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*Corresponding author:
Otorhinolaryngology- Head &Neck Copyright © 2015 Caspian Journal of Neurological Sciences. All rights reserved.
Surgery department, Faculty of
Medicine, Guilan University of Please cite this paper as:
Medical Sciences, Rasht, Iran Motasaddi-Zarandi M, Nemati Sh, Panahi R, Akbari M. Benign Paroxysmal Positional Vertigo
Email: drshadmannemati_ent@yahoo.com
Incidence in Meniere’s Disease: Is Meniere's Disease a Predisposing Factor?. Caspian J Neurol
Sci 2015; 1(1):7-11.
Introduction
eniere’s disease (MD) is a
M
large number of factors have been proposed
chronic illness defined as an as precursors to the development of
idiopathic syndrome of endolymphatic hydrops, including excessive
endolymphatic hydrops. The disease is endolymph production, decreased endolymph
characterised by recurrent spontaneous absorption by the endolymphatic sac, ionic
episodes of vertigo, fluctuating hearing loss, imbalance, genetic abnormalities, viral
aural fullness or pressure and tinnitus (1). A infections, dietary factors, vascular
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Caspian J Neurol Sci 2015 March; 1(1): 7-11
irregularities and others (2). According to it has been widely accepted that BPPV is
the guidelines from the Committee on caused by basophilic material adherent to the
Hearing and Equilibrium of the American cupula of the semicircular canal
Academy of Otolaryngology–Head and Neck (cupulolithiasis) or free-floating material
Surgery (AAO-HNS), three major symptoms derived from degenerative otoconia in the
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Benign Paroxysmal Positional Vertigo and Meniere’s Disease Motasaddi-Zarandi M et al.
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Caspian J Neurol Sci 2015 March; 1(1): 7-11
al. considered an increased SP/AP ratio as BPPV and MD (12). They reported that
characteristic of endolymphatic hydrops. 5.6% of their patients had both MD and
They reported that 85% of 100 patients had an BPPV. Meniere's symptoms preceded the
SP/AP ratio above 0.5 (5). In the present onset of BPPV in all of them, and except
study, about 65% of patients had elevated for one patient who experienced BPPV
SP/AP ratios. The results of this study can be bilaterally; BPPV was limited to the same ear
used for commenting about the relationship as well as the MD. All patients in our study
between ECochG test results and MD. also had Meniere's symptoms before onset of
Overall, the prevalence of BPPV has been BPPV.
reported to range from 10.7 to 64 per It should be considered that hydrops of the
100,000 people with a lifetime prevalence of cochlea and/or vestibular system is not
2.4 percent (3, 16). Some types of BPPV necessarily associated with a history of
that occur after an inner ear disease are called episodic vertigo (2). This could be another
secondary BPPV (s-BPPV). Although the reason for the hypothesis of s-BPPV, although
aetiology of idiopathic BPPV (i-BPPV) the lack of vestibular symptoms in patients
remains obscure, morphological changes in with hydrops can be explained on the basis,
vestibular otoconia are thought to be a major that symptoms were present, but not
cause. In contrast, the varied etiologies of s- documented in the medical history. However,
BPPV have been known and include head hydropically induced damage to the maculae
trauma, viral neurolabyrinthitis, MD, of the utricle and saccule may be a possible
otologic surgery and ototoxic drugs (17). The mechanism that leads to eardust falling off
association of BPPV and MD has into the semicircular canals (12, 13). Partial
occasionally been reported (11-14, 17). There obstruction of the membranous labyrinth may
are also reports of incidence rates of MD be a possible explanation of the coexistence of
among patients with BPPV as low as 0.5% MD and BPPV (12). Besides, free-floating
and as high as 31% (10, 14). Balatsouras et al. otoliths could induce hydrops by mechanically
found a prevalence of 8.4% of this clinical obstructing the longitudinal flow and
entity in patients with BPPV. They examined absorption of endolymph (8). Therefore, it
345 patients diagnosed with BPPV. Among seems that MD may harbour a greater risk of
them, 29 patients had been previously developing BPPV.
diagnosed with MD (18). In the present
study we found that 15.4% of our patients Conclusion
had BPPV secondary to MD. Also, results of Based on our findings, MD and BPPV are
this investigation showed that patients who related. Also a longer duration of MD may
had BPPV with MD had a longer history of result in a greater risk of development of
MD. Comparisons of duration of MD among BPPV and the incidence of BPPV is affected
patients with and without BPPV showed a more by duration of disease and condition of
the labyrinth than by aging.
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