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To investigate the effect and mechanism of sodium ferulate in the treatment of Ménière disease (MD) model mice. Methods BALB/c mice were selected, and an MD model was constructed using posterior fossa epidural approach combined with intraperitoneal injection of aldosterone. Sixty model mice were randomly grouped into the model group, the low dose sodium ferulate group, the medium dose sodium ferulate group, the high dose sodium ferulate group and the dexamethasone group, with 12 mice in each group. Another 12 BALB/c mice were selected as the sham operation group. After grouping and tympanic administration, auditory evoked brainstem response (ABR) was applied to detect the hearing level of mice in each group. HE staining and magnetic resonance imaging (MRI) were applied to observe the morphology of cochlea and membranous labyrinth hydrops of mice in each group. Enzyme-linked immunosorbent assay was applied to detect serum levels of lipoprotein a [Lp(a)], pro-inflammatory factor interleukin-6 (IL-6) and tumor necrosis factor-α (TNFα) in each group. Immunohistochemical staining and Western blot assay were applied to detect the expression of Lp(a) in each group. Results Compared with the sham operation group, the ABR threshold, the score of membranous labyrinth hydrops, the proportion of middle stage area, serum levels of Lp(a), IL-6 and TNF- α, the IOD value of Lp(a) positive expression and the expression of Lp(a) protein in the cochlea of mice were significantly increased in the model group (P＜ 0.05). Compared with the model group, the ABR threshold, the score of membranous labyrinth hydrops, the proportion of middle stage area, levels of serum Lp(a), IL-6 and TNF-α, the IOD value of Lp(a) positive expression and the expression of Lp(a) protein in the cochlea of mice were significantly decreased in the low, medium and high dose sodium ferulate groups and the dexamethasone group (P＜0.05), and the effect of high dose sodium ferulate was more obvious. Conclusion Sodium ferulate can down regulate the expression of Lp(a) protein, reduce the production of proinflammatory factors, inhibit the inflammatory reaction, thereby alleviating the symptoms of membranous labyrinth hydrops in MD mice, and improving their auditory function. [ABSTRACT FROM AUTHOR]

In order to standardize scientific drug use in vertigo, the Vertigo Committee of the Chinese Medical Education Association established an expert group to form Expert Consensus on Betahistine Mesylate in the Treatment of Vertigo after repeated discussion based on the existing medical evidence, and combined with the rich clinical experience of experts. The consensus includes the pharmacological basis of histamines, the strength of recommendation, dosage, course, review methods, medication for special populations, adverse drug reactions and other aspects of betahistine mesylate in common vertigo diseases (such as benign paroxysmal position vertigo, Menieres disease, and vestibular neuritis, etc.) to guide doctors in clinical work.

doi：10.3969/j.issn.1672⁃6731.2021.02.010

Ménière's disease is an unexplained peripheral vestibular disease with endolymphatic hydrops as the main pathological features. Pathogenesis and pathophysiology mechanism are not clear at present. Summarizing the advances of epidemiology, pathophysiology and clinical manifestations is conducive to clinicians' understanding and in-depth study of the disease. DOI: 10.3969/j.issn.1672-6731.2019.02.002

Semicircular canal occlusion（SCO） is a surgical technique widely used for treating vertigo symptoms. It is primarily aimed at treating benign paroxysmal positional vertigo（BPPV）, Ménière's disease（MD）, labyrinthine fistula, and superior semicircular canal dehiscence syndrome, among others. This review aims to comprehensively summarize the development, evolution, relevant basic research, and clinical applications of semicircular canal occlusion, especially the application of endoscopic technology in recent years, and explore its practical value in the field of surgical treatment for vertigo., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Ménière's disease is an unexplained peripheral vestibular disease with endolymphatic hydrops as the main pathological features. Pathogenesis and pathophysiology mechanism are not clear at present. Summarizing the advances of epidemiology, pathophysiology and clinical manifestations is conducive to clinicians' understanding and in-depth study of the disease. [ABSTRACT FROM AUTHOR]

