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Laryngorhinootologie 2015; 94(08): 530-554
DOI: 10.1055/s-0035-1555808
Facharztwissen-HNO
© Georg Thieme Verlag KG Stuttgart · New York

Morbus Menière

Menière’s Disease
S. K. Plontke
,
R. Gürkov
Further Information

Publication History

Publication Date:
04 August 2015 (online)

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Zusammenfassung

Der Morbus Menière ist eine der häufigsten Innenohrerkrankungen und Schwindelsyndrome. Er ist definiert als das idiopathische Syndrom des endolymphatischen Hydrops. Dieser kann spontan auftreten und ist dann vermutlich durch eine Kombination verschiedener interner und externer prädisponierender Faktoren bedingt. Ein endolymphatischer Hydrops kann sich aber auch im Gefolge spezifischer Erkrankungen mit Innenohrschädigungen finden (z. B. beim Vestibularisschwannom). In den letzten Jahren wurden große Fortschritte bei der Diagnostik des Morbus Menière erreicht, allen voran die Möglichkeit, den endolymphatischen Hydrops am Patienten mittels MRT-Untersuchung zu visualisieren. Die therapeutischen Versuche sind aktuell – mit Ausnahme der ablativen Verfahren – noch immer mit Unsicherheiten behaftet. In dieser Übersicht werden bewährte Konzepte und aktuelle Ansätze in der Pathophysiologie, Diagnostik und Therapie auch unter dem Aspekt der evidenzbasierten Medizin erläutert.

Abstract

Menière`s disease is one of the most common inner ear and vestibular disorders. It is defined as the idiopathic syndrome of endolymphatic hydrops (ELH). Despite the development of several different animal models of ELH, its etiology and pathogenesis is still unresolved. In humans, endolymphatic hydrops may occur spontaneously or as a consequence of specific disorders with distinct inner ear pathologies, e. g., infectious labyrinthitis, noise induced hearing loss or vestibular schwannoma. Recent imaging studies using MRI have shown that hydropic ear disease is associated not only with the full triad of vertigo, hearing, loss and tinnitus/aural pressure, but also with inner ear symptoms that do not fulfill the clinical criteria of definite Menière’s disease as set forth by the AAO-HNS. Therefore, terms like “atypical” or “cochlear”/“vestibular” Menière’s disease or “forme fruste” should be avoided and the term “Menière’s disease” should universally be applied according only to these guidelines. Besides that, the recent possibility of visualizing endolymphatic hydrops on MRI and thereby ascertaining the diagnosis in difficult cases and new audiovestibular function tests for the indirect detection of endolymphatic hydrops show promising results. Evidenced based reviews of currently available therapeutic options still reveal many uncertainties with regard to efficacy, with the exception of the ablative therapies, e. g., intratympanic gentamicin application.

 

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