Meniere's Disease

Description

In many ways we are at a new pinnacle of discovery in Biology and Medicine. Never before has there been such rapid discovery of the fundamental issues involving cellular mechanisms, immunology, genetics, molecular biology and neuroscience. Each day we read about diseases for which the cause or a genetic basis has been identified, or for which a successful new treatment has been developed. With some of the best and the brightest students from our medical schools now turning to otolaryngology as their chosen profession, and with the attention of basic scientists newly focused on the inner ear, it is conceivable that many diseases that cause terrible afflictions to our patients will soon be cured. Unfortunately, we are not yet there in Meniere's disease. Reading through this textbook, written by the leading experts in this field, I see pieces of the puzzle but not the solution. The etiology of this disease remains 'idiopathic'. However, this is only because of our ignorance, and there are significant clues to its cause. There are derangements in serological factors seen in too many patients to suggest that it is all coincidental or anecdotal. Patients have acute exacerbations of the disease and then long periods of remission. Yet there is an inexorable loss of inner ear function despite relative quiescence in the disease over time. There is no doubt that this is a disease that has a great propensity to become bilateral, does that suggest that it is autoimmune, genetic or infectious? We spend an inordinate amount of time trying to restore function to the endolymphatic sac - but is this the correct approach, or does Meniere's disease really represent an 'overfunctioning' sac rather than an underfunctioning one? In the provocative chapter by Gibson, we see evidence suggesting that the sac's destruction may alleviate symptoms rather than creating worsening endolymphatic hydrops. In medical school we are taught to attempt to classify diseases into one of several categories: metabolic, developmental, neoplastic, genetic, autoimmune and infectious. In Meniere's disease we can only with certainty rule out one of these categories, and that is neoplastic. There is evidence cited in the literature that supports each one of the other categories. If the disease is multifactorial, all this evidence may be valid. It seems, therefore, that we have not yet unlocked the mechanism underlying the development of Meniere's disease. Until that occurs we will continue to search for effective therapy, though it will not be curative. I look forward to the next decade of research on this disorder, as we find more precise means of determining the specific etiology for the development of Meniere's disease in a single individual, and begin to apply new ways of treating the inner ear with drug delivery systems, gene therapy and methods not yet invented. I suspect and hope that by the time the Second Edition of this textbook is written the etiology(ies) will be determined, and that rational therapies based on these etiologies will be readily available.