The etiopathogenesis of Meniere's disease has remained controversial since the early 1900s. Many investigators have studied the histopathology of the inner ear in patients with this disorder. Three basic pathologic mechanisms have emerged: fibrosis of the endolymphatic sac and vestibular epithelia, altered glycoprotein metabolism, and inner ear viral infection. This article reviews the current understanding of these three basic pathologic processes.
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References
1.
HallpikeCSCairnsH. Observations on the pathology of Meniere's syndromeJ Laryngol Otol1938;53:625–55
2.
YamakawaY. über pathologische Veränderung bei einem Meniere-KrankenJ Otorhinolaryngol Soc Jpn1938;44:2310–2
3.
ArenbergIKMarovitzWFShambaughGE. The role of the endolymphatic sac in the pathogenesis of endolymphatic hydrops in manActa Otolaryngol1970;suppl 275:1–49
4.
ArenbergIKNorbackDHShambaughGE. Distribution and density of subepithelial collagen in the endolymphatic sac in patients with Meniere's diseaseAm J Otol1985;6:449–54
LimDJGlasscockME. Fine morphology of the endolymphatic sac in Meniere's disease In: VosteenK-HSchuknechtHPfaltzCR, eds. Meniere's disease. Pathogenesis, diagnosis and treatment.New York: Georg Thieme Verlag, 1981:115–27
7.
SchindlerRA. The ultrastructure of the endolymphatic sac in manLaryngoscope1980;suppl 21:1–39
8.
YasawaYKitaharaM. Electron microscopic studies of the endolymphatic sac in Meniere's diseaseORL J Otorhinolaryngol Relat Spec1981;43:121–30
9.
NorbackDHArenbergIK. The endolymphatic sac in Meniere's disease: An ultrastructural analysisAnat Rec1979;193:752–3
10.
KimuraRSSchuknechtHF. Membranous hydrops in the inner ear of the guinea pig after obliteration of the endolymphatic sacPract Oto-Rhino-Laryngol1965;27:343–53
11.
Rask-AndersenHFribergUBagger-SjöbäckD. The ultrastructure of the human endolymphatic ductActa Otolaryngol (Stockh)1984;suppl 406:61–6
12.
FribergURask-AndersenHBagger-SjöbäckD. Human endolymphatic duct: An ultrastructural studyArch Otolaryngol1984;110:421–8
13.
Bagger-SjöbäckDFribergURask-AndersenH. Human endolymphatic sac: An ultrastructural studyArch Otolaryngol Head Neck Surg1986;112:398–409
14.
WackymPAFribergUBagger-SjöbäckDRask-AndersenH. Human endolymphatic duct: Possible mechanisms of endolymph outflowAnn Otol Rhinol Laryngol1986;95:409–14
15.
WackymPAFribergUBagger-SjöbäckDLinthicumFHFriedmannIRask-AndersenH. Human endolymphatic sac: Possible mechanisms of pressure regulationJ Laryngol Otol1987;101:768–79
16.
WackymPAFribergULinthicumFH. Human endolymphatic sac: Morphologic evidence of immunologic functionAnn Otol Rhinol Laryngol1987;96:276–81
17.
WackymPALinthicumFHWardPHHouseWFMicevychPEBagger-SjöbäckD. Re-evaluation of the role of the human endolymphatic sac in Meniere's diseaseOtolaryngol Head Neck Surg1990;102:732–44
18.
LindsayJR. Labyrinthine dropsy and Ménière's diseaseArch Otolaryngol1942;35:853–67
LindsayJR. Pathology. Symposium: Meniere's diseaseTrans Am Acad Ophth Otolaryngol1956;60:172–6
21.
LindsayJR. Effect of obliteration of the endolymphatic sac and duct in the monkeyArch Otolaryngol1947;45:1–13
22.
ShambaughGEJr. Surgery of the endolymphatic sacArch Otolaryngol1966;83:29–39
23.
SandoIIkedaM. The vestibular aqueduct in patients with Meniere's disease: A temporal bone histopathological investigationActa Otolaryngol1984;97:558–70
24.
SandoIIkedaM. Pneumatization and thickness of the petrous bone in patients with Meniere's disease. A histopathological studyAnn Otol Rhinol Laryngol1985;suppl 118:2–5
25.
IkedaMSandoI. Vascularity of endolymphatic sac in Meniere's disease. A histopathological studyAnn Otol Rhinol Laryngol1985;suppl 118:6–10
26.
