Endolenfatik Hidrops ve Ménière Hastalığı
Özet
Bu bölümde, iç kulağın membranöz labirentini etkileyen periferik vestibüler bir patoloji olan Ménière hastalığı ve temelindeki endolenfatik hidrops mekanizması incelenmektedir. Uluslararası güncel tanı sınıflamaları (Kesin ve Muhtemel) ışığında; epizodik vertigo, düşük-orta frekansları tutan dalgalı sensörinöral işitme kaybı, tinnitus ve kulakta dolgunluk hissinden oluşan klasik klinik tablo ile atipik varyantlar detaylandırılmaktadır. Bölümde hidrops gelişimine yol açan rüptür, iyon transport bozuklukları, drenaj aksaklıkları ve immünolojik/genetik etkenler gibi etiyopatogenetik süreçler ele alınmaktadır. Tanıda saf ses odyometrisi, elektrofizyolojik testler (ECochG, VEMP) ve 3T gadolinyumlu MRG yöntemlerinin yeri açıklanırken; klinik pratikte sıkça karışan vestibüler migren ile ayırıcı tanı kriterleri vurgulanmaktadır. Tedavi yaklaşımında diyet ve betahistin/diüretik tabanlı oral profilaksiden, akut atak yönetimine; dirençli olgularda uygulanan intratimpanik steroid (deksametazon) ve ablatif gentamisin tedavilerinden, cerrahi seçenekler (endolenfatik kese cerrahisi, labirentektomi) ve vestibüler rehabilitasyona uzanan basamaklı yönetim algoritmaları sunulmaktadır.
Referanslar
Paparella MM. The biography of Meniere's disease. Otolaryngologic Clinics of North America. 2010;43(5): 949-959.
Perez-Carpena P, Lopez-Escamez JA. Current understanding and clinical management of Meniere's disease: A systematic review. Seminars in Neurology. 2020;40(1): 138-150. doi:10.1055/s-0039-3402065
Sajjadi H, Paparella MM. Meniere's disease. The Lancet. 2008;372(9636): 406-414.
Strupp M, Lopez-Escamez JA, Kim JS, et al. Meniere's disease: Diagnostic criteria. Journal of Vestibular Research. 2015;25(5-6): 199-206.
Perez-Garrigues H, Lopez-Escamez JA, Perez P, et al. Time course of episodes of definitive vertigo in Meniere's disease. Archives of Otolaryngology–Head & Neck Surgery. 2008;134(11): 1149-1154.
Committee on Hearing and Equilibrium. Guidelines for the diagnosis and evaluation of therapy in Ménière's disease. Otolaryngology–Head and Neck Surgery. 1995;113(3): 181-185.
Merchant SN, Adams JC, Nadol JB. Pathophysiology of Meniere's disease: Are symptoms caused by endolymphatic hydrops? Otology & Neurotology. 2005;26(4): 747-758.
Schuknecht HF. Pathology of the Ear. 2nd ed. Philadelphia: Lea & Febiger; 1993.
Gürkov R, Pyykkö I, Zou J, et al. What is Menière's disease? A contemporary re-evaluation of endolymphatic hydrops. Journal of Neurology. 2016;263(Suppl 1):S71-S81.
Fukushima M, Kitahara T, Uno Y, et al. Changes in aquaporin expression in the endolymphatic sac in Ménière's disease. Acta Otolaryngologica. 2010;130(1):53–60.
Frejo L, Gallego-Martinez A, Requena T, et al. Genetic basis of Menière disease. Current Opinion in Neurology. 2023;36(1):89-96.
Lopez-Escamez JA, Vela J, Frejo L. Immune-related disorders associated with Ménière's disease: A systematic review and meta-analysis. Otolaryngology–Head and Neck Surgery. 2023;169(5): 1122-1131.
Park HJ, Migliaccio AA, Della Santina CC, et al. Search-coil head-thrust and caloric tests in Meniere's disease. Acta Oto-Laryngologica. 2005;125(8): 852-857.
Nakashima T, Naganawa S, Pyykko I, et al. Grading of endolymphatic hydrops using magnetic resonance imaging. Acta Oto-Laryngologica Supplementum. 2009;(560): 5-8.
Gurkov R, Flatz W, Louza J, et al. In vivo detection of endolymphatic hydrops in Meniere's disease using local gadolinium injection. Audiology and Neurotology. 2011;16(6): 363-372.
Neff BA, Staab JP, Eggers SD, et al. Auditory and vestibular symptoms and chronic subjective dizziness in Meniere's disease, vestibular migraine and concomitant disease. Otology & Neurotology. 2012;33(7): 1235-1244.
Basura GJ, Adams ME, Monfared A, et al. Clinical Practice Guideline: Ménière’s Disease. Otolaryngology–Head and Neck Surgery. 2020;162(2_suppl): S1-S55.
Goto F, Tsutsumi T, Ogawa K. Dietary sodium restriction in patients with Meniere's disease. Acta Oto-Laryngologica. 2013;133(11): 1142-1146.
James AL, Burton MJ. Betahistine for Meniere's disease or syndrome. Cochrane Database of Systematic Reviews. 2001;(1): CD001873.
Santos PM, Hall RA, Snyder JM, et al. Diuretics for Meniere's disease or syndrome. Cochrane Database of Systematic Reviews. 2006;(3): CD003599.
Hu A, Parnes LS. Intratympanic steroids for inner ear disorders: A review. Audiology and Neurotology. 2009;14(6): 373-382.
Phillips JS, Westerberg B. Intratympanic steroids for Meniere's disease or syndrome. Cochrane Database of Systematic Reviews. 2011;(5): CD008514.
Huon LK, Fang TY, Wang PC. Outcomes of intratympanic gentamicin injection to treat Meniere's disease. Otology & Neurotology. 2012;33(5): 706-714.
Silverstein H, Isaacson JE, Olds MJ, et al. Intratympanic gentamicin treatment for Meniere's disease. Otolaryngologic Clinics of North America. 2004;37(5): 1041-1057.
Pullens B, van Benthem PPG. Intratympanic gentamicin for Meniere's disease or syndrome. Cochrane Database of Systematic Reviews. 2011;(3): CD008234.
Telischi FF, Luxford WM. Long-term efficacy of endolymphatic sac surgery for Meniere's disease. Otolaryngology–Head and Neck Surgery. 1993;109(1): 33-37.
Luxford E, Berliner KI, Lee J, et al. Long-term outcomes of labyrinthectomy for Meniere's disease. Otology & Neurotology. 2014;35(6): 1038-1043.
Claes FE, Van de Heyning PH, Gilles A, et al. Vestibular rehabilitation in patients with Meniere's disease. The Laryngoscope. 2011;121(4): 850-858.
