Journal of Neurology

, Volume 264, Supplement 1, pp 48–54 | Cite as

Do patients with Ménière’s disease have attacks of syncope?

  • Ilmari Pyykkö
  • Vinaya Manchaiah
  • Jing Zou
  • Hilla Levo
  • Erna Kentala
Original communication

Abstract

The aim of the present study was to evaluate the prevalence and associated factors for syncope among patients with Ménière’s disease (MD). An attack of syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously and without a localizing neurological deficit. The study used an across-sectional survey design. Information from a database consisting of 961 individuals was collected from the Finnish Ménière Association. The data contained case histories, general health-related quality of life (HRQoL), and impact measurements of the complaints. In the current study sample, syncope occurred in 12.3% of the patients with MD. It was more prevalent among elderly persons and among those with a longer duration of MD. Syncope was significantly associated with disturbances of otolith function reflected as Tumarkin attacks, gait and balance problems, environmental change of pressure, and physical strain. It was also associated with visual blurring; in fact, patients with otolith dysfunction in MD often experience visual field changes. It was also associated with headache, but not with migraine. Syncope was experienced as frightening and HRQoL was significantly worsened. The patient had higher anxiety scores, and suffered more from fatigue. The results demonstrate that neurally mediated syncope occurs in patients with an advanced form of MD who suffer from Tumarkin attacks due to failure in otolith function. The mechanism seems to be triggered through the vestibular sympathetic reflex when the otolith system fails due to disrupted utricular otolithic membrane mediate erroneous positional information from the otolith organ to the vasomotor centres in the brain stem and medulla.

Keywords

Ménière’s disease Tumarkin attacks Drop attack Fainting vestibular disorder Otolith organ Syncope 

