Preface

**Section 5 Ménière's Disease - Audiological and Vestibular**

Chapter 6 **Audiological Assessment in Meniere's Disease 71**

Chapter 8 **Hearing and Vestibular Testing in Menière's Disease 99**

Chapter 9 **Testing of the Semicircular Canal Function in Vertigo and**

Stavros Hatzopoulos, Andrea Ciorba, Virginia Corazzi and Piotr

Ricardo Rodrigues Figueiredo, Andréia Aparecida de Azevedo and

Eduardo Amaro Bogaz, André Freitas Cavallini da Silva, Davi Knoll

Monique Antunes De Souza Chelminski Barreto, Alleluia Lima Losno Ledesma, Marlene Escher Boger and Carlos Augusto Costa

Fatih Oghan, Ibrahim Erdim, Metin Çeliker, Muhammet Fatih Topuz,

Chapter 7 **Electrophysiology in Ménière's Disease 83**

Madalina Gabriela Georgescu

**Evaluation 69**

**VI** Contents

Dinesh Kumar Sharma

Pauliana Lamounier

**Dizziness 119** Holger A. Rambold

Chapter 10 **OAEs and Meniere Disease 137**

Henryk Skarzynski

**Section 6 Ménière's Disease and Tinnitus 149**

Chapter 11 **Ménière's Disease and Tinnitus 151**

Norma de Oliveira Penido

**Section 7 Ménière's Disease Treatment 159**

Chapter 12 **Meniere's Disease Treatment 161**

Pires De Oliveira

Ribeiro and Gabriel dos Santos Freitas

Chapter 13 **Intratympanic Drug Delivery for Tinnitus Treatment 175**

Chapter 14 **Intratympanic Steroid Treatment in Méniére Disease 187**

Ahmet Uluat, Onur Erdogan and Sinan Aksoy

Ménière's disease is an alteration of the inner ear characterized by two groups of symp‐ toms: vestibular symptoms and auditory symptoms. Classical symptoms such as fluctuat‐ ing hearing loss, tinnitus, atrial fullness, and concomitant dizziness greatly aid the otorhinolaryngologist to diagnose carriers of the disease. But in many patients, their pre‐ sentation may be different.

In this book, we will adopt the term Ménière's disease to follow the prevailing trend among most research groups and discuss the main topics, current and past ideas about etiopatho‐ genesis, diagnosis, and treatment of Ménière's disease and Ménière's disease associated with migraine.

It is likely that there are genotypic—racial, as well as phenotypic—environmental factors that influence the prevalence difference between countries. One of the major problems in this respect is that the initial presentation of the disease is often the cochlear form, which is not clinically recognized, and is again attributed to another specific cause or is presumed to be simply due to aging. Even after the vestibular component becomes obvious, long periods of remission may mask the complete final image of the syndrome with episodic vertigo, fluctuating autistic loss, tinnitus, and aural fullness. Therefore, generally in clinical practice, only moderate to severe cases are tabulated in the estimates so far.

Some of the epidemiologically published studies to date have tended to blend different epi‐ demiological concepts. The direction of these studies is mainly retrospective (the themes are identified after a result or illness), and they actually measure only prevalence (existing events or the number of cases of a disease at a given moment divided by the population at risk). Only prospective studies (subjects are identified before a result or illness; future events are counted) would have the power to adequately measure this incidence. Although more reflective of real life than an artificial experiment, retrospective observational studies are susceptible to bias.

The multiplicity of diagnostic criteria is another problem that makes it difficult to establish the true incidence of Ménière's disease in the general population. In 1972, the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Sur‐ gery (AAO-HNS) proposed a specific definition of the disease and guidelines for the evalua‐ tion of Ménière in communicating treatment results. In 1985, it was considered that the definition of Ménière's disease needed to be restricted to cases with a complete set of classic signs and symptoms. The 1995 criteria were intended to simplify the definition of Ménière's disease and allow greater flexibility, making it usable in a wide range of studies and classifi‐ cations. A minimum set of signs and symptoms must be filled in such a way that the degree of certainty of the diagnosis can be established.

Currently, there is no universally accepted theory about the pathophysiology of do-ence. Through histopathological studies, it is presumed that endolymphatic hydrops is the most descriptive pathological characteristic of Ménière's disease. The pathophysiology of the symptoms is still disputed: ruptures of membranes, increased pressure and mechanical dis‐ placement of the peripheral organs as the saccule by endolymph accumulation, viral infec‐ tions, and autoimmune disease in addition to several other theories that have already been reported. It can be seen that in this scheme currently accepted endolymphatic hydrops is no longer a central etiology but rather as one of the manifestations of the syndrome. And the exact mechanism of the etiopathogenesis of the syndrome remains unknown. It is believed that a multifactorial inheritance is the best response, in which the necessary conditions are met to lead to malabsorption of the endolymph and, subsequently, to dropsy. Clinical and laboratory evidence supports this concept.

**Dr. Fayez Bahmad Jr**

Health Science Faculty of the University of Brasilia The Brasiliense Institute of Otolaryngology Brasilia, Brazil

**Section 1**
