**Ménière's Disease and Tinnitus**

Ricardo Rodrigues Figueiredo,

Andréia Aparecida de Azevedo and

Norma de Oliveira Penido

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/66390

#### **Abstract**

Tinnitus is one of the Ménière's disease clue symptoms, but by far less studied than ver‐ tigo or other types of dizziness. The typical Ménière's tinnitus is a low pitched fluctuating one. Although controversial, cochlear Ménière's disease may account for a tinnitus sub‐ type, a fact that may impact on tinnitus diagnosis and treatment. Further studies focused on tinnitus are necessary to clarify at which extent Ménière's disease may have a role in some types of chronic tinnitus.

**Keywords:** tinnitus, Ménière's disease, hearing loss, vertigo, dizziness

#### **1. Introduction**

Ménière disease (MD) is a chronic inner ear condition that was first described by Prosper Ménière in the nineteenth century [1]. His initial description of the disease including hearing loss, vertigo and tinnitus was accurate, but the pathophysiology of the condition was only described 75 years later. The endolymphatic hydrops is the main finding, initially ascertained only in post‐mortem exams and nowadays detectable in high resolution magnetic resonance imaging (MRI) [2].

The reported prevalence of MD is 190–513/100,000 cases [3]. Classical symptoms include fluc‐ tuating hearing loss, aural fullness and periodic vertigo and tinnitus [2]. The diagnosis criteria from the American Academy of Otolaryngology and Head and Neck Surgery (AAO‐HNS)

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and the Bárány Society do not recognize an eventual 'cochlear' Ménière disease [4], but recent imaging studies (gadolinium contrasted 3T MRI) are more sympathetic with this possibility [5].

Although virtually all patients that fulfilled the AAO‐HNF clinical criteria for MD whose inner ears were evaluated post‐mortem exhibited endolymphatic hydrops (EH), not all the patients with Proven EH developed MD [2]. Many theories concerning the pathophysiology of MD have been proposed, including changes in endolymph reabsorption due to anatomical variations, perfusion/reperfusion vascular changes, autoimmune mechanisms and changes in water homeostasis [6]. Aquaporins (AQP) are involved in fluid regulation in the inner ear, specifically the subtypes AQP 1, 4 and 6 [6, 7]. It has been demonstrated that vasopressin and oxytocin have a direct effect on aquaporin‐mediated regulation of inner ear fluids [7]. Moreover, cytochemical changes in AQP 4 and 6 expressions in the cochlear supporting cells were demonstrated in MD inner ears [6].
