniga MG, Janky KL, Schubert MC, Carey JP. Adams JC. Menieres disease (MD) consists of a tetrad of episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Kitahara T, Doi K, Maekawa C, et al. Endolymphatic hydrops in Mnires disease: cause, consequence, or epiphenomenon? Research studies conducted in recent years concerning the pathogenesis and pathophysiology of Meniere's disease would provide an insight for the improvement of diagnosis and treatment of this weakening disease. Ear Nose Throat J. PMC House JW, Doherty JK, Fisher LM, Derebery MJ, Berliner KI. Chuan W, Yuan L, Wen J, Jianwei Z, Caiji W, Zeqi Z, Yalan L, Renlong J, Kang L, Wei L, Houguang L, Wen L, Yuehua Q, Xuanyi L. Braz J Otorhinolaryngol. 1992;102(2):1358. Yoo TJ, Stuart JM, Kang AH, Townes AS, Tomoda K, Dixit S. Type II collagen autoimmunity in otosclerosis and Menieres disease. However, ablation completely destroyed the sac and created significant surgical stress and trauma, so it is not considered a trustworthy method to cause the changes observed in Menieres disease. CrossRef Google Scholar, Staab JP (2020) Persistent postural-perceptual dizziness. Kubo T, Sakashita T, Kusuki M, Nakai Y. Magn Reson Med Sci. The inner ear is composed of membranous structures (collectively known as the membranous labyrinth) encased by a bone shell (the bony labyrinth). Laryngoscope. Mnire's disease typically affects people between the ages of 40- and 60-years-old and can impact . Meniere Disease | Johns Hopkins Medicine 2016;263(Suppl 1):S829. One found a variation in the heat shock protein HSP70-1, possibly involved in the cellular stress response61; the other, a variation in adducing (Gly460Trp), which was associated with changes in the metabolism of sodium and in the activity of Na+,K+-ATPase.62. The mechanism and pathophysiology associated with MD development remains under-evaluated. Semi-quantification of endolymphatic size on MR imaging after intravenous injection of single-dose gadodiamide: comparison between two types of processing strategies. https://doi.org/10.1007/978-3-662-63610-7_3, DOI: https://doi.org/10.1007/978-3-662-63610-7_3, Publisher Name: Springer, Berlin, Heidelberg. The diagnosis and treatment of Menieres disease. 2005;88:818. The cause of Meniere's disease isn't known. Otolaryngol Clin N Am. History of Meniere's disease and its clinical presentation. Migraine features in patients with Menieres disease. 2008;128:88791. 2010;71(Suppl 1):269. Kutlubaev MA, Pal'chun VT, Savel'eva EE, Guseva AL. Unable to load your collection due to an error, Unable to load your delegates due to an error. Meniere disease subtyping: the direction of diagnosis and treatment in The prevalence of migraine in Menieres disease. Ghavami Y, Mahboubi H, Yau AY, Maducdoc M, Djalilian HR. Acta Otolaryngol (Stockh). Lopez-Escamez JA, Vilchez JR, Soto-Varela A, et al. Hallpike CS, Cairns H. Observations on the pathology of Mnires syndrome: (section of otology). Degerman E, Int Zandt R, Plbrink A-K, Magnusson M. Vasopressin induces endolymphatic hydrops in mouse inner ear, as evaluated with repeated 9. Lin YS, Lin LC, Lee FP, Lee KJ. CAS 1991;100(3):21925. Ann Otol Rhinol Laryngol 119:583589, Morgenstern C (1985) Pathophysiology, clinic, and conservative therapy of Menieres disease. 1969;89(6):81625. 2014;124:96973. The changing direction of nystagmus in acute Menires disease: pathophysiological implications. In severe cases of Menieres disease, Reissners membrane can bulge into the helicotrema, as well as through the saccule into the semicircular canals (especially the horizontal canal)7 and onto the footplate of the stapes (Fig. Hebbar GK, Rask-Andersen H, Linthicum FH Jr. Three-dimensional analysis of 61 human endolymphatic ducts and sacs in ears with and without Menieres disease. Laryngoscope. Before The most common reported causes of Mnire disease were autoimmune or immune-mediated, genetic, or structural dysfunction of the inner ear. Detection and grading of endolymphatic hydrops in Menire disease using MR imaging. Issues that affect the fluid, which might lead to Meniere's disease, include: Poor fluid drainage. Preface. Various factors associated with the phenomenon of hydrops include functional or anatomic obstruction of endolymphatic flow, malabsorption of endolymph, genetic anomalies, vasodilation, allergy, viral infection, and autoimmunity. Grkov R, Kantner C, Strupp M, Flatz W, Krause E, Ertl-Wagner B. Endolymphatic hydrops in patients with vestibular migraine and auditory symptoms. Typically, only one ear is affected initially, but over time, both ears may become involved. Pathogenesis and Etiology of Mnire Disease: A Scoping - PubMed Epub 2014 Feb 13. 