This study aimed to evaluate the benefits of betahistine or vestibular rehabilitation (Tetrax biofeedback) on the quality of life and fall risk in patients with Ménière's disease.

Sixty-six patients with Ménière's disease were randomly divided into three groups: betahistine, Tetrax and control groups. Patients’ Dizziness Handicap Index and Tetrax fall index scores were obtained before and after treatment.

Patients in the betahistine and Tetrax groups showed significant improvements in Dizziness Handicap Index and fall index scores after treatment versus before treatment (p < 0.05). The improvements in the Tetrax group were significantly greater than those in the betahistine group (p < 0.05).

Betahistine and vestibular rehabilitation (Tetrax biofeedback) improve the quality of life and reduce the risk of falling in patients with Ménière's disease. Vestibular rehabilitation (Tetrax biofeedback) is an effective management method for Ménière's disease.

Recent developments in magnetic resonance imaging have enabled demonstration of endolymphatic hydrops, and the clinical application of these imaging studies in Ménière's disease is being explored.

To evaluate our centre's experience to date of hydrops magnetic resonance imaging in patients with episodic vertigo.

Magnetic resonance imaging was performed using a high-resolution three-dimensional fluid-attenuated inversion recovery sequence on a 3 Tesla scanner at 4 hours following double-dose gadolinium administration.

The study included 31 patients, 28 of whom had a clinical diagnosis of Ménière's disease. In unilateral Ménière's disease, magnetic resonance imaging was able to lateralise endolymphatic hydrops to the clinically symptomatic ear in all cases. Mild hydrops was often seen in clinically asymptomatic ears.

There is a good correlation between the clinical symptoms and lateralisation of hydropic changes on magnetic resonance imaging. Further refinements of imaging techniques and grading system will likely improve the diagnostic accuracy and clinical utilisation of hydrops magnetic resonance imaging.

To determine the age of onset of Ménière's disease in patients who visited a specialised dizziness clinic, and to verify whether the trend of a delayed onset age of Ménière's disease as reported for the Japanese population also occurs in the Netherlands.

A retrospective data analysis was performed of patients diagnosed with ‘definite’ Ménière's disease who visited our clinic between January 2000 and December 2013.

Mean onset age of Ménière's disease among the 296 patients was 53.0 ± 14.1 years; 209 patients (71 per cent) were diagnosed between the fifth and seventh decades of life. No trend towards a later onset of Ménière's disease was found (regression beta co-efficient for year of presentation was 0.03; 95 per cent confidence interval = −0.34–0.61; p = 0.58).

Ménière's disease has a peak incidence between 40 and 69 years of age. No shift towards a later onset age of Ménière's disease was found.

To determine whether the distribution of membrane lesions associated with Ménière's disease is random, as might be expected from a pervasive process such as hydrops, or orderly, as might be expected if membrane resistance is graded.

A meta-analysis of temporal bone reports on 184 specimens demonstrating endolymphatic hydrops was undertaken to determine membrane lesion evolution and distribution.

Lesion distribution was found to be orderly and cochleocentric. No random scattershot lesions were reported in any study. Disease always started in the cochlear apex, even in non-symptomatic cases, and then involved the saccule, utricle, ampullae and canal system in that precise sequence as the disease progressed.

The orderly lesion progression in the otopathology associated with Ménière's disease suggests that the hydropic process has a graded non-random effect on the labyrinth. These findings suggest a pathological staging system that may be useful in temporal bone evaluation.

To assess the epidemiology of vestibular vertigo, including the new entity of vestibular migraine, in a neuro-otology clinic population in the biggest public hospital in Thailand.

A prospective study involving all patients presenting to the neuro-otology clinic in the Rajavithi Hospital in Bangkok between November 2007 and November 2008.

The population studied consisted of adults referred to the neuro-otology clinic. Accepted international criteria and standardised otological and, when necessary, psychiatric assessment were applied to establish each diagnosis. The association between diagnoses and potential triggers was explored.

Of the 167 patients assessed, the most prevalent conditions encountered were benign paroxysmal positional vertigo and vestibular migraine. The prevalence of vestibular migraine was 29.3 per cent. No cases of Ménière's disease were encountered. An association was found between vestibular migraine and inadequate sleep, insomnia and changes of head position.