Objective: By detecting the levels of proteins in the Toll-like receptor-4/nuclear factor-κB （TLR4/NF-κB） signaling pathway and downstream proinflammatory cytokines in peripheral blood of patients with Meniere's disease （MD）, Pittsburgh Sleep Quality Index （PSQI） scores were collected to investigate the correlation between sleep disorders and MD and the role of TLR4/NF-κB signaling pathway in mediating sleep disorders inducing MD. Methods: Thirty-two MD patients and 20 family members of patients without middle ear and inner ear related diseases were selected. Basic data, PSQI and fasting peripheral blood of all subjects were collected. Enzyme linked immunosorbent assay.The levels of interleukin-1β（IL-1β）, tumor necrosis factor-α（TNF-α）, monocyte chemokine-1（MCP-1）, Toll-like receptor 4（TLR4） and nuclear factor-κB（NF-κB） in peripheral blood were detected by ELISA, and the data were statistically analyzed. Results: ①PSQI score of MD group was higher than that of normal control group, and the difference was statistically significant（ P <0.01）; The scores of every factors of PSQI in MD group were higher than those in normal control group, and the scores of factors 2, 4 and 6 were significantly different from those in normal control group. ②In the MD group, there were 18 patients with sleep disorders, with a prevalence rate of 56.25%, including 6 males with a prevalence rate of 50.00% and 12 females with a prevalence rate of 60.00%. ③The levels of five test indexes in MD group, sleep disorder group and non-sleep disorder group were higher than those in control group, and the levels of TLR4 and NF-κB in MD group were significantly different from those in control group（ P <0.05）. The levels of IL-1β, TNF-α, TLR4 and NF-κB in sleep disorder group were significantly different from those in control group（ P <0.05）. The levels of five test indexes in non-sleep disorder group were not statistically significant compared with those in control group. The levels of five test indexes in the MD sleep disorder group were higher than those in the MD group and the non-sleep disorder group, with no statistical significance. The levels of five test indexes in MD group were higher than those in non-sleep disorder group, with no statistical significance（ P >0.05）. Conclusion: ①Sleep disorders may be one of the important predisposing factors of some MD, and the effects of sleep disorders on MD are different between the sexes. ②Sleep disorders may activate TLR4/NF-κB signaling pathway to induce MD. The selection of TLR4/NF-κB signaling pathway related proteins and downstream pro-inflammatory factor inhibitors to intervene MD may provide a new idea for protecting the hearing balance function of MD., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To investigate the peripheral blood inflammatory markers including white blood cell count (WBC), monocytes, neutrophils, lymphocytes, platelets, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), high-density lipoprotein(HDL-C), low-density lipoprotein and fibrinogen (FIB) in Ménière's disease (MD) patients with and without migraine, and to explore the relationship between the inflammatory response with MD and migraine. Methods: The general physical condition, clinical manifestations, pure-tone audiometry, and peripheral blood inflammatory markers of 92 unilateral MD patients who were hospitalized in Peking University People's Hospital for surgical treatment from January 2017 to January 2021 were continuously collected. Meanwhile, 50 healthy controls matched with age and sex were included, and their general physical conditions and peripheral blood inflammatory markers were also collected. This study consisted of two parts. First, the differences in epidemical characteristics and peripheral blood inflammatory markers between MD patients and healthy controls were compared by univariate analysis. Second, all 92 MD patients were divided into two subgroups according to whether they were accompanied by migraine. The clinical characteristics and peripheral blood inflammatory markers of MD patients with and without migraine were compared by univariate analysis. Thereafter, binary Logistic regression was used to analyze the related factors of whether MD patients were accompanied with migraine. Results: Compared with the healthy control group, the peripheral blood WBC, neutrophils and FIB of MD patients were significantly increased (all P <0.05). Compared with MD patients without migraine, MD patients with migraine had higher female prevalence, longer disease history, lower low-frequency hearing threshold, higher frequency of vertigo attacks and higher HDL-C levels (all P <0.05), meanwhile, female, frequency of vestibular attacks and HDL-C were independent related factors of whether MD patients were accompanied with migraine. Conclusion: The occurrence of MD and migraine may be related to the inflammatory response. The level of anti-inflammatory factors in the blood of MD patients with migraine are higher, suggesting that the inflammatory response status of MD patients with and without migraine is different.

