Skip to main content Accessibility help
×
Home
Hostname: page-component-59b7f5684b-fmrbl Total loading time: 0.588 Render date: 2022-10-05T15:16:51.136Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": true, "useSa": true } hasContentIssue true

High jugular bulb in a cohort of patients with definite Ménière's disease

Published online by Cambridge University Press:  11 November 2014

M Hitier
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Centre Hospitalier Universitaire de Caen, France Department of Anatomy, University of Caen Lower Normandy (‘UNICAEN’), France U 1075 COMETE, Institut national de la santé et de la recherche médicale (‘INSERM’), Caen, France
V Roger
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Centre Hospitalier Universitaire de Caen, France
S Moreau
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Centre Hospitalier Universitaire de Caen, France Department of Anatomy, University of Caen Lower Normandy (‘UNICAEN’), France
V Patron
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Centre Hospitalier Universitaire de Caen, France
Rights & Permissions[Opens in a new window]

Abstract

Type
Letter to the Editors
Copyright
Copyright © JLO (1984) Limited 2014 

Dear Sirs,

We read the article by Redfern et al.,Reference Redfern, Brown and Benson1 entitled ‘High jugular bulb in a cohort of patients with definite Ménière's disease’, with great interest. This study supports the findings of the recent study by Park et al.,Reference Park, Shen, Keil, Kuhl and Westhofen2 which focused on the same topic using a different methodology. Both studies show an increase of jugular bulb abnormalities in Ménière's disease compared with the asymptomatic sideReference Redfern, Brown and Benson1 or a control group.Reference Park, Shen, Keil, Kuhl and Westhofen2 This approach provides a new means to understand Ménière's disease physiopathology. In addition, the findings have clinical consequences that are worth knowing by the surgeon. Indeed, as explained by Redfern et al., some Ménière's symptoms have already been cured by surgicalReference Couloigner, Grayeli, Bouccara, Julien and Sterkers3, Reference Kieran and Meyer4 or endovascularReference Hitier, Barbier, Marie-Aude, Moreau, Courtheoux and Patron5 treatments of jugular bulb abnormalities. Nevertheless, jugular bulb abnormalities – even with inner-ear or aqueduct dehiscences – are asymptomatic in nearly half of the cases.Reference Friedmann, Eubig, Winata, Pramanik, Merchant and Lalwani6

It is thus important to differentiate between those jugular bulb abnormalities that are responsible for the Ménière's-like syndromes and those which are fortuitous associations. To do this, the surgeon must look for four clues which indicate that a jugular bulb abnormality is symptomatic: (1) vertigo may be induced by high venous pressure (coughing, Valsalva manoeuvre)Reference Hitier, Barbier, Marie-Aude, Moreau, Courtheoux and Patron5 or sound (i.e. Tullio phenomenon);Reference Friedmann, Le, Pramanik and Lalwani7 (2) tinnitus may be pulsatile (in 33 per cent of cases);Reference Hitier, Barbier, Marie-Aude, Moreau, Courtheoux and Patron5, Reference Friedmann, Le, Pramanik and Lalwani7 (3) a nystagmus may be identified when performing vestibular nystagmography during the Valsalva manoeuvre;Reference Hitier, Barbier, Marie-Aude, Moreau, Courtheoux and Patron5 and (4) vestibular evoked myogenic potential may show a threshold below 70 dB (in 63 per cent of cases).Reference Hitier, Barbier, Marie-Aude, Moreau, Courtheoux and Patron5, Reference Friedmann, Eubig, Winata, Pramanik, Merchant and Lalwani6 These low thresholds (as in superior canal dehiscence) result from a third window phenomenon;Reference Minor8 they differ from typical Ménière's disease, which exhibits no vestibular evoked myogenic potential responses despite a stimulus of 100 dB (in 54 per cent of cases).Reference de Waele, Tran Ba Huy, Diard, Freyss and Vidal9

In conclusion, this study by Redfern et al. reminds us that Ménière's disease is, by definition, idiopathic, which means its physiopathology is not completely understood. It is likely that different mechanisms are hidden within the ‘idiopathic’ element, including symptomatic dehiscence induced by jugular bulb abnormalities. It is therefore important that screening for symptomatic jugular bulb abnormalities is conducted and a specific treatment proposed.

References

1Redfern, RE, Brown, M, Benson, AG. High jugular bulb in a cohort of patients with definite Ménière's disease. J Laryngol Otol 2014;128:759–64CrossRefGoogle Scholar
2Park, JJ, Shen, A, Keil, S, Kuhl, C, Westhofen, M. Jugular bulb abnormalities in patients with Meniere's disease using high-resolution computed tomography. Eur Arch Otorhinolaryngol 2014. Epub 2014 Mar 20Google Scholar
3Couloigner, V, Grayeli, AB, Bouccara, D, Julien, N, Sterkers, O. Surgical treatment of the high jugular bulb in patients with Ménière's disease and pulsatile tinnitus. Eur Arch Otorhinolaryngol 1999;256:224–9CrossRefGoogle ScholarPubMed
4Kieran, SM, Meyer, TA. Cochlear Ménière's disease in association with a high jugular bulb. Otol Neurotol 2014. Epub 2014 Aug 12Google Scholar
5Hitier, M, Barbier, C, Marie-Aude, T, Moreau, S, Courtheoux, P, Patron, V. New treatment of vertigo caused by jugular bulb abnormalities. Surg Innov 2013;21:365–71CrossRefGoogle ScholarPubMed
6Friedmann, DR, Eubig, J, Winata, LS, Pramanik, BK, Merchant, SN, Lalwani, AK. A clinical and histopathologic study of jugular bulb abnormalities. Arch Otolaryngol Head Neck Surg 2012;138:6671CrossRefGoogle ScholarPubMed
7Friedmann, DR, Le, BT, Pramanik, BK, Lalwani, AK. Clinical spectrum of patients with erosion of the inner ear by jugular bulb abnormalities. Laryngoscope 2010;120:365–72Google ScholarPubMed
8Minor, LB. Clinical manifestations of superior semicircular canal dehiscence. Laryngoscope 2005;115:1717–27CrossRefGoogle ScholarPubMed
9de Waele, C, Tran Ba Huy, P, Diard, JP, Freyss, G, Vidal, PP. Saccular dysfunction in Ménière's patients. A vestibular-evoked myogenic potential study. Ann N Y Acad Sci 1999;871:392–7CrossRefGoogle ScholarPubMed
You have Access

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

High jugular bulb in a cohort of patients with definite Ménière's disease
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

High jugular bulb in a cohort of patients with definite Ménière's disease
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

High jugular bulb in a cohort of patients with definite Ménière's disease
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *