title: Endolymphatic hydrops and Ménière's disease: a lesion meta-analysis.
abstract: OBJECTIVE
  To determine whether the distribution of membrane lesions associated with Ménière's disease is random, as might be expected from a pervasive process such as hydrops, or orderly, as might be expected if membrane resistance is graded.
  
  
  METHODS
  A meta-analysis of temporal bone reports on 184 specimens demonstrating endolymphatic hydrops was undertaken to determine membrane lesion evolution and distribution.
  
  
  RESULTS
  Lesion distribution was found to be orderly and cochleocentric. No random scattershot lesions were reported in any study. Disease always started in the cochlear apex, even in non-symptomatic cases, and then involved the saccule, utricle, ampullae and canal system in that precise sequence as the disease progressed.
  
  
  CONCLUSIONS
  The orderly lesion progression in the otopathology associated with Ménière's disease suggests that the hydropic process has a graded non-random effect on the labyrinth. These findings suggest a pathological staging system that may be useful in temporal bone evaluation.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery,Columbia University Medical Center,New York,New York,USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Pender
mesh_terms: D018450:Disease Progression; D007758:Ear, Inner / Q000473:pathology; D018159:Endolymphatic Hydrops / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008575:Meniere Disease / Q000175:diagnosis / Q000473:pathology*; D012444:Saccule and Utricle / Q000473:pathology; D013701:Temporal Bone / Q000473:pathology