5); fibrous tissue proliferation within the vestibule; and focal loss of neurons, as well as degeneration of the dendrites, in the upper middle and apical turns of the cochlea (Fig. 2015;36(5):86572. The arrow points to a dense deposit on the cupula of the crista ampullaris, characterizing cupulolithiasis of the posterior semicircular canal. Int J Audiol. A: Specimen from a non-diseased donor; squared area = normal-sized vestibular aqueduct. J Neurol. Pathophysiologic theories in the etiology of Menieres disease. Otolaryngol Head Neck Surg. Recent studies have examined how autoinflammatory processes and vestibular migraine may be associated with Mnire disease. Arch Otolaryngol Head Neck Surg. Hughes GB, Kinney SE, Barna BP, Calabrese LH. Black FO, Effron MZ, Burns DS. Histopathology of Meniere's disease. Cell Physiol Biochem. 2012;132(10):105460. Semin Neurol 40(1):130137. HHS Vulnerability Disclosure, Help In most cases only one ear (unilateral) is involved, but both ears (bilateral) may be affected. 2023 May-Jun;89(3):469-476. doi: 10.1016/j.bjorl.2023.03.002. Provided by the Springer Nature SharedIt content-sharing initiative, Diagnosis and Treatment of Vestibular Disorders, https://doi.org/10.1007/978-3-319-97858-1_13. 2022;148(4):360368. Radiological presence of vascular loops in the cerebellopontine angle region in patients with unilateral Mnire's disease. Genetic evidence for an ethnic diversity in the susceptibility to Menieres disease. Cephalalgia. Endolymphatic hydrops revealed by intravenous gadolinium injection in patients with Menieres disease. Pfeiffer, Munich, p S.256, Foster CA, Breeze RE (2013) Endolymphatic hydrops in Menieres disease: cause, consequence, or epiphenomenon? 2010;267(1):139. 2008;100(3):3348. Further evidence of the role of the endolymphatic sac in endolymph absorption was provided by Kimura and Schuknecht,36 who successfully created endolymphatic hydrops in animals by surgically ablating the sac. Acta Otolaryngol. Blockage of longitudinal flow in Menieres disease: A human temporal bone study. 1983;93(11 Pt 1):140815. Indications for surgery in Menieres disease. II. 2013;34(3):55969. A two-year randomized trial of interventions to decrease stress hormone vasopressin production in patients with Menieres disease-a pilot study. 2005;125:8527. 2008;70(1):2831. 2005;26(1):7481. Laryngoscope. Jahn AF. Park JJ, Shen A, Keil S, Kuhl C, Westhofen M. Jugular bulb abnormalities in patients with Menieres disease using high-resolution computed tomography. Mnire's Disease - ENT Health This scoping review found that Mnire disease is a multifactorial disease with lifelong comorbidities and loss of quality-associated life-years whose most commonly reported causes were structural dysfunction, immunologic damage, and genetic susceptibility. Inoue A, Egami N, Fujimoto C, Kinoshita M, Yamasoba T, Iwasaki S. Vestibular evoked myogenic potentials in vestibular migraine. McGarvie LA, Curthoys IS, MacDougall HG, Halmagyi GM. The association of the plasma vasopressin level during attacks with a prognosis of Menieres disease. 2000;143(12):238. The membranous labyrinth comprises the following structures: the scala media, scala vestibuli, and scala tympani of the cochlea; the ductus reuniens; the saccule; the utricle; the semicircular canals; the endolymphatic duct; and the endolymphatic sac. Prosper Mnire and his disease. Yamakawa K. Temporal Bone Histopathology of Menieres Patient. 1991;485:4652. The use of electrocochleography in the diagnosis of Menires disease. Roheim PS, Brusilow SW. Balkany TJ, Sires B, Arenberg IK. Study with vestibular-evoked myogenic potential.
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