Download PDF
CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(02): e160-e164
DOI: 10.1055/s-0042-1749087
Review Article | Artigo de Revisão

What a Neurosurgeon Should Know About the Endolymphatic Sac: Part 3 – Ménière Disease

O que um Neurocirurgião Deve Saber Sobre o Saco Endolinfático: Parte 3 – Doença de Ménière
Marco Antônio Schlindwein Vaz 
1   Department of Neurosurgery, The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, RS, Brazil
,
Jander Moreira Monteiro
1   Department of Neurosurgery, The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, RS, Brazil
,
Joel Lavinsky
1   Department of Neurosurgery, The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, RS, Brazil
,
Giuseppe Casella Santis
2   Department of Medicine, University of North Georgia (UNG), Dahlonega, Georgia, United States
,
Marcelo Assis Moro da Rocha Filho
3   Department of Otology and Otoneurology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
,
Carmen Austrália Paredes Marcondes Ribas
4   Department of Medicine, Faculdade Evangélica Mackenzie do Paraná (FEMPAR), Curitiba, PR, Brazil
,
Ricardo Marques Lopes de Araújo
5   Department of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
,
Eberval Gadelha Figueiredo
5   Department of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
,
Gustavo Rassier Isolan
1   Department of Neurosurgery, The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, RS, Brazil
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective To elucidate all the aspects that neurosurgeons should know about the Ménière disease (MD).

Methods Review of guidelines, books, and studies from 1933 to 2021, from basic to translational research, using human and animal endolymphatic sac (ES) tissue or cells, as well as reviews, case reports, and papers about surgical experience. This article is divided into three parts. In this last part, we review the MD.

Results The MD is one of the most common pathologies in the ES. It was first described by Prosper Ménière in 1861 with its clinical triad: dizziness, tinnitus, and hearing loss. A lot of theories relating ES to the MD have been proposed. Some of them postulate that it is caused by a narrowing and shortening in the endolymphatic duct, and others relate it to severe inflammation on the ES. Mostly due to the lack of understanding of this pathology, the diagnosis is mainly clinical, despite histopathology being helpful to confirm the diagnosis. The treatment of the MD can be done in 3 different ways: pharmacological, nonpharmacological, and surgical.

Conclusion The MD is one of the most common pathologies in the inner ear and has been largely studied over the years. The latest diagnosis guidelines must help in the classification and give better basis for diagnosis and treatment, which, despite not being curative yet, has improved over the years. Pharmacological treatment based on the possible etiologies, allied with proper diet and routine exercise, is showing promising results.

Resumo

Objetivo Elucidar todos os aspectos que neurocirurgiões devem saber sobre a doença de Ménière (DM).

Métodos Revisão das diretrizes, livros e estudos de 1933 até 2021, de pesquisa básica até translacional, usando tecidos ou células do saco endolinfático (SE) humanas e animais, além de revisões, relatos de caso e artigos sobre experiencia cirúrgica. Este artigo é dividido em três partes. Nesta última nós revisamos a DM.

Resultados A DM é uma das patologias mais comuns do SE. Ela foi inicialmente descrita por Prosper Ménière em 1861 com a tríade clínica: tontura, zumbido e diminuição da audição. Muitas teorias têm relacionado o SE com a DM. Algumas delas postulam que esta é causada por uma diminuição e estreitamento do ducto endolinfático e outras a relacionam com uma inflamação grave do SE. Principalmente devido à falta de entendimento sobre a patologia, o diagnóstico é primariamente clínico, apesar da Histopatologia ajudar na confirmação diagnóstica. O tratamento da DM pode ser feito de três diferentes formas: farmacológico, não farmacológico e cirúrgico.

Conclusão A DM é um dos distúrbios mais comuns da orelha interna e tem sido muito estudada nos últimos anos. As diretrizes mais recentes devem ajudar na classificação e fornecer mais bases para o diagnóstico e tratamento, que, apesar de ainda não ser curativo, teve grandes avanços ao longo dos anos. O tratamento farmacológico baseado nas teorias etiológicas, aliado com dieta apropriada e exercícios físicos rotineiros, tem mostrado excelentes resultados.

