Pathogenesis and Management of Ménière's Syndrome in Terms of Microcirculation

Abstract

Physiopathology of microcirculation in the inner ear indicates 4 possible sources of excessive accumulation of endolymph which constitute the pathogenic mechanism of Meniere''s syndrome: increased filtration at the arterial end of the capillary network in stria vascularis; decreased re-absorption at the venous end caused in hypoproteinemia of the blood plasma; excessive accumulation of hydrophilic proteins (hyaluronic mucopoly-saccharides) within the endolymph, mechanical block within the saccular duct. The etiology of the endolymphatic hydrops is multiple: increase of hydrostatic pressure at the arterial end in stria vascularis, hypoproteinemia of the blood plasma caused by dysproteinemia affecting the whole organism; primary deficit of hyaluronidases formation from causes affecting the whole organism or from intrinsic or extrinsic inhibitors; excessive action of anti-hyaluronidases. Clinical management of Meniere''s syndrome consists of correction of the metabolic error involving the whole organism, control of acute, chronic and "physiological" infections by judicious application of antibiotics, sulfa compounds and topical antiseptics, reduction of the filtration at the arterial end in stria vascularis by a histamine analogue.