Practica Oto-Rhino-Laryngologica

Report of a Nationwide Survey on Ménière's Disease

Appearance Rate of Severe Cases

Isamu Watanabe, Kimihiro Nakae, Jin Okubo, Kanemasa Mizukoshi

1980 Volume 73 Issue 6special Pages 1001-1009
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1001

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A nationwide survey on definite cases of Ménière's disease was made during the period from June 20 to June 25, 1977. A questionnaire covering the number of patients experiencing difficulties in routine life was submitted to 435 Departments of Otolaryngology, Internal Medicine and Neurology of general hospitals including University Hospitals in Japan. Data obtained from 214 such departments were evaluated satistically.
(1) The proportion of definite cases of Ménière's disease in the total number of patients treated during the same period was an average of 0.88% for new patients, 0.73% for outpatients and 0.74% for inpatients.
(2) The number of patients severely disabled in their daily lives was an average of 54.7% of definite cases of Ménière's disease, and these cases were classified into five types:
A type: repeated attacks of vertigo
male 129/320 (40.3%) female 100/342 (29.2%)
B type: persistent dizziness or unsteadiness remaining after the vertiginous attacks
male 35/320 (10.9%) female 51/342 (14.9%)
C type: unilateral profound deafness
male 31/320 (9.6%) female 22/342 (6.43%)
D type: bilateral profound deafness
male 8/320 (2.50%) female 9/342 (2.63%)
E type: miscellaneous
male 18/320 (5.63%) female 4/342 (1.17%)

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Epidemiological and Clinical Survey on Definite Cases of Bilateral Meniere's Disease as Reported by Seventeen Members of Meniere's Disease Research Committee of Japan During 1975-1976

Kanemasa Mizukoshi, Kazumitsu Ishikawa, Yukio Watanabe, Haruko Yamazak ...

1980 Volume 73 Issue 6special Pages 1010-1022
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1010

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Between April 1975, and December 1976, the second national epidemiological and clinical investigations of Meniere's disease in Japan were carried out by the Meniere's Disease Research Committee, as supported by the Ministry of Health and Welfare. Among 520 patients with definite Meniere's disease, 48 (9.4%) were considered to be bilateral Meniere's disease by all the 17 members of this Research Committee, respectively.
Epidemiological and clinical features in 48 patients with bilateral Meniere's disease were collected and statistically analyzed in comparison with 465 cases of unilateral Meniere's disease, in whom affected ears were determined by each reseacher.
Characteristic epidemiological and clinical features were as follows:
1) Sex-ratio: The male to female ratio in bilateral Meniere's disease was 66:100, respectively.
2) Age distribution: Peaks were noted at the age group of 40-49 for both males and females.
3) Family history: 4 cases (8.3 percent) of the 48 patients with bilateral involvement had a close relative who had Meniere's disease.
4) Preceding events: Mental and physical fatigue before vertiginous attack were reported in 35 and 42 percent of bilateral Meniere's disease series, respectively.
5) Season and time of onset: There was a high frequency of vertiginous attack in spring in the bilateral Meniere's disease, and high frequency of such attacks peaked in the afternoon (13:00-14:00).
6) Marriage: The incidence of bilateral Meniere's disease was higher in married persons.
7) Past history and complication: There was a higher incidence of hypotension and diabetes mellitus in past history in cases of bilateral involvement.
8) Hearing impairment in bilateral cases was higher than in unilateral cases.
9) The incidence of bilateral Meniere's disease increased with increasing duration of the disease. Such was also found by Enander and Stahle (1967) and Kitahara (1975).
10) The most common vertiginous attack in those with bilateral involvement showed the characteristic feature of a more extensive rotatory spontaneous vertigo than was seen in cases of unilateral involvement.

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The Prevalence of Ménière's Disease in Japan

Kimihiro Nakae, Hiroshi Nitta, Yoshio Hattori, Kazuho Maeda, Isamu Wat ...

