Published online Nov 28, 2015. doi: 10.5319/wjo.v5.i4.90
Peer-review started: May 12, 2015
First decision: June 24, 2015
Revised: July 25, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: November 28, 2015
After discovering an inner ear hemorrhage, Prosper Menière ascribed disease to the inner ear for the first time. Since that time, a lot of efforts have been made to determine the pathophysiologic causes of the classical symptoms sensorineural hearing loss, vertigo attacks, tinnitus and ear fullness. According to its express pattern Menière’s disease may appear as classical and atypical disease. In the last decades, huge advances have taken place in biochemical and physiological research and in pathophysiological understanding of the inner ear and its diseases. This encloses stimulus perception and conduction, regulation of inner-ear fluid homeostasis and inner ear diseases with underlying genetics. Menière’s disease pathophysiologic correlate is an endolymphatic hydrops which is characterized by changes of inner ear homeostasis with its parameters volume, concentration, osmolarity and pressure of the endolymph. Hormones, autonomous system and the immunsystem together with purinergic, adrenergic and muscarinic receptors, steroids, vasopressin, atrial natriuretic peptide and aquaporin channels regulate inner ear homeostasis. Consequently, general diagnostics comprise a magnetic resonance imaging with gadolinium, vestibular diagnostics and tone audiometry. Standard therapy for acute inner ear symptoms is limited to cortisone infusions together with a rheologic agent or a radical scavenger. For acute vertigo attacks and for the mainstay therapy antivertiginous pharmaceuticals are given. In severe cases destruction of the vestibular hair cells by ototoxic antibiotics, endolymphatic sac surgery or neurectomy of the vestibular nerve might be necessary. Certainly, in research there is a move from simple pharmaceutical therapy forward to nanoparticle-based, genetic-based and stem cell therapy.
Core tip: Morbus Menière has beome the reference type of inner ear disease. It may express all kind of inner ear symptoms at once, but appears as atypical disease as well. There have been immense achievements in physiologic and biochemical understanding for the inner ear, various inner ear diseases in general and Menière's disease specifically. Pathophysiologic understanding, ongoing research and therapeutic options for Menière’s disease are described and discussed.