Objective: This study was to retrospectively analyze the results of vestibular-evoked myogenic potentials（VEMP） in unilateral Meniere's disease（MD） patients. Methods: The clinical assessment results of MD patients who visited the department between January 2016 to February 2022 were reviewed. Unilateral MD patients who met the inclusion and exclusion criteria were divided into three groups according to clinical stages, namely, group 1（stage Ⅰ+ stage Ⅱ）, group 2（stage Ⅲ） and group 3（stage Ⅳ）. The normal value data were used to investigate the incidence of abnormal P1 and N1 latencies, abnormal P1-N1 interwave latency, and abnormal interaural amplitude asymmetry ratio（IAR）. Afterwards, considering all the above mentioned parameters, the VEMP result of each patient was graded into four levels（grade 1 means VEMP result is normal, grade 2, 3 and 4 means the VEMP result is abnormal in different degrees）. The correlation between VEMP result level and pure tone average（PTA） of MD patients in different clinical stages was examined. Results: The prevalence of cVEMP in three groups was 84.2%, 70.0% and 33.3%, respectively（ P <0.05）. The prevalence of oVEMP in three groups was 63.2%, 34.0% and 16.7%, respectively（ P <0.05）. The incidence of abnormal P1 latency, N1 letancy and P1-N1 interwave latency of cVEMP was 21.1%, 26.3% and 24.6%, respectively. The incidence of abnormal P1 latency, N1 latency and interwave latency of oVEMP was 15.6%, 43.8% and 3.1%, respectively. The incidence of abnormal cVEMP IAR in group 1, group 2 and group 3 was 6.7%, 21.2% and 33.3%, respectively（ P >0.05）. The incidence of abnormal IAR of oVEMP in group 1, group 2 and group 3 was 16.7%, 23.1% and 0, respectively（ P >0.05）. cVEMP and oVEMP result levels were significantly correlated with PTA（ r =0.339, P <0.01; r =0.362, P <0.01 ）, respectively. Conclusion: With the progression of MD, the function of saccule-vestibular inferior nerve pathway and utricle-vestibular superior nerve pathway would deteriorate in the same way as hearing., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To observe the effectiveness of vestibular rehabilitation in Ménière's disease patients with chronic imbalance. Methods: Forty-five Ménière's disease patients with chronic imbalance treated in vertigo specialist clinic of Eye and ENT Hospital of Fudan University from December 2020 to December 2021 were enrolled. Patients were divided randomly into two groups, 23 patients in experimental group and 22 patients in control group. Both groups received routine outpatient treatment, and the experimental group received an additional vestibular rehabilitation for 8 weeks. All patients were evaluated with dizziness handicap inventory （DHI） at baseline and 8-week follow-up, and the incidence of fall was calculated. The occurrence of adverse events during the study was also recorded. Results: There was no significant difference in baseline data between the two groups （ P >0.05）. During the study, 1 patient were lost to follow-up and 2 patients dropped out. A total of 42 patients completed the study. Intentionality analysis was performed on lost follow-up patients. After 8 weeks of the treatment, there were significant statistically differences in difference values of DHI and DHI-F scores（ d₁ =-30.22±3.78, d₂ =-13.09±4.85, t =-2.799, P <0.05; d₁ =-12.43±1.46, d₂ =-4.55±2.17, t =-3.043, P <0.05）, while no significant difference was showed in the difference values of DHI-P and DHI-E scores（ P >0.05）. There was no significant difference in incidence of fall between two groups（ P >0.05）, but the incidence of experimental group decreased significantly compared with that before treatment（4.35% vs 34.78%, χ² =4.973, P <0.05）. No serious adverse event was reported in the two groups. Conclusion: Vestibular rehabilitation can improve the balance function and reduce risk of fall in Ménière's disease patients with chronic imbalance. Therefore, it is worthy of clinical application., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To construct a prediction model for Ménière's disease based on neural network and evaluate its prediction ability. Methods: Sixty-four patients with Ménière's disease underwent gadolinium enhanced magnetic resonance imaging of inner ear which showed endolymphatic hydrops. Meanwhile, 40 healthy adults were enrolled as controls. The database of wideband tympanometry of patients and control subjects was analyzed, and the neural network model was established by MATLAB 2021a software. The prediction ability of the model was evaluated by accuracy, positive predictive value, negative predictive value, the Youden index, sensitivity, specificity, receiver operating characteristic curve and area under curve （AUC）. Results: A feedforward network model was built with a single hidden layer to predict Ménière's disease with wideband tympanometry. There were 104 features in the input layer, 13 neuron nodes in the hidden layer and 1 output neuron in the output layer. The accuracy of the model was 83.2%, the positive predictive value was 80.7%, the negative predictive value was 84.3%, the sensitivity was 76.5%, the specificity was 83.7%, the Youden index was 0.602, and the AUC was 0.855. Conclusion: Based on neural network, the prediction model of Ménière's disease with high accuracy was constructed according to the results of wideband tympanometry, which provided reference for the diagnose of Ménière's disease., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To explore the wideband absorbance characteristics of patients with Meniere's disease（MD）. Methods: Wideband acoustic immittance was performed in 52 patients with unilateral Meniere's disease（UMD） and 30 control subjects with normal hearing. All UMD patients underwent pure tone audiometry, 226 Hz acoustic immittance, wideband acoustic immittance, and gadolinium contrast MRI. Sixteen frequency points were chosen to analyze the wideband absorbance at ambient and peak pressure, and the subjects were grouped as UMD group vs. control group and asymptomatic group. The student's t -test was used to compare the absorbance difference between them. Results: Both at peak and ambient pressure, there was a significant difference between the MD group and control group at 1587 Hz, 2000 Hz, 2519 Hz, 3174 Hz, and 4000 Hz; the MD group was lower than the control group（ P <0.05）; there were no differences between the asymptomatic group and the symptomatic group, there also was a significant difference between the asymptomatic group and control group at 1587-4000 Hz（ P <0.05）. Conclusion: The wideband absorbance in MD patients was significantly reduced within the frequency range of 1587-4000 Hz, and wideband acoustic immittance seems to be cost-effective in predicting MD., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