1980 Volume 73 Issue 6special Pages 1023-1029
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1023

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A method to determine the prevalence of Meniere's disease in Japan was based on the probability distribution of intervals of medical care and presented as formula No. 3 in this paper. This method made feasible not only estimation of a prevalence of a disease during survey intervals but also enabled comparison of one prevalence to another despite different survey intervals i. e. one day and a week.
Random sampling survey of hospitals and clinics in one day all over the country, and all large hospitals survey during one week in Japan, showed that the prevalence of Meniere's disease in Japan was estimated to be 160 per million population from the “one day survey” and here the diagnosis of the disease would probably not be so definite as in “a one week survey”. The prevalence of the disease estimated from the latter survey was one-fourth to the former i. e. 40 per million.
The geographical distribution of the disease was found to be higher in the southern regions of Japan.

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A Survey of Ménière's Disease among Personnel of a Medical Institution

Koichi Yasuda, Ayako Otaguro, Toshiko Tsuchihashi

1980 Volume 73 Issue 6special Pages 1030-1038
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1030

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The percentage of a given population with Meniere's disease is of great interest to those concerned with the study of this disease entity. To our knowledge there are no reliable data available. This is partly because studies conducted along this line have placed emphasis solely on victims of this disease and little attention was given the population from which the patients had derived. Thus, a survey in a closed population of a known composition was carried out.
The survey was carried out among personnel of Hamanomachi Hospital. As of June 1, 1977 this hospital employed 497 persons. All these persons were contacted by questionnaire and asked to return the filled in papers to us. The recovery rate for answers was 100%.
There were 45 persons with Meniere's disease, that is 9% of the population. This group of persons comprised 3 males (2% of the male personnel) and 42 females (12% of the female personnel). The incidence of the disease in this small population tended to rise with advancing age.
From the data, estimation was made of the number of females with Meniere's disease, aged between 20 and 59 years, for the whole of Japan. Of 3510×10⁴ Japanese women 20 to 59 years of age, 600×10⁴ (17%) were estimated as having the disease.
Assuming that among the 452 personnel who had been diagnosed as not having Meniere's disease there are those who have a high probability of developing the disease. We therefore attempted to isolate such persons using the following criteria: (1) a history of vertigo, (2) episodes of dizziness with concurrent tinnitus and/or hearing loss, and (3) a history of dizziness with episodes of aural stuffiness and nausea occurring with fatigue. Eighty-one of the personnel, which corresponds to 20% of those free from the disease under investigation, were found to satisfy these criteria. A retrospective study of answers to the questionnaire recovered from 6 persons who developed the disease after the survey demonstrated the legitimacy of the 3 criteria mentioned above for detection of latent Meniere's disease.

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Histopathology of the Endolymphatic Sac

Tetsuo Ishii, Sachiko Moriguchi

1980 Volume 73 Issue 6special Pages 1039-1049
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1039

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Histopathological studies were performed on the endolymphatic sac in serial sections of 69 children and adults (123 ears) and 15 fetuses (30 ears). In the latter (13-39 weeks), the endolymphatic sac showed a wide, single lumen which did not contain precipitates. Rugosity was absent here. In 20% of all the adult endolymphatic sacs, the sac lumen showed a tubular, branched form which was not particularly related to the pathology of the inner ear. The dark pigment in the perisaccular tissue appeared to be melanin. This pigment was found in 44% of 125 ears and was not related to age, sex or inner ear pathology. Nineteen percent of adult ears showed a polypoid hyperplasia. Retention of thick precipitates in the sac lumen was observed in 47% of all ears. These precipitates were identified as mucopolysaccharide and mucoprotein, occupying almost all the lumen of the intermediate portion. No correlation was found between these precipitates in the sac and pathology in the endolymphatic system of inner ear. These pathological findings in the human endolymphatic sac make for a difficult evaluation of the endolymphatic sac, as related to causative factors of endolymphatic hydrops and/or other endolymphatic disorders.

