[Therapeutic considerations in vascular diseases of the inner ear]

I propose an analogy between vascular diseases of the inner ear and those of other organs like brain, heart or peripheral vessel diseases in which functional and organic alteration can be objectively demonstrated. Symptomatic disturbances of inner ear circulation are monoform in its clinical appearance and the term of 'otangina' is proposed for the functional result. Three types of vascular distribution are discussed for the different regulatory entities, (I) the proximal cerebral vascular type, (II) the predistal innervated regulatory type and the (III) capillary regulatory type. The formal etiology of inner ear vascular diseases is is developed on the base of organic vascular lesions, i.e. arteriosclerosis, functional alterations, i.e. vasospastic disease, and finally change in the microcirculation by alterations of the rheology of the blood. Hypertension is portrayed as a main example for cardiovascular risk factors with respect to inner ear circulatory damage but diabetes mellitus, cigarette smoking and other metabolic diseases leading to vascular disturbances have to be considered. From these considerations I have developed a basic program for the diagnosis of vascular metabolic risk factors which should be realized before any treatment is advocated. I have critically evaluated the benefit and possible hazardous effects of so called 'vasoactive' and 'cephalotropic' drugs. For most inner ear circulatory disease such therapy is contraindicated. The models of drug treatment of acute deafness and the chronic or persistent inner ear deafness should be evaluated in prospective studies.