**9. The role of CNS in MD**

The CNS modulates functions of the inner ear by several mechanisms, which may have a bearing on the pathophysiology of MD. Alterations in autonomic activity may modulate vas‐ cular tone which could set off an acute attack with longer term effects resulting in a chronic damage. Since cochlear fine tuning is compromised in MD, it is likely that efferent pathways are likely to be involved in acute attacks. The role of the neuroendocrine system causing meta‐ bolic dysfunction is yet to be elucidated.