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Histopathological Findings in Ménière's Disease

Electron Microscopic Studies

Yoshiro Yazawa, Masaaki Kitahara

1980 Volume 73 Issue 6special Pages 1050-1055
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1050

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Twelve specimens taken from the rugose portion of the endolymphatic sac during drainage operation for Meniere's disease were studied under electron microscope. Epithelial cells from the endolympatic sac were detected in only one of the 12 specimens.
In electronmicrographs of these epithelial cells, only a few small microvilli were detected on the cell surface and there was a number of inclusion bodies and numerous vesicles in the cytoplasm.
Fibrosis in the subepithelial connective tissue and even in the degenerated epithelial cells was sometimes evident in the other specimens. Fibrosis in this area may disturb absorption of the endolymph in the endolymphatic sac and may induce an endolymphatic hydrops.

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Pseudo-fistula Symptom in Ménière's Disease

Kohji Tokumasu, Rokuro Kawano, Kozo Furukawa

1980 Volume 73 Issue 6special Pages 1056-1063
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1056

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Horizontal ocular deviations was induced by pressing against the middle ear ossicles in two cases of Ménière's disease and were identified electronystagmographically during Rosen's chorda tympani sectioning operation, under local anesthesia.
In other one case of Ménière's disease, the patient complained that the surroundings were moving towards the side of the diseased ear when the external meatus of the diseased ear was pressed.
It was assumed that a slight inward deflection of the foot plate of the stapes in the diseased ear induced the conjugate horizontal ocular deviation towards the opposite side and the sensation of shifting of the objects to the same side.
A pseudo-fistula symptom in Ménière's disease might be related to the saccular hydrops which was frequently reported as being found among tissues obtained at the time of autopsy in cases of Ménière's disease.

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Differences in the Prognosis of Ménière's Disease with Reference to Incipient Symptoms

Kiichiro Taguchi, Tetsuya Ishiyama

1980 Volume 73 Issue 6special Pages 1064-1068
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1064

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The relationship between the incipient symptoms and the long-term prognosis of Ménière's disease was investigated. Forty-five patients who had been suffering from definite Ménière's disease for more than 5 years were selected as the subjects.
These patients were classified into 3 main groups on the basis of the incipient symptoms: the first group with vertigo or dizziness, the second with some cochlear symptoms and the third with symptoms related to the autonomic nervous system.
There was a significant difference in the period from the incipient symptom to the active stage of the disease between the vertigo subgroup and the tinnitus subgroup, the latter showing a longer interval.
There was also a significant difference in the average age at the first attack of the incipient symptom between the vertigo subgroup and the subgroup with dizziness, the latter being older in age.
In the vertigo and tinnitus subgroups, more than three attacks per month occurred during the active stage.

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Clinical Investigation of Diseases Similar and Marginal to Meniere's Disease

Takashi Matsunaga, Tamiko Nimura, Nozomu Mori, Yuriko Suizu, Ryuzi Kat ...

1980 Volume 73 Issue 6special Pages 1069-1075
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1069

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We compared the symptom of vertigo and the clinical laboratory findings of so-called vestibular Meniere's disease, sudden deafness with vertigo and viral diseases accompanied by vertigo respectively.
We assumed that so-called vestibular Meniere's disease may be one resembling the clinical pathogenesis of Meniere's disease, as determined by the conditions of vertigo attacks, the similarities of the progression of vertigo etc., although in a few cases having shifted from so-called vestibular Meniere's disease to established Meniere's disease, that were a great many peripheral disturbances noted in the caloric test and a few patients responded negatively to the furosemide test.
In addition, judging from the findings that sudden deafness with vertigo was similar to findings in cases of viral diseases accompanied by vertigo and that there were bilateral peripheral disturbance types seen in the caloric test, we could not always rule out a virus as a cause of the sudden deafness.
Labyrinthine lesions such as are seen in cases of Meniere's disease as well as retrolabyrinthine lesions may also be involved in cases of sudden deafness with vertigo.

