Tinnitus & early endolymphatic hydrops.

Ménière's disease with all of its clinical manifestations can be divided into two categories – those symptoms that derive from the cochlea (the anterior labyrinth) and/or those that arise from the vestibular labyrinth or the posterior part of the inner ear. The symptoms that arise from the cochlea include hearing loss, which can be fluctuant and progressive and often is, or tinnitus which can be intermittent or constant and can vary in intensity and quality. Other symptoms include aural pressure which is predominantly a symptom of the pars inferior, so far as we can tell, from histopathological studies of endolymphatic hydrops of the pars inferior, namely the saccule and the cochlear duct or the scala media, and loudness intolerance (recruitment). Symptoms that derive from the posterior labyrinth include, of course, episodic vertigo or other forms of vestibular upset. Also as we have described in the past, motion or positional vertigo is a very common aspect of Ménière's disease invariably present during a vestibular episode; but very often in between episodes as well. Disequilibrium and imbalance can occur with or between vertiginous episodes. Collapse attacks, or so called Tumarkin attacks occur most likely from disruption of an otolithic organ. There is no question that Ménière's disease when it occurs in its typical or classical form including all of the above symptoms is easy to diagnose. It is also definitely true that one can have Ménière's disease involving either the anterior or the posterior labyrinth one to the exclusion of the other. Moreover we have seen many patients with vesti-bular Ménière's disease who years later displayed hearing loss and had typical or classical Ménière's disease as well. Patients can have cochlear hydrops or cochlear Ménière's disease, or symptoms referable to the anterior labyrinth to the exclusion of vertigo and symptoms that derive from the posterior labyrinth. On many occasions while studying the natural cause of Ménière's disease, those patients often will, years later, develop vestibular symptoms also. We have earlier described that the cause of Ménière's disease is multifactorial inheritance, that its pathogenesis is endolymph malabsorption and that the symptoms are a combination of chemical and physical changes involving sensory cells and the membranes of both the anterior and posterior parts of the inner ear. We continue to believe this to be the case having seen many thousands of patients who have had Ménière's disease in its various forms. It has been …