Keywords

endolymphatic sac - Ménière disease - neurosurgery

Palavras-chave

saco endolinfático - doença de Ménière - neurocirurgia


Publication History

Received: 08 February 2022

Accepted: 06 April 2022

Article published online:
28 June 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Kim SH, Nam GS, Choi JY. Pathophysiologic Findings in the Human Endolymphatic Sac in Endolymphatic Hydrops: Functional and Molecular Evidence. Ann Otol Rhinol Laryngol 2019; 128 (6_suppl): 76S-83S
    CrossrefPubMedGoogle Scholar
  • 2 Altermatt HJ, Gebbers JO, Müller C, Arnold W, Laissue JA. Human endolymphatic sac: evidence for a role in inner ear immune defence. ORL J Otorhinolaryngol Relat Spec 1990; 52 (03) 143-148
    CrossrefPubMedGoogle Scholar
  • 3 Arnold W, Altermatt HJ, Arnold R, Gebbers JO, Laissue J. Somatostatin (somatostatinlike) immunoreactive cells in the human inner ear. Arch Otolaryngol Head Neck Surg 1986; 112 (09) 934-937
    CrossrefPubMedGoogle Scholar
  • 4 Arnold W, Altermatt HJ, Gebbers J-O, Laissue J. Secretory immunoglobulin A in the human endolymphatic sac. An immunohistochemical study. ORL J Otorhinolaryngol Relat Spec 1984; 46 (06) 286-288
    CrossrefPubMedGoogle Scholar
  • 5 Harris JP. Immunology of the inner ear: evidence of local antibody production. Ann Otol Rhinol Laryngol 1984; 93 (2 Pt 1): 157-162
    CrossrefPubMedGoogle Scholar
  • 6 Harris JP. Immunology of the inner ear: response of the inner ear to antigen challenge. Otolaryngol Head Neck Surg 1983; 91 (01) 18-32
    CrossrefPubMedGoogle Scholar
  • 7 Kawauchi H, Ichimiya I, Kaneda N, Mogi G. Distribution of immunocompetent cells in the endolymphatic sac. Ann Otol Rhinol Laryngol Suppl 1992; 157 (01) 39-47
    CrossrefPubMedGoogle Scholar
  • 8 Lundquist PG. Aspects on endolymphatic sac morphology and function. Arch Otorhinolaryngol 1976; 212 (04) 231-240
    CrossrefPubMedGoogle Scholar
  • 9 Mori N, Miyashita T, Inamoto R. et al. Ion transport its regulation in the endolymphatic sac: suggestions for clinical aspects of Meniere's disease. Eur Arch Otorhinolaryngol 2017; 274 (04) 1813-1820
    CrossrefPubMedGoogle Scholar
  • 10 Tomiyama S, Harris JP. The role of the endolymphatic sac in inner ear immunity. Acta Otolaryngol 1987; May-Jun; 103 (5–6): 182-188 DOI: 10.3109/00016488709107782. . PMID: 21449640
    CrossrefPubMedGoogle Scholar
  • 11 Tomiyama S, Harris JP. The role of the endolymphatic sac in inner car immunology. Acta Otolaryngol 1987; 103 (01) 182-188
    CrossrefPubMedGoogle Scholar
  • 12 Sajjadi H, Paparella MM. Meniere's disease. Lancet 2008; Aug 2; 372 (9636) 406-414 DOI: 10.1016/S0140-6736(08)61161-7. . PMID: 18675691
    CrossrefPubMedGoogle Scholar
  • 13 Cahali S, Cahali MB, Lavinsky L, Cahali RB. Hidropisia Endolinfática. In: de Campos CAH, Costa HOO. editors Tratado de otorrinolaringologia. 1rt ed. São Paulo: Rocca; 2003. (02) 479-485
    Google Scholar
  • 14 Bahmad Jr F. Doença/síndrome de Ménière. In: Piltcher OB, da Costa SS, Maahs GS, Kuhl G, authors. Rotinas em otorrinolaringologia. 1rd ed. Porto Alegre: Artamed; 2015: 108-121
    Google Scholar
  • 15 Alexander TH, Harris JP. Current epidemiology of Meniere's syndrome. Otolaryngol Clin North Am 2010; 43 (05) 965-970
    CrossrefPubMedGoogle Scholar
  • 16 Kimura RS. Experimental blockage of the endolymphatic sac and duct and its effect on the inner ear of the guinea pig. Ann Otol Rhinol Laryngol 1967; 76: 664-687
    CrossrefPubMedGoogle Scholar
  • 17 Fukuoka H, Takumi Y, Tsukada K. et al. Comparison of the diagnostic value of 3 T MRI after intratympanic injection of GBCA, electrocochleography, and the glycerol test in patients with Meniere's disease. Acta Otolaryngol 2012; 132 (02) 141-145
    CrossrefPubMedGoogle Scholar
  • 18 Paparella MM. Pathology of Meniere's disease. Ann Otol Rhinol Laryngol Suppl 1984; 112 (01) 31-35
    CrossrefPubMedGoogle Scholar
  • 19 Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A. Criterios diagnósticos de enfermedad de Menière. Documento de consenso de la Bárány Society, la Japan Society for Equilibrium Research, la European Academy of Otology and Neurotology (EAONO), la American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) y la Korean Balance Society [Diagnostic criteria for Menière's disease. Consensus document of the Bárány Society, the Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society]. Acta Otorrinolaringol Esp 2016; Jan-Feb; 67 (1) 1-7 . Spanish. Doi: 10.1016/j.otorri.2015.05.005. Epub 2015 Aug 12. PMID: 26277738
    CrossrefPubMedGoogle Scholar
  • 20 Portmann G. Surgical treatment of vertigo by opening of the saccus endolymphaticus. Arch Otolaryngol 1969; 89 (06) 809-815
    CrossrefPubMedGoogle Scholar
  • 21 Dandy WE. Ménière's disease: symptoms, objective findings and treatment in forty-two cases. Arch Otolaryngol 1934; 20 (01) 1-30 DOI: 10.1001/archotol.1934.03600010008001.
    CrossrefPubMedGoogle Scholar
  • 22 Silverstein H, Norrell H, Smouha E, Jones R. Combined retrolab-retrosigmoid vestibular neurectomy. An evolution in approach. Am J Otol 1989; May; 10 (3) 166-169 . PMID: 2787602
    PubMedGoogle Scholar