References

  1. 1.
    Kenny RA, Brignole M, Dan GA, Deharo JC, van Dijk JG, Doherty C, Hamdan M, Moya A, Parry SW, Sutton R, Ungar A, Wieling W (2015) Syncope Unit: rationale and requirement—the European Heart Rhythm Association position statement endorsed by the Heart Rhythm Society. Europace 17(9):1325–1340. doi:10.1093/europace/euv115 CrossRefPubMedGoogle Scholar
  2. 2.
    Thiruganasambandamoorthy V, Sheldon R (2015) Syncope confusion. CMAJ 187(7):521. doi:10.1503/cmaj.115-0030 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Sheldon RS, Morillo CA, Krahn AD et al (2011) Standardized approaches to the investigation of syncope: Canadian Cardiovascular Society position paper. Can J Cardiol 27:246–253CrossRefPubMedGoogle Scholar
  4. 4.
    Moya A, Sutton R, Ammirati F et al (2009) Guidelines for the diagnosis and management of syncope. Eur Heart J 30:2631–2671CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Berecki-Gisolf J, Sheldon A, Wieling W, van Dijk N, Costantino G, Furlan R, Shen WK, Sheldon R (2013) Identifying cardiac syncope based on clinical history: a literature-based model tested in four independent datasets. PLoS One 8(9):e75255. doi:10.1371/journal.pone.0075255 (eCollection 2013) CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    O’Mahony D, Foote C (1998) Prospective evaluation of unexplained syncope, dizziness, and falls among community-dwelling elderly adults. J Gerontol A BiolSci Med Sci 53(6):M435–M440CrossRefGoogle Scholar
  7. 7.
    Hallgren E, Migeotte PF, Kornilova L, Delière Q, Fransen E, Glukhikh D, Moore ST, Clément G, Diedrich A, MacDougall H, Wuyts FL (2015) Dysfunctional vestibular system causes a blood pressure drop in astronauts returning from space. SciRep 5:17627. doi:10.1038/srep17627 Google Scholar
  8. 8.
    Raphan T, Cohen B, Xiang Y, Yakushin SB (2016) A model of blood pressure, heart rate, and vaso-vagal responses produced by vestibulo-sympathetic activation. Front Neurosci 10:96. doi:10.3389/fnins.2016.00096 PMID: 27065779 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Yates BJ, Bolton PS, Macefield VG (2014) Vestibulo-sympathetic responses. Compr Physiol 4:851–887CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Holstein GR, Friedrich VL Jr, Martinelli GP (2014) Projection neurons of the vestibulo-sympathetic reflex pathway. J Comp Neurol 522(9):2053–2074. doi:10.1002/cne.23517 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    McBride DW, Reis C, Frank E, Klebe DW, Zhang JH, Applegate R 2nd, Tang J (2016) An experimental model of vasovagal syncope induces cerebral hypoperfusion and fainting-like behavior in awake rats. PLoS One 11(9):e0163280. doi:10.1371/journal.pone.0163280 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kaufmann H, Biaggioni I, Voustianiouk A, Diedrich A, Costa F, Clarke R et al (2002) Vestibular control of sympathetic activity. An otolith-sympathetic reflex in humans. Exp Brain Res 143:463–469. doi:10.1007/s00221-002-1002-3 CrossRefPubMedGoogle Scholar
  13. 13.
    Kentala E, Havia M, Pyykkö I (2001) Short lasting drop attacks in Meniere’s disease. Otolaryngol Head Neck Surg 124:526–530CrossRefPubMedGoogle Scholar
  14. 14.
    Pyykkö I, Nakashima T, Yoshida Y, Zou J, Naganawa S (2013) Meniere’s disease: a reappraisal supported by a variable latency of symptoms and the MRI visualisation of endolymphatic hydrops. BMJ Open. doi:10.1136/bmjopen-2012-001555 (pii: e001555) PubMedPubMedCentralGoogle Scholar
  15. 15.
    Calzada AP, Lopez IA, Ishiyama G, Ishiyama A (2012) Otolithic membrane damage in patients with endolymphatichydrops and drop attacks. OtolNeurotol 33(9):1593–1598. doi:10.1097/MAO.0b013e318271c48b Google Scholar
  16. 16.
    Ishiyama G, Ishiyam A, Baloh RW (2003) Drop attacks and vertigo secondary to a non-meniere otologic cause. Arch Neurol 60:71–75CrossRefPubMedGoogle Scholar
  17. 17.
    Brandt T, Dieterich M (1993) Vestibular falls. J Vestib Res 3(1):3–14PubMedGoogle Scholar
  18. 18.
    Pyykkö I, Manchaiah V, Zou J, Levo H, Kentala E (2017) Vestibular syncope: a disorder associated with drop attack in Ménière’s disease. AurisNasus Larynx (Accepted)Google Scholar
  19. 19.
    Kentala E (1996) Characteristics of six otologic diseases involving vertigo. Am J Otol 17(6):883–892PubMedGoogle Scholar
  20. 20.