This study provides current data on the epidemiology of vestibular vertigo in a Thai neuro-otology out-patient population. The results include data on the prevalence of the new diagnostic entity of vestibular migraine, and on its association with potential triggers.

Cochlear implantation has been used to rehabilitate profoundly deafened adults for more than 25 years. However, surgical labyrinthectomy is often considered a contraindication to cochlear implantation, especially if there is a significant delay between the two procedures. As the role of cochlear implantation continues to expand, this idea requires reconsideration.

A 59-year-old woman presented to our clinic after undergoing bilateral surgical labyrinthectomies for intractable Ménière's disease 21 years prior. Despite the significant time delay, she underwent cochlear implantation with a good audiological outcome and improved quality of life.

Changes to the cochlea and vestibule following surgical labyrinthectomy include cochlear ossification and obliteration of the vestibule. These issues have been thought to limit the potential for cochlear implantation, especially when there is a significant delay between the two procedures. However, delayed cochlear implantation, even decades after labyrinthectomy, remains a viable treatment option which can benefit selected patients.

Transtympanic administration of gentamicin may be suitable to achieve unilateral vestibular ablation, in order to control unilateral Ménière's disease. In low doses, gentamicin appears to affect selectively the vestibular system, with relative sparing of the cochlea. An experimental study on guinea pigs was conducted to determine what single dose of gentamicin would produce a unilateral vestibular organ lesion when applied to the middle ear.

Experimental and prospective.

Four groups of guinea pigs received different gentamicin doses (1, 5, 10 and 25 mg) administered to the middle ear. The animals' vestibular organs were then assessed by scanning electron microscopy, in order to quantify the level of vestibular damage.

Study of the utricular macula and the ampullar crista of the lateral semicircular canal revealed vestibular neuroepithelial lesions in all infused ears.

The severity of the vestibular neuroepithelial lesions was dose-dependent. Lower gentamicin doses were observed to damage vestibular structures more than cochlear structures.

In recent years, techniques such as computerised dynamic posturography have facilitated objective evaluation of patients with balance disorders. In this study, we used computerised dynamic posturography for clinical staging of Ménière's disease.

We applied a computerised dynamic posturography sensory organisation test to 53 patients with American Academy of Otolaryngology criteria of Ménière's disease. The following parameters were considered in data analysis: computerised dynamic posturography scores for testing the patient's centre of gravity with a mobile surface, immobile visual surroundings and eyes closed, scores for testing with a mobile surface, mobile visual surroundings and eyes open, and vestibular ratio. We used four hearing threshold stages (although we had no patients at stage four).

This study did not observe a statistically significant correlation between audiometric hearing thresholds and computerised dynamic posturography scores. Computerised dynamic posturography scores showed statistically significant variation with time elapsed since the last vertigo attack. Although our results showed an increasing trend in computerised dynamic posturography scores as Ménière's disease activity level decreased from recent post-attack (i.e. less than one week since last attack) through late post-attack (i.e. one week to 60 days since last attack) to inactive (i.e. more than 60 days since last attack), these differences were not statistically significant.

To present the theory that large vestibular aqueduct syndrome (i.e. the recognised existence of an enlarged vestibular aqueduct with progressive sensorineural hearing loss) and endolymphatic hydrops are due to a common primary dysfunction of inner-ear fluid homeostasis.

Case report and review of the world literature concerning large vestibular aqueduct syndrome and endolymphatic hydrops.

We report a family in which one sibling suffered from large vestibular aqueduct syndrome while the other had classic Ménière's disease. This suggests that large vestibular aqueduct syndrome and endolymphatic hydrops, in some cases, may be due to a common primary dysfunction of inner-ear fluid homeostasis.

To our knowledge, this is the first report in the world literature to postulate that variation in the relative compliance of inner-ear membranes could be the factor that determines the manifestation of the disorder as either endolymphatic hydrops or large vestibular aqueduct syndrome.

To evaluate hearing results following intratympanic gentamicin perfusion in patients with Ménière's disease.

