The membrane rupture theory of Menière's disease--is it valid?
The Membrane Rupture Theory states that the acute attack of Menière's disease occurs when endolymph, with its high potassium ion concentration, escapes into the perilymph and surrounds the first-order neuron. Initially, this causes partial depolarization of the nerve and an increased resting discharge, followed by complete depolarization. Clinically, one would expect an initial irritative nystagmus (toward the affected side) followed by a paralytic nystagmus (toward the unaffected side). To confirm this, the guinea pig perilymphatic space was perfused with an artificial endolymph solution. The results confirmed an irritative/paralytic sequence of nystagmus that differs from the pattern of spontaneous nystagmus observed with ENG monitoring during the acute attack of Menière's disease. Early in the attack, one observes a paralytic nystagmus followed by a secondary nystagmus beating toward the affected side (similar to an irritative nystagmus) as the patient recovers. This raises questions about the validity of the Membrane Rupture Theory.
Brown
D H
DH
Department of Otolaryngology, University of Western Ontario, London, Canada.
McClure
J A
JA
Downar-Zapolski
Z
Z
D000818:Animals; D004195:Disease Models, Animal; D007758:Ear, Inner / Q000293:injuries / Q000503:physiopathology*; D004584:Electronystagmography; D006168:Guinea Pigs; D008575:Meniere Disease / Q000209:etiology* / Q000503:physiopathology; D009759:Nystagmus, Pathologic / Q000503:physiopathology; D009994:Osmolar Concentration; D010477:Perfusion; D010498:Perilymph / Q000502:physiology; D011188:Potassium / Q000502:physiology; D012421:Rupture
D011188:Potassium