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Recurrent Vertigo after Sudden Deafness

Haruko Yamazaki, Kanemasa Mizukoshi, Kazumitsu Ishikawa, Yukio Watanab ...

1980 Volume 73 Issue 6special Pages 1076-1081
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1076

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Patients in whom recurrent vertigo which developed after sudden deafness were examined and the following conclusions were obtained.
Only five were found to have a recurrent vertigo among 69 patients with sudden deafness. Meniere's disease and suspected cases were excluded in these 69. Three of the 5 cases showed neurotological findings of highly damaged inner ear, and the other two showed the findings which involved central nervous system disturbances. Thus, recurrent vertigo after sudden deafness may have a different etiology. Careful diagnosis is required to determine the cause of recurrent vertigo after sudden deafness and long term observations are absolutely required.

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Vertigo of Delayed Onset after Sudde Deafness and Sensorineural Deafness Followed by Mumps

Ken Kitamura, Atsushi Komatsuzaki

1980 Volume 73 Issue 6special Pages 1082-1093
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1082

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An entity of episodic vertigo of delayed onset following sudden deafness and sensorineural hearing loss after mumps is described. Data on five patients with sudden dafnfess and three patients with sensorineural hearing loss after mumps are presented. The latency between sudden onset of sensorineural hearing loss and the onset of the vertigo varied from four days to six years.
There is no patient with sudden deafness who had a history of vestibular symptoms at the time of the sudden loss of hearing. Two out of three patients who had sensorineural hearing loss after mumps had a simultaneous involvement of the vestibular apparatus, with transient vertigo. The episodic vertigo, delayed in onset after sudden sensorineural hearing loss in the eight patients was usually spontaneous. Postural vertigo was noted in only one patient.
The nature of the inner ear pathology responsible for the episodic vertigo in these patients is speculative. One patient after sudden deafness had an episodic vertigo accompanied by tinnitus in the previously deafened ear. The characteristics of vertigo in this patient are indistinguishable from those seen in cases of Meniere's disease. The pathophysiology of the vertigo in this patient was found to be related to endolymphatic hydrops.
The delay of four days to six years between the sudden onset of hearing loss and the later onset of ipsilateral otogenic vertigo is puzzling. Schuknecht and others have suggested that viral labyrinthitis is the likely etiology of sudden deafness. Cochleosaccular degeneration is a common finding in documented viral labyrinthitis. Zajtchuk stated that the pathophysiology of viral labyrinthitis involves an acute stage and a chronic stage. In the chronic stage, degeneration process of neural elements, new bone formation and fibrous tissue take place in the membranous labyrinth. Thus, episodic vertigo may be the result of a progressive inner ear degeneration after sudden sensorineural hearing loss.

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Five Patients with Recurrent Vertigenous Attacks Subsequent to Profound Sudden Hearing Loss

Fumihito Suzuki, Jiro Hozawa, Akiko Takagi

1980 Volume 73 Issue 6special Pages 1094-1100
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1094

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Five patients with long term recurrent vertigenous attacks subsequent to profound sudden hearing loss were observed neurotologically and the related pathology was investigated.
Characteristic findings were as follows;
1) subjective; positional vertigo
2) objective; direction changing positional nystagmus and marked canal paresis in the bithermal caloric test
3) no fluctuating tinnitus or hearing loss; the cerebellopontine angle cystic arachnitis and broad vascular disorder including those in the central nervous system were assumed to be the etiology. Concerning the arachnitis, physiomechanical, inflammatory, and/or a hydrodynamic influence on the labyrinth via the perilymphatic system were seemed likely to occur.

