Pathophysiology of Meniere's syndrome: Are symptoms caused by endolymphatic hydrops?
Pathophysiology of Meniere's syndrome: Are symptoms caused by endolymphatic hydrops?
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DOI：
10.1097/00129492-200501000-00013
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发表时间：
2005-01-01
影响因子：
2.1
通讯作者：
Nadol, JB
中科院分区：
文献类型：
--
作者：
Merchant, SN;Adams, JC;Nadol, JB
背景：梅尼尔氏综合征与内淋巴积水的关联导致了一个中心假设的形成：许多可能的病因导致积水，而积水反过来又产生症状。然而，这种水肿作为最终共同途径的假设尚未得到最终证明。具体目的：检查人类颞骨中水肿在引起梅尼埃综合征症状中的作用。如果中心假设成立，则每例梅尼埃综合征都应该有积水，并且每例积水都应表现出典型症状。方法：回顾临床诊断为梅尼埃综合征的颞骨病例（28例）或组织病理学诊断为积水的病例（79例）。结果：所有28例具有梅尼埃综合征典型症状的病例均至少一只耳出现积水。然而，事实并非如此。其中特发性积水9例，继发性积水10例，但均未表现出梅尼埃综合征的典型症状。文献综述揭示了无症状积水的病例（与本研究类似），以及生前存在梅尼埃综合征症状但组织学未观察到积水的病例。我们还回顾了最近的实验数据，其中豚鼠内淋巴管阻塞导致在水肿发生之前螺旋韧带纤维细胞内的细胞化学异常。该结果与以下假设一致：积水是由于螺旋韧带内调节元件破坏而引起的液体稳态紊乱所致。结论：内淋巴积水应被视为梅尼埃综合征的组织学标志物，而不是直接导致其症状的原因。
Background: The association of Menire's syndrome with endolymphatic hydrops has led to the formation of a central hypothesis: many possible etiologic factors lead to hydrops, and hydrops in turn generates the symptoms. However, this hypothesis of hydrops as being the final common pathway has not been proven conclusively.Specific Aim: To examine human temporal bones with respect to the role of hydrops in causing symptoms in Meniere's syndrome. If the central hypothesis were true, every case of Menire's syndrome should have hydrops and every case of hydrops should show the typical symptoms.Methods: Review of archival temporal bone cases with a clinical diagnosis of Meniere's syndrome (28 cases) or a histopathologic diagnosis of hydrops (79 cases).Results: All 28 cases with classical symptoms of Meniere's syndrome showed hydrops in at least one ear. However, the reverse was not true. There were 9 cases with idiopathic hydrops and 10 cases with secondary hydrops, but the patients did not exhibit the classic symptoms of Meniere's syndrome. A review of the literature revealed cases with asymptomatic hydrops (similar to the current study), as well as cases where symptoms of Meniere's syndrome existed during life but no hydrops was observed on histology. We also review recent experimental data where obstruction of the endolymphatic duct in guinea pigs resulted in cytochemical abnormalities within fibrocytes of the spiral ligament before development of hydrops. This result is consistent with the hypothesis that hydrops resulted from disordered fluid homeostasis caused by disruption of regulatory elements within the spiral ligament.Conclusion: Endolymphatic hydrops should be considered as a histologic marker for Meniere's syndrome rather than being directly responsible for its symptoms.