    Radtke A, Lempert T, von Brevern M, Feldmann M, Lezius F, Neuhauser H (2011) Prevalence and complications of orthostatic dizziness in the general population. ClinAuton Res 21(3):161–168. doi:10.1007/s10286-010-0114-2 Google Scholar
  21. 21.
    Rose KM, Eigenbrodt ML, Biga RL et al (2006) Orthostatic hypotension predicts mortality in middle-aged adults: the Atherosclerosis Risk In Communities (ARIC) Study. Circulation 114:630–636CrossRefPubMedGoogle Scholar
  22. 22.
    Cohen B, Yakushin SB, Holstein BR (2011) What does galvanic vestibular stimulation actually activate? Front Neurol 2:90. doi:10.3389/fneur.2011.00090 PubMedGoogle Scholar
  23. 23.
    Yakushin SB, Martinelli GP, Raphan T, Xiang Y, Holstein GR, Cohen B (2014) Vasovagal oscillations and vasovagal responses produced by the vestibulo-sympathetic reflex in the rat. Front Neurol 5:37. doi:10.3389/fneur.2014.00037 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kerman IA, Emanuel BA, Yates BJ (2000) Vestibular stimulation leads to distinct hemodynamic patterning. Am J Physiol Regul Integr Comp Physiol 279:R118–R125PubMedGoogle Scholar
  25. 25.
    Kerman IA, Yates BJ, McAllen RM (2000) Anatomic patterning in the expression of vestibulosympathetic reflexes. Am J Physiol Regul Integr Comp Physiol 279:R109–R117PubMedGoogle Scholar
  26. 26.
    Lewis T (1932) Vasovagal syncope and the carotid sinus mechanism. Br Med J 3723:873–876. doi:10.1136/bmj.1.3723.873 CrossRefGoogle Scholar
  27. 27.
    Raphan T, Cohen B, Xiang Y, Yakushin SB (2016) A model of blood pressure, heart rate, and vaso-vagal responses produced by vestibulo-sympathetic activation. Front Neurol 10:96. doi:10.3389/fnins.2016.00096 Google Scholar
  28. 28.
    Nowak L, Nowak FG, Janko S, Dorwarth U, Hoffmann E, Botzenhardt F (2007) Investigation of various types of neurocardiogenic response to head-up tilting by extended hemodynamic and neurohumoral monitoring. Pacing ClinElectrophysiol 30(5):623–630CrossRefGoogle Scholar
  29. 29.
    Yates BJ (1996) Vestibular influences on the autonomic nervous system. Ann NY AcadSci 781:458–473CrossRefGoogle Scholar
  30. 30.
    Xerri C, Barthélémy J, Harlay F, Borel L, Lacour M (1987) Neuronal coding of linear motion in the vestibular nuclei of the alert cat. I. Response characteristics to vertical otolith stimulation. Exp Brain Res 65:569–581. doi:10.1007/BF00235980 CrossRefPubMedGoogle Scholar
  31. 31.
    Viana LM, Bahmad F Jr, Rauch SD (2014) Intratympanic gentamicin as a treatment for drop attacks in patients with Meniere’s disease. Laryngoscope 124(9):2151–2154. doi:10.1002/lary.24716 CrossRefPubMedGoogle Scholar
  32. 32.
    Pyykkö I, Ishizaki H, Kaasinen S, Aalto H (1994) Intratympanic gentamicin in bilateral Meniere’s disease. Otolaryngol Head Neck Surg 110:162–167CrossRefPubMedGoogle Scholar
  33. 33.
    Fedorowski A, Melander O (2013) Syndromes of orthostatic intolerance: a hidden danger. J Intern Med 273(4):322–335. doi:10.1111/joim.12021 CrossRefPubMedGoogle Scholar
  34. 34.
    Aoki M, Burchill P, Yates B, Golding JF (2000) Gresty MA Graviceptive control of blood pressure in man. Arch Ital Biol 138(1):93–97PubMedGoogle Scholar
  35. 35.
    Hammam E, Kwok K, Macefield VG (2013) Modulation of muscle sympathetic nerve activity by low-frequency physiological activation of the vestibular utricle in awake humans. Exp Brain Res 230(1):137–142. doi:10.1007/s00221-013-3637-7 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Ilmari Pyykkö
    • 1
  • Vinaya Manchaiah
    • 2
    • 3
    • 4
    • 5
  • Jing Zou
    • 1
    • 6
  • Hilla Levo
    • 7
  • Erna Kentala
    • 7
  1. 1.Hearing and Balance Research Unit, Department of OtolaryngologyUniversity of TampereTampereFinland
  2. 2.Department of Speech and Hearing SciencesLamar UniversityBeaumontUSA
  3. 3.Department of Behavioral Science and Learning, Linnaeus Centre HEAD, Swedish Institute for Disability ResearchLinköping UniversityLinköpingSweden
  4. 4.Audiology IndiaMysoreIndia
  5. 5.Department of Speech and Hearing, School of Allied Health SciencesManipal UniversityKarnatakaIndia
  6. 6.Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head and Neck Surgery of Chinese PLA, Changhai HospitalSecond Military Medical UniversityShanghaiChina
  7. 7.Department of OtolaryngologyUniversity of HelsinkiHelsinkiFinland

Personalised recommendations