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Paroxyamal Positional Vertigo with Unilateral Vestibular Dysfunction

Kiichiro Taguchi, Tetsuya Ishiyama

1980 Volume 73 Issue 6special Pages 1101-1108
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1101

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There are borderline differences between benign paroxysmal positional vertigo and Ménière's disease.
Two patients showed typical paroxysmal positional vertigo when in the supine position. Disorders of the central nervous system were not evident. The results of the caloric test revealed a canal paresis and the furosemide test was positive, suggesting that the origin of the disorders was probably hydrops of the labyrinth. The patients made a favorable progress while on conservative treatment.

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Movement of the Body's Center of Gravity while Standing in Patients with Ménière's Disease

Kiichiro Taguchi

1980 Volume 73 Issue 6special Pages 1109-1117
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1109

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Body sway while standing was observed using a straingauge-platform system and a minocomputer to clarify the characteristics of disequilibrium in patients with Ménière's disease.
The test were conducted on 20 patients with unilateral definite Ménière's disease. Each subject was placed on the platform of the sensonograph with feet together and asked to look straight ahead. The output from the sensonograph was connected to a plotting unit. The information obtained was at the same time fed into a data recorder, which separately stored the data of the lateral and antero-posterior movement of the center of gravity on the magnetic tape. The recorded data on the tape was fed into a digital computer for further analysis.
The following results were obtained:
1. Three types of locus patterns were traced. The centripetal type was observed in 9 subjects, the left and right type in 6 and the forward and backward type in 5.
2. The total length of the locus traced by the center of gravity in the patients with Ménière's disease during one minute standing was 57.4±9.9cm with the eyes open and 90.3±23.7cm with the eyes closed, while that of the normal subjects was 53.2±8.0cm with eyes open and 78.6±14.1cm with eyes closed.
3. In patients with Ménière's disease, the time course in the position of the center of gravity was affected by the spontaneous nystagmus. The relationship between the average position of the center of gravity and the direction of the spontaneous nystagmus was certain and showed a shift of the position to the direction of slow phase of the nystagmus.
4. Calculated and depicted frequency spectra of the movement of the center of gravity in the patients with Ménière's disease resembled that of Type II or Type III of the spectra in normal subjects, which suggested a tendency towards orthostatic hypotension or psychic tension.

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The Mecholyl Test in Inner Ear Diseases

Takuya Uemura, Mitsuko Itoh, Naoko Kikuchi, Machiko Takeda, Keiko Mats ...

1980 Volume 73 Issue 6special Pages 1118-1123
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1118

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The positive rates of abnormal miosis following the application of 5% mecholyl solution to the eyes increased on the affected side in the following order of during intervals, adjunctive spells, and definitive spells in cases of Meniere's disease. The test results were compared with those obtained from patients with sudden deafness, labyrinthitis, and vestibular neuronitis. 1) Five out of 17 cases (29%) of sudden deafness showed positive reactions on the affected side, when examined within two weeks after the onset of the disease. In the five cases showing positive reactions, three had no vertigo or objective findings.
2) Five patients with labyrinthitis and four patients with vestibular neuronitis were examined by the mecholyl test. In no patient was the abnormal miosis limited to the affected side.
These results demonstrate that the mecholyl test is not positive merely as the result of an abnormality of the vestibulo-autonomic reflex. Therefore, the positive mecholyl tests in cases of Meniere's disease indicate a dysfunction of the autonomic nervous system on the affected side.

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Evaluation of Effects of Treatment of Meniere's Disease