Middle-ear perfusion of 0.4 ml of gentamicin 40 mg/ml solution was performed in Ménière's disease patients who had previously failed to respond to other medical treatment.

Between May 1999 and November 2005, 22 patients (mean age 58.5 years) underwent intratympanic gentamicin perfusion. Mean follow up was 30 months. At the first post-perfusion visit (four to six weeks following perfusion), three of the 22 patients (13.63 per cent) had a pure tone average improvement of at least 10 dB, 15 (68.18 per cent) showed no change and four (18.18 per cent) demonstrated a decrease in hearing of more than 10 dB. Regarding speech discrimination scores, one patient (4.54 per cent) exhibited an improvement of at least 15 per cent, 15 (68.18 per cent) showed no change and six (27.27 per cent) showed a decrease of at least 15 per cent. After long-term follow up (12–40 months following perfusion), 10 patients (45.45 per cent) showed stable hearing, and 12 (54.54 per cent) exhibited a pure tone average decrease of more than 10 dB. Six patients (27.27 per cent) showed a speech discrimination score decrease of at least 15 per cent, while 16 (72.72 per cent) had no change. Complete cessation of vertigo was reported by 20 of the 22 patients (90.9 per cent), while two (9.09 per cent) reported episodic vertigo spells.

Intratympanic gentamicin perfusion provides effective control of vertigo in patients with Ménière's disease. However, significant hearing loss may occur immediately after perfusion; therefore, this treatment should be considered only for patients whose hearing has already been affected by the disease.

To highlight a case of spontaneous intracranial hypotension presenting to the ENT surgeon.

We present a case report and a review of the literature concerning spontaneous intracranial hypotension.

Spontaneous intracranial hypotension is a rare diagnosis, particularly to the ENT surgeon. We report a patient with tinnitus, hearing loss and headache, symptoms suggestive of an ENT diagnosis such as Ménière's disease or vestibular schwannoma. However, magnetic resonance imaging revealed the characteristic findings of spontaneous intracranial hypotension. The patient's symptoms resolved, except for a mild residual tinnitus, with conservative management alone.

This case highlights the importance of considering spontaneous intracranial hypotension as a differential diagnosis of certain ENT symptoms.

To assess the long term outcome of gentamicin inner-ear perfusion using the Silverstein MicroWick™ in the treatment of Ménière's disease.

Retrospective questionnaire survey of patients and review of medical records.

A district general hospital.

All 15 patients who completed a minimum follow up of at least 24 months were included.

Subjective symptoms, change in hearing thresholds and Glasgow benefit inventory scores.

Based on the American Association of Otolaryngology-Head and Neck Surgery (1995) guidelines for reporting, 80 per cent of respondents obtained class A vertigo control and 20 per cent obtained class B control. Respondents' functional level improved from pre-operative levels of between three and six to post-operative levels of between one and three. Three respondents had pre-operative ‘dead ears’ and one developed the condition post-operatively. Hearing deteriorated further in three respondents, improved in two and remained unchanged in the rest. Respondents with class A control demonstrated improved quality of life, with a mean Glasgow benefit inventory total score of +34.

Transtympanic gentamicin therapy via the Silverstein MicroWick results in good vertigo control. Patients should however be made fully aware of the risk of hearing deterioration.

Dizziness is a common presenting complaint in primary healthcare. One differential diagnosis is Ménière's disease. The UK National Health Service ‘Prodigy’ guidelines have been produced to help healthcare professionals to diagnose and manage Ménière's disease. The aim of this audit was to consider how Ménière's disease is managed in general practice, and to assess how well general practitioners adhere to the Prodigy guidelines.

We identified general practices near the Torbay region of south Devon which had a ‘TQ’ postcode. There were 41 practices, staffed by a total of 203 general practitioners. We wrote to each general practitioner, asking them to fill in a questionnaire regarding Ménière's disease. Our practice response rate was 68 per cent and our individual rate 43 per cent.

The mean correct answer rate was >50 per cent. The respondents achieved this despite few being aware of any formal guidelines, and none being aware of the Prodigy guidelines.

Detailed knowledge of Ménière's disease was uncommon, and formal guidelines were not frequently consulted.