An essay on the pathology and treatment of Ménière's disease

Abstract

Since his original papers appeared Ménière's name has come to be attached somehwat loosely to a variety of clinical conditions presenting the syndrome of vertigo, tinnitus and deafness. In some of these, signs and symptoms of cochlear and vestibular upset are clearly recognizable as being due to inflammatory, neoplastic or other processes involving the labyrinth, the eighth nerve, or its central connections. With these excluded, however, there still remains a considerable group in which these signs and symptoms present certain recognizable peculiarities in their mode of onset, character and clinical course. The papers of Crowe (1938) and of Wright (1937) did much to clarify our views on the clinical identification of this group of subjects. Both of these authors were agreed in attributing the condition to a specific variety of labyrinthine disease, and their views were strongly supported by the publication in 1938 and subsequently by Hallpike in association with Cairns Wright (1940) and Harrison (1954) of the histological findings in the temporal bones of four cases of this kind. In all, the affected labyrinth was found to be the seat of certain peculiar changes indicative of an obstructive distention of the endolymph system. These findings have since been confirmed by several other authors and it is now possible to regard these investigations as having established the morphological basis of a disease sui generis of the labyrinth.According to modern views based upon these clinical and pathological studies, the term 'Méniére's disease' should be reserved for this particular group of cases readily recognizable as a clinical entity and presenting within the labyrinth the specific type of morbid change indicative of endolymphatic distention.