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European Archives of Oto-Rhino-Laryngology

, Volume 272, Issue 1, pp 77–82 | Cite as

Chronic cerebrospinal venous insufficiency in patients with Ménière’s disease

  • R. Filipo
  • F. Ciciarello
  • G. Attanasio
  • P. Mancini
  • E. Covelli
  • L. Agati
  • F. Fedele
  • M. ViccaroEmail author
Otology

Abstract

To analyze the presence of chronic cerebrospinal venous insufficiency parameter and vascular abnormalities, in the internal jugular veins (IJVs) and/or vertebral veins in sitting and supine posture, in patients with Meniere’s disease compared to healthy general population. A prospective study on 32 patients affected by definite Ménière was performed from February 2012 to January 2013. All subjects underwent an echo-color Doppler examination of the cerebrospinal venous flow. 21 of the 32 Menieric patients showed a statistically significant reflux in the intracranial veins versus healthy (65.6 vs 25%; P < 0.001). A high prevalence of IJVs stenosis with hemodynamic changes (increased velocity or absence of flow) was observed (66.7 vs 33.3%; P < 0.05). The other parameters considered did not show statistically significant differences among the two groups. The results obtained showed a vascular pattern of cerebrospinal venous system present in patients affected by definite Meniere. This vascular impairment significantly affects the vascular areas more directly involved in the venous drainage of the inner ear. Thus venous stasis may be considered a further pathogenetic mechanism for development of Meniere’s disease.

Keywords

Ménière’s disease CCSVI 

Notes

Acknowledgments

The authors have no financial disclosures.

Conflict of interest

None.