T. Tokita, H. Miyata, T. Maki, N. Asai, M. Hashimoto, M. Maeda, S. Tan ...

1980 Volume 73 Issue 6special Pages 1124-1130
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1124

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We report herein the examinations required for evaluation of the effects of treatment of Meniere's disease. Prior to the discussion, it is indispensable to clarify the design of the treatment. In the treatment, the authors take into consideration the following three subjects: (1) treatment of vertigo, (2) treatment of damage to the inner ear, and (3) treatment of recurrence of attacks of vertigo.
(1) For evaluation of effects of treatment of vertigo in attacks and dizziness in the chronic stage of the disease, complaints of vertigo and spontaneous nystagmus as objective evidence of vertigo should be investigated. Furthermore, righting reflex and deviation test should be performed in order to demonstrate the mechanism of improvement of the vertigo. Despite the improvement obtained by inhibitory effects of drugs on the vertigo, the righting function and deviation phenomenon remain unchanged. On the contrary, when the pathological condition of the inner ear is healed there is an improvement of these signs.
(2) Effects of the treatment for damage of the inner ear are evaluated by hearing and caloric tests. In cases where the labyrinthine excitability is not reversible, compensatory process of balancing activity of the body should be examined using the standing test, tests for spontaneous nystagmus, deviation and caloric tests and tests for postrotatory nystagmus. Disappearance of spontaneous nystagmus and deviation phenomenon reveal a recovery of static balance of the vestibular system. Disappearance of asymmetry of postrotatory nystagmus indicates a restoration of balance in the kinetic labyrinthine reflexes.
(3) Recurrences of attacks of vertigo are treated on the basis of the results of examination of etiologic factors of Meniere's disease in each patient. Effects of this treatment should be evaluated by long-term follow-up of the vertiginous attacks.

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Clinical Value of Cupulometry for Evaluation of the Effect of Treatment in Ménière's Disease

Jiro Hozawa, Fumihito Suzuki, Akiko Takagi

1980 Volume 73 Issue 6special Pages 1131-1133
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1131

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Differences in the results of vestibular function tests between the pre-and posttreatment stage were assessed for 184 patients with Meniere's disease. The vestibular function tests included were:
Mann's test, writing test, spontaneous nystagmus, positional nystagmus, positioning nystagmus, caloric test, and cupulometry.
Among these tests, the result of cupulometry corresponded most accurately with the subjective symptoms (vertigo).

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Estimation of Treatment of Patients with Meniere's Disease by Questionnaires

Tsutomu Yamazaki, Sachie Watanabe, Hideo Kozaki, Takao Abe, Kazuo Yama ...

1980 Volume 73 Issue 6special Pages 1134-1141
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1134

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Clinical effects of therapy given from 1973 to 1977 to 42 patients with Meniere's disease were evaluated by follow-up questionnaires.
Vertigo was relieved in 38 (90%): there was no attack of vertigo in 17 (40%) and vertigo was relieved in 21 (50%).
On the other hand, cochlear disorders were improved in 14 (33%), unchanged in 23 (55%), and aggravated in 6 (14%).
In 21 patients with Meniere's disease of 2-3 years duration, vertigo was relieved in 20 (95%).
In 20 patients who experienced relief, attack of vertigo did not occur in 8 (38%), and vertigo was relieved in 12 (57%), and aggravated in 2 (10%). Hearing loss as a side effect of therapy was not evident on the audiograms.
Furosemide given in small doses was most effective in cases of recurrences of the vertigo.
While on small doses of Furosemide, hearing loss was not aggravated in any patient, rather hearing improvement in speech discrimination occurred in 60 to 90 percent in one patient.
When anti-vertiginous drugs were given, the regional action of the sympathetic system in a-adrenergic stimulation was probably related to changes in excitability of unilateral organs (in Meniere's disease) other than static dysfunction (in sensorineural hearing loss and equilibrium disorders) and relief for symptoms of Meniere's disease was evident.

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Influence of Drugs on Fluctuant Hearing Loss in Bilateral Meniere's Disease

Munetaka Yamakawa, Noboru Sakai, Mariko Maki, Tutomu Yamazaki

1980 Volume 73 Issue 6special Pages 1142-1147
Published: June 25, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.6special_1142

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A female aged 44 diagnosed as having bilateral Meniere's disease was treated by various medications. While on a vasodilator, hearing ability remained unchanged. Furosemide and steroid treatments resulted in a good response. Hearing impairment in one ear is often accompanied by improvement in the contralateral ear. This phenomenon is one of the characteristics of bilateral Meniere's disease.

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