Demyelination of Vestibular Nerve Axons in Unilateral Ménière's Disease

Author:

Spencer Robert F.12,Sismanis Aristides1,Kilpatrick Jefferson K.1,Shaia Wayne T.1

Affiliation:

1. Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond.

2. Department of Anatomy, School of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond.

Abstract

We conducted a study to determine whether vestibular nerves inpatients with unilateral Ménière's disease whose symptoms are refractory to medical management exhibit neuropathologic changes. We also endeavored to determine whether retrocochlear abnormalities are primary or secondary factors in the disease process. To these ends, we obtained vestibular nerve segments from five patients during retrosigmoid (posteriorfossa) neurectomy, immediately fixed them, and processed them for light and electron microscopy. We found that all five segments exhibited moderate to severe demyelination with axonal sparing. Moreover, we noted that reactive astrocytes produced an extensive proliferation of fibrous processes and that the microglia assumed a phagocytic role. We conclude that the possible etiologies of demyelination include viral and/or immune-mediated factors similar to those seen in other demyelinating diseases, such as multiple sclerosis and Guillain-Barré syndrome. Our findings suggest that some forms of Ménière's disease that are refractory to traditional medical management might be the result of retrocochlear pathology that affects the neuroglial portion of the vestibular nerve.

Publisher

SAGE Publications

Subject

Otorhinolaryngology

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