IkedaMSandoI. Paravestibular canaliculus in Meniere's disease. A histopathological studyAnn Otol Rhinol Laryngol1985;suppl 118:11–6
27.
IkedaMSandoI. The endolymphatic duct and sac in patients with Meniere's disease. A temporal bone histopathological investigationAnn Otol Rhinol Laryngol1984;93:540–6
28.
AltmannFFowlerEP. Histological findings in Meniere's symptom complexAnn Otol Rhinol Laryngol1943;52:52–80
29.
AltmannFZechnerG. The pathology and pathogenesis of endolymphatic hydropsArch Ohren Näsen Kehlkopfheilkd1968;192:1–19
30.
WackymPASchuknechtHFWardPHLinthicumFHJrKernerMMAframianDBellTS. Blinded, controlled study of endolymphatic duct and sac fibrosis in Ménière's disease In: FilipoRBarbaraM, eds. Ménière's disease: perspectives in the 90's.Amsterdam: Kugler Publications, 1994:209–15
31.
QuijanoMLSchuknechtHFBradleyDH. The incidence of fibrosis in the vestibular ganglia in Meniere's diseaseArch Otorhinolaryngol1988;245:133–5
32.
Bagger-SjöbäckDFribergURask-AndersenH. The human endolymphatic duct and sac: An ultrastructural investigation under normal and pathological conditions In: NadolJB, ed. Ménière's disease.Amsterdam: Kugler and Ghedini Publications, 1989:75–80
33.
Fitzgerald-O'ConnorAFBagger-SjöbäckDFribergURask-AndersenH. Basal lamina pathology of the utricle and endolymphatic duct in Ménière's diseaseORL J Otorhinolaryngol Relat Spec1985;47:288–93
34.
FribergUWackymPABagger-SjöbäckDRask-AndersenH. Effect of labyrinthectomy on the endolymphatic sac. A histological, ultrastructural and computer-aided morphometric investigation in the mouseActa Otolaryngol (Stockh)1986;101:172–82
35.
ErwallCFribergUBagger-SjöbäckDRask-AndersenH. Degradation of the homogeneous substance in the endolymphatic sacActa Otolaryngol (Stockh)1988;105:209–17
36.
TakumidaMBagger-SjöbäckDRask-AndersenH. Cytochemical identification of secreted carbohydrates in the endolymphatic sacActa Otolaryngol (Stockh)1988;106:417–27
37.
TakumidaMBagger-SjöbäckDRask-AndersenH. Ruthenium red staining of the endolymphatic sac in the guinea pigJ Laryngol Otol1988;102:760–5
38.
HebbarGKRask-AndersenHLinthicumFH. Three-dimensional analysis of 61 human endolymphatic ducts and sacs in ears with and without Meniere's diseaseAnn Otol Rhinol Laryngol1991;100:219–25
39.
PalvaTHortlingLYlikoskiJCollanY. Viral culture and electron microscopy of ganglion cells in Meniere's disease and Bell's palsyActa Otolaryngol (Stockh)1978;86:269–75
40.
PodvinecMUlrichJPfaltzCR. Neuropathic findings in Bell's palsy In: GrahamMDHouseWF, eds. Disorders of the facial nerve.New York: Raven Press, 1982:207–20
41.
ArenbergIKWalkerDWShambaughGEJr. The role of the endolymphatic sac and viruses in the pathogenesis of endolymphatic hydrops: An ultrastructural analysis of endolymphatic sac biopsies In: ArenbergIK, ed. Surgery of the inner ear. Proceedings of the Third International Symposium and Workshops on the Surgery of the Inner Ear.Amsterdam: Kugler Publications, 1991:31–52
42.
WackymPAStorperISFuY-SHouseWFWardPH. Differential diagnosis of virus-like particles in the human inner earAm J Otol1992;13:431–7
43.
DavisLEJohnssonL-G. Viral infections of the inner ear: Clinical, virologic, and pathologic studies in humans and animalsAm J Otolaryngol1983;4:347–62
44.
FukudaSKeithleyEMHarrisJP. Experimental cytomegalovirus infection: Viremic spread to the inner earAm J Otolaryngol1988;9:135–41
45.
WackymPAPopperPKernerMMGrodyWW. Varicellazoster DNA in temporal bones of patients with Ramsay Hunt syndromeLancet1993;342:1555
46.
WellingDBDanielsRLBrainardJWesternLMPriorTW. Detection of viral DNA in endolymphatic sac tissue from Meniere's disease patientsAm J Otol1994;15:639–43