〓 Objective: To analyze the clinical characteristics of patients with benign paroxysmal positional vertigo, summarize experience for diagnosis and treatment activities and to explore the risk factors related to the onset of BPPV and provide reference for early intervention to reduce the risk factor exposure of BPPV. Methods: One hundred and twelve patients with BPPV were included in the study, and clinical data including age, gender, onset symptoms and duration, past medical history and family history were analyzed. A One-way ANOVA was performed on 16 variables using age, gender, diabetes, hyperuric acid, hyperlipidemia, osteoporosis, hypertension, coronary heart disease, stroke, Meniere's disease, suppurative otitis media, vestibular neuronitis, sudden deafness, head injury, ear nose/maxillofacial surgery and autoimmune thyroiditis. The statistically significant parameters of the one-way ANOVA were included in the multivariate regression analysis to explore the independent risk factors for BPPV. Results: Seventy-six cases（67.86%） of BPPV patients were primary BPPV, 36 cases（32.14%） were secondary BPPV（ P <0.01）. The gender composition（male, female）, ears involvement（unilateral, bilateral） and semicircular canal involvement（posterior semicircular canal, horizontal semicircular canal, anterior semicircular canal, mixed type） were different between the two groups（ P <0.05）. During the follow-up period, 34（30.36%） patients relapsed, of which 19（25.00%） were the primary patients and 15（41.67%） were the secondary patients（ P <0.01）. Diabetes（ P =0.004）, osteoporosis（ P =0.017）, hypertension（ P =0.013）, stroke（ P =0.005） and suppurative otitis media（ P =0.031） were related to the onset of BPPV. Conclusion: BPPV patients are mainly primary, while the secondary patients are more likely to relapse after being cured. Diabetes, osteoporosis, hypertension, stroke and suppurative otitis media are independent risk factors for the onset of BPPV., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Twenty-five patients diagnosed with otogenic vertigo at the outpatient clinic of the Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January to June 2020 were selected. Among them, 8 cases were male and 17 cases were female, aged (48±13) years. All the patients underwent internet combined with offline follow-up vestibular rehabilitation for 12 weeks, which included vestibulo-ocular reflex exercises, proprioceptive exercises and static/dynamic balance exercises. Computerized dynamic posturography (CDP) and dizziness handicap inventory (DHI) scores were compared before and after rehabilitation. The DHI score improved significantly after 12 weeks of vestibular rehabilitation (48.3±15.9 vs 26.7±17.9, t =5.319, P <0.001). Meanwhile, the sensory organization test (SOT) score was also improved (73.3±8.1 vs 76.1±6.6, t =2.066, P =0.050), while the difference of motor control test (MCT) latent stage score before and after rehabilitation was not statistically significant (140±13 vs 141±16, t =0.791, P =0.436). The current study demonstrates that vestibular rehabilitation based on mobile internet is convenient, economical and effective, and patients can benefit from it.

Objective: To investigate the frequency characteristics and the pathological characteristics of the horizontal crista ampullaris in patients with Meniere's disease,and to analyse its structural basis. Methods: Between March, 2019 and November, 2019, seventy-two patients diagnosed as Meniere's disease (27 males and 45 females, aged from 13 to 74 years, with a course of disease ranging from 4 months to 32 years)in Shandong Provincial ENT Hospital were included.Caloric test, sinusoidal harmonic acceleration test (SