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Ménière's disease: ‘a riddle wrapped in a mystery inside an enigma’. Has the key been found?

Published online by Cambridge University Press:  05 October 2018

Abstract

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Editorial
Copyright
Copyright © JLO (1984) Limited, 2018 

Churchill's wartime comment on the Soviet Union (British Broadcasting Corporation broadcast, London, 1st October 1939) could equally be applied to Ménière's disease.Reference Flood and Kenyon1 The cause of Ménière's disease still remains an enigma, despite some 157 years since Prosper Ménière's original observations in 1861. In this month's issue of The Journal of Laryngology & Otology, Jeremy Hornibrook postulates a saccular otoconial theory for Ménière's disease.Reference Hornibrook2, 3 In that article, evidence that Ménière's disease is caused by detached saccular otoconia is presented. It is hoped that as the resolution of inner-ear imaging in human ears advances, further progress will be made in elucidating the exact pathophysiological mechanism of Ménière's disease.Reference Patel, Oberman, Zacharia and Isildak4

Also in this month's issue, Puttasiddaiah and Browning describe a novel technique of using piezo surgery to remove external auditory canal exostoses.Reference Puttasiddaiah and Browning5 The authors propose that such a technique lessens the risk of injury to surrounding structures. The article follows the use of the ultrasonic bone aspirator for temporal bone dissection, which similarly reduces injury to surrounding structures and can be utilised endoscopically.Reference Gardner, Sappington, Arriaga and Kanotra6 If the safety profile of this technique is indeed demonstrated over time, then it offers the potential for simultaneous bilateral surgery to be performed in the future, thereby reducing the recovery time for patients with bilateral exostoses.

A study by Siupsinskiene et al. in this month's issue of The Journal examines the relationship between intranasal Helicobacter pylori infection and nasal polyps.Reference Siupsinskiene, Katutiene, Jonikiene, Janciauskas and Vaitkus7 This work follows their previous study published last year, which demonstrated an association between H pylori infection and chronic tonsillitis and laryngopharyngeal reflux.Reference Siupsinskiene, Katutiene, Jonikiene, Janciauskas and Vaitkus8 In this latest study, the authors found a higher rate of H pylori carriage in the nasal polyp patients compared with controls (28.9 per cent vs 3.3 per cent; p = 0.005). Further work is required to determine whether H pylori is simply an ‘innocent bystander’ colonising the upper airway preferentially in nasal polyp patients (e.g. chronic inflammation of the sinonasal mucosa may create a more suitable environment for the bacterium to survive), or whether there is indeed a causal relationship between H pylori intranasal colonisation and sinonasal disease.

References

1Flood, LM, Kenyon, G. Concepts of Ménière's disease in the Archives of The Journal of Laryngology and Otology. J Laryngol Otol 2014;128:308–17CrossRefGoogle Scholar
2Hornibrook, J. Saccular otoconia as a cause of Ménière's disease: hypothesis based on two theories. J Laryngol Otol 2018;132:771–4Google Scholar
3A new theory for Meniere's disease: detached otoconia. In: https://youtu.be/1XDffXknE1c [10 September 2018]Google Scholar
4Patel, VA, Oberman, BS, Zacharia, TT, Isildak, H. Magnetic resonance imaging findings in Ménière's disease. J Laryngol Otol 2017;131:602–7CrossRefGoogle ScholarPubMed
5Puttasiddaiah, PM, Browning, ST. Removal of external ear canal exostoses by piezo surgery: a novel technique. J Laryngol Otol 2018;132:840–1Google Scholar
6Gardner, EG, Sappington, J, Arriaga, MA, Kanotra, SP. Ultrasonic bone aspirator use in endoscopic ear surgery: feasibility and safety assessed using cadaveric temporal bones. J Laryngol Otol 2017;131:987–90CrossRefGoogle ScholarPubMed
7Siupsinskiene, N, Katutiene, I, Jonikiene, V, Janciauskas, D, Vaitkus, S. Intranasal Helicobacter pylori infection in patients with chronic rhinosinusitis with polyposis. J Laryngol Otol 2018;132:816–21Google Scholar
8Siupsinskiene, N, Katutiene, I, Jonikiene, V, Janciauskas, D, Vaitkus, S. Helicobacter pylori in the tonsillar tissue: a possible association with chronic tonsillitis and laryngopharyngeal reflux. J Laryngol Otol 2017;131:549–56CrossRefGoogle ScholarPubMed

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