Abstract
Ménière’s disease (MD) is a debilitating disorder with unclear pathophysiology whose diagnosis often relies on clinical judgment rather than objective testing. To complicate matters further, a dissociation has emerged between two vestibular function tests commonly used in patients with MD to examine the same end-organ (the semicircular canals): the caloric test and video head impulse testing (vHIT). Caloric responses are often abnormal, while vHIT results remain normal. Explaining this dissociation could reveal novel insights into MD pathophysiology. Here, we conduct a histopathological study using temporal bone specimens (N = 58, 21 MD-affected ears and 37 age-matched controls) and their clinical testing data to examine current hypotheses aimed at this dissociation. We find otolith membrane herniation into the horizontal semicircular canal in 69% of MD ears, with 90% of these ears demonstrating a diminished caloric response. No ears with a normal response had this herniation. Moreover, we evaluated the semicircular canals for endolymphatic hydrops, which had been hypothesized to contribute to the dissociation, and found no evidence of duct dilation/hydrops. We did, however, note a potentially novel morphologic finding—smaller bony labyrinth cross-sectional diameters/areas in some MD ear canals compared to controls, suggesting relative size of the membranous duct to the bony canal rather than absolute size may be of importance. Taken together, this study refines hypotheses on the vestibular test dissociation in MD, holding diagnostic implications and expanding our understanding of the mechanisms underlying this enigmatic disease.
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Funding
National Institutes of Health K23DC018302 (B.K.W); Hearing Health Foundation (B.K.W); Robert and Kate Niehaus Foundation (B.K.W.); National Institutes of Health – National Institute on Deafness and Other Communication Disorders grant 2T32DC000027 (N.S.A., J.P.C); National Institutes of Health grant T32000027 (A.M.L.); David M. Rubenstein Fund for Hearing Research (A.M.L.); National Institutes of Health grant R01 DC006685 (R.D.R.); National Institute on Deafness and Other Communication Disorders National Temporal Bone, Hearing and Balance Pathology Registry Resource U24DC013983-01 (F.S.); National Institute on Deafness and Other Communication Disorders U24DC020850 (B.K.W., A.M.L., J.P.C.)
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Conceptualization: LLS, NSA, JMP, JPC, BKW; Methodology: LLS, NSA, BKW, JMP, RDR, JPC; Formal analysis: LLS; Investigation: LLS, NSA; Visualization: LLS, JPC, BKW; Resources: DAC, FS, AML; Supervision: BKW; Writing—original draft: LLS; Writing—review & editing: LLS, NSA, DAC, JMP, AML, RDR, JPC, FS, BKW.
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Shen, L.L., Andresen, N.S., Chari, D.A. et al. Otolith Membrane Herniation, not Semicircular Canal Duct Dilation, Is Associated with Decreased Caloric Responses in Ménière’s Disease. JARO 24, 95–106 (2023). https://doi.org/10.1007/s10162-022-00883-x
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DOI: https://doi.org/10.1007/s10162-022-00883-x