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Industry: Email Alert RSS FeedDelayed endolymphatic hydrops: Study and review of clinical implications and surgical treatment - Brief Article
Ear, Nose & Throat Journal, Feb, 2001 by Tsun-Sheng Huang, Ching-Chen Lin
Schuknecht et al also reported that a subclinical viral labyrinthitis during infancy might be a common cause of both contralateral DEH and Meniere's disease. [4] Support for this suggestion is provided by evidence that some bilateral loss of vestibular function occurs in contralateral cases. Moreover, a subclinical attack in the deafened ear in conjunction with the precipitating cause of hearing loss often results in hydrops in the ipsilateral ear. Caloric test results in the 160 patients in this series resulted in similar findings (tables 5 and 6).
Furthermore, in another series of 159 patients who had a total or profound unilateral hearing loss for a period of years, we found that 14 (8.8%) had DEH-seven contralateral, six ipsilateral, and one bilateral. Of the 145 patients who had no DEH symptoms and whose cause of unilateral deafness was unknown, 17 were randomly chosen to undergo caloric ENG in both ears, in addition to routine audiometric and radiologic studies. It is interesting that three of these patients exhibited a reduced yestibular response in the normal-hearing ear and one had no response. Conversely, not all of the deafened ears evidenced a compromised vestibular function; there were five normal caloric responses, indicating that there was a simultaneous vestibular insult in both the deafened ear and the hearing ear.
The eventual development of DEH symptoms in asymptomatic ears appears to be inevitable. Indeed, in a study that spanned 14 years, Kamei found that 27 of 89 juveniles (30%) who had a total unilateral deafness eventually developed episodic vertigo; three also complained of fluctuating hearing in the previously normal contralateral ear. [11] In addition, Schuknecht et al reported that 42 of 62 patients with profound unilateral deafness (68%) had experienced deafness of unknown etiology during childhood. [4]
Our findings appear to be relevant to the propositions expressed by Schuknecht and Gulya that (1) DEH and Meniere's disease are related, (2) that they are caused primarily by a viral labyrinthitis in patients who have deafness of unknown etiology, and (3) that DEN is a pathologic condition that is the final common manifestation of a variety of otologic insults. [7]
Surgical treatment. When medical therapy fails in the treatment of ipsilateral DEH, labyrinthectomy is curative of debilitating vertigo. In our series, labyrinthectomy eliminated vertigo in all 56 patients who underwent the procedure (table 3). Seven of these patients, most of whom were elderly, continued to experience dizziness; this would be expected because the central compensation mechanisms in older patients are often compromised.
ELS surgery has been recommended by Hicks and Wright [5] and by Pulec. [12] It is a more conservative option than labyrinthectomy for controlling vertigo, although it is not always as successful. [12-21] In our series, ELS surgery was performed on six patients (seven ears), and vertigo was eliminated in three patients.
Two other surgical modalities--cochleosacculotomy and streptomycin perfusion of the labyrinth--were used in our series, and they were also effective. Cochleosacculotomy was successful in four of five patients; the one patient who failed was subsequently and successfully treated with streptomycin perfusion. When streptomycin is delivered systemically at the appropriate dosage, it can selectively destroy the vestibular labyrinth while sparing cochlear function. [22] Similarly, local aminoglycoside antibiotics applied adjacent to the inner ear can also selectively destroy the vestibular stereocilia and sensory cells while leaving the first-order neurons intact and causing only minimal damage to the cochlea. [23-26]
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