References

  1. 1.
    Radtke A, von Brevern M, Feldmann M, Lezius F, Lempert T, Ziese T, Neuhauser H (2008) Screening for Meniere’s disease in the general population—the needle in the haystack. Acta Otolaryngol 128:272–276PubMedCrossRefGoogle Scholar
  2. 2.
    Harrys JP, Alexander TH (2010) Current-day prevalence of Meniere’s Syndrome. Audiol Neurotol 15:318–322CrossRefGoogle Scholar
  3. 3.
    (1995) Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg, 113:181–185Google Scholar
  4. 4.
    Shambaugh GE Jr (1966) Surgery of the endolymphatic sac. Arch Otolaryngol 83(4):305–315PubMedCrossRefGoogle Scholar
  5. 5.
    Williams HL Jr (1965) A review of the literature as to the physiologic dysfunction of Meniere’s disease: a new hypothesis as to its fundamental cause. Laryngoscope 75(11):1661–1689PubMedCrossRefGoogle Scholar
  6. 6.
    Godlowski Z (1972) Hyperosmosis of endolymph as primary pathogenic mechanism of Meniere’s Disease and its clinical management. Acta Otolaryngol Suppl 299:1–36PubMedGoogle Scholar
  7. 7.
    Coelho DH, Roland JT Jr, Golfinos JG (2008) Posterior fossa meningiomas presenting with Ménière’s-like symptoms: case report. Neurosurgery 63(5):E1001. doi: 10.1227/01.NEU.0000327883.36668.B4 (discussion E1001)PubMedCrossRefGoogle Scholar
  8. 8.
    Couloigner V, Grayeli AB, Bouccara D, Julien N, Sterkers O (1999) Surgical treatment of the high jugular bulb in patients with Ménière’s disease and pulsatile tinnitus. Eur Arch Otorhinolaryngol 256(5):224–229PubMedCrossRefGoogle Scholar
  9. 9.
    Axelsson A (1988) Comparative anatomy of cochlear blood vessels. Am J Otolaryngol 9(6):278–290PubMedCrossRefGoogle Scholar
  10. 10.
    Mazzoni A (1990) The vascular anatomy of the vestibular labyrinth in man. Acta Otolaryngol Suppl 472:1–83 (Review)PubMedCrossRefGoogle Scholar
  11. 11.
    Zamboni P (2006) The big idea: iron-dependent inflammation in venous disease and proposed parallels in multiple sclerosis. J R Soc Med 99(11):589–593PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Diaconu CI, Conway D, Fox RJ, Rae-Grant A (2012) Chronic cerebrospinal venous insufficiency as a cause of multiple sclerosis: controversy and reality. Curr Treat Options Cardiovasc Med 14(2):203–214PubMedCrossRefGoogle Scholar
  13. 13.
    Zamboni P, Galeotti R, Menegatti E (2009) Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Phychiatry 80:392–399CrossRefGoogle Scholar
  14. 14.
    Valdueza JM, Doepp F, Schreiber SJ, van Oosten BW, Schmierer K, Paul F (2013) What went wrong? The flawed concept of cerebrospinal venous insufficiency. J Cereb Blood Flow Metab 33(5):657–668. doi: 10.1038/jcbfm.2013.31 PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Comi G, Battaglia M, Bertolotto A, Sette MD, Ghezzi A, Malferrari G, Salvetti M, Sormani M, Tesio L, Stolz E, Zaratin P, Mancardi G; the CoSMo Collaborative Study Group (2013) Observational case-control study of the prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: results from the CoSMo study. Mult Scler, [Epub ahead of print]Google Scholar
  16. 16.
    Zamboni P, Morovic S, Menegatti E, Viselner G, Nicolaides AN (2011) Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound—recommendations for a protocol. Int Angiol 30(6):571–597PubMedGoogle Scholar
  17. 17.
    Ciccone MM, Galeandro AI, Scicchitano P, Zito A, Gesualdo M, Sassara M, Cortese F, Dachille A, Carbonara R, Federico F, Livrea P, Trojano M (2012) Multigate quality Doppler profiles and morphological/hemodynamic alterations in multiple sclerosis patients. Curr Neurovasc Res 9(2):120–127PubMedCrossRefGoogle Scholar
  18. 18.
    Valdueza JM, Schmierer K, Mehraein S, Einhaupl KM (1996) Assessment of normal flow velocity in basal cerebral veins. A transcranial Doppler ultrasound study. Stroke 27:1221–1225PubMedCrossRefGoogle Scholar
  19. 19.
    Lepori D, Capasso P, Fournier D, Genton CY, Schnyder P (1999) High-resolution ultrasound evaluation of internal jugular venous valves. Eur Radiol 9:1222–1226PubMedCrossRefGoogle Scholar
  20. 20.
    Radak D, Kolar J, Tanaskovic S, Sagic D, Antonic Z, Mitrasinovic A, Babic S, Nenezic D, Ilijevski N (2012) Morphological and hemodynamic abnormalities in the jugular veins of patients with multiple sclerosis. Phlebology 27(4):168–172. doi: 10.1258/phleb.2011.011004 (Epub 2011 Sep 8)PubMedCrossRefGoogle Scholar
  21. 21.
    Simka M, Kostecki J, Zaniewski M, Majewski E, Hartel M (2010) Extracranial Doppler sonographic criteria of chronic cerebrospinal venous insufficiency in the patients with multiple sclerosis. Int Angiol 29(2):109–114PubMedGoogle Scholar
  22. 22.
    Nicolaides AN, Morovic S, Menegatti E, Viselner G, Zamboni P (2011) Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound: recommendations for a protocol. Funct Neurol 26(4):229–248PubMedCentralPubMedGoogle Scholar
  23. 23.
    Laupacis A, Lillie E, Dueck A, Straus S, Perrier L, Burton JM, Aviv R, Thorpe K, Feasby T, Spears J (2011) Association between chronic cerebrospinal venous insufficiency and multiple sclerosis: a meta-analysis. CMAJ 183(16):E1203–E1212. doi: 10.1503/cmaj.111074 (Epub 2011 Oct 3)PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Salt AN, Plontke SK (2010) Endolymphatic hydrops: pathophysiology and experimental models. Otolaryngol Clin N Am 43(5):971–983. doi: 10.1016/j.otc.2010.05.007 (Review)CrossRefGoogle Scholar
  25. 25.
    Gibson WPR, Kaufmann Arenberg I (1991) The circulation of endolymph and a new theory of the attacks occurring in Ménière’s disease. In: Kaufmann AI (ed) Inner ear surgery. Kugler Publications, The Hague, pp 17–23Google Scholar
  26. 26.
    Friedman RA, Ryan AF (1999) The molecular mechanism and genetics of Meniere disease. In: Harris JP (ed) Meniere’s disease. Kugler Pubblications, The Hague, pp 356–369Google Scholar
  27. 27.
    Takeda T, Takeda S, Kakigi A, Okada T, Nishioka R, Taguchi D, Nishimura M, Nakatani H (2010) Hormonal aspects of Ménière’s disease on the basis of clinical and experimental studies. ORL J Otorhinolaryngol Relat Spec 71(Suppl 1):1–9 (Epub 2010 Feb 24)PubMedGoogle Scholar
  28. 28.
    van Cruijsen N, Jaspers JP, van de Wiel HB, Wit HP, Albers FW (2006) Psychological assessment of patients with Menière’s disease. Int J Audiol 45(9):496–502PubMedCrossRefGoogle Scholar
  29. 29.
    McCabe BF (1979) Autoimmune sensorineural hearing loss. Ann Otol Rhinol Laryngol 88(5 Pt 1):585–589PubMedCrossRefGoogle Scholar
  30. 30.
    Nicolaides AN (2005) Chronic venous disease and the leukocyte-endothelium interaction: from symptoms to ulceration. Angiology 56(Suppl 1):S11–S19 (Review)PubMedCrossRefGoogle Scholar
  31. 31.
    Masutani H, Takahashi H, Sando I (1992) Stria vascularis in Mèniere’s disease: a qualitative histopathological study. Auris Nasus Larynx 19(3):145–152PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • R. Filipo
    • 2
  • F. Ciciarello
    • 1
  • G. Attanasio
    • 2
  • P. Mancini
    • 2
  • E. Covelli
    • 2
  • L. Agati
    • 1
  • F. Fedele
    • 1
  • M. Viccaro
    • 2
    Email author
  1. 1.Department of Cardiovascular, Respiratory, Geriatric and Morphologic Sciences, Umberto I Polyclinic of Rome“Sapienza” UniversityRomeItaly
  2. 2.Department of Sensory Organs, Umberto I Polyclinic of Rome“Sapienza” UniversityRomeItaly

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