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Endolymph pressure in Menière's disease
1Shea Clinic, Memphis, TN 38119.
Abstract:
During the streptomycin perfusion/shunt of the lateral semicircular duct operation for Meniere's disease, the lateral semicircular duct is exposed by removal of the bone of the lateral semicircular canal. Before perfusion with streptomycin and creation of a shunt in the lateral semicircular duct, the pressure in the lateral semicircular duct is measured while electrocochleography is being recorded. In most ears with Meniere's disease, the pressure necessary to indent the lateral semicircular duct is 2 to 3 mm of water. The pressure is more in those ears with a large negative summating potential than in those with a normal negative summating potential. The pressure is less after the shunt in the lateral semicircular duct is created and the negative summating potential returns to normal. In some ears with the classic picture of Meniere's disease, the endolymph pressure is normal and there is a normal negative summating potential. Presumably, one should not create a shunt in the lateral semicircular duct in ears with normal pressure.
Insights
This study measured endolymphatic pressure in Meniere's disease patients undergoing streptomycin perfusion. Elevated pressure correlated with negative summating potentials, decreasing after surgical shunting.
Area of Science:
- Otolaryngology
- Neurosurgery
- Neuroscience
Background:
- Meniere's disease is a disorder of the inner ear.
- Streptomycin perfusion/shunt is a surgical treatment for Meniere's disease.
- Endolymphatic pressure and electrocochleography are key diagnostic indicators.
Purpose of the Study:
- To investigate the relationship between endolymphatic pressure and electrocochleography findings in Meniere's disease.
- To evaluate the effect of streptomycin perfusion/shunt on endolymphatic pressure.
- To determine criteria for surgical intervention.
Main Methods:
- Exposure of the lateral semicircular duct via bone removal.
- Measurement of lateral semicircular duct pressure before and after streptomycin perfusion/shunt.
- Simultaneous recording of electrocochleography during pressure measurements.
Main Results:
- Endolymphatic pressure in Meniere's disease typically ranges from 2 to 3 mm of water.
- Higher pressures are observed in ears with large negative summating potentials.
- Pressure decreases and negative summating potentials normalize after surgical shunting.
Conclusions:
- Endolymphatic pressure is a significant factor in Meniere's disease pathophysiology.
- Streptomycin perfusion/shunt effectively reduces elevated endolymphatic pressure.
- Surgical shunting may not be indicated in cases with normal endolymphatic pressure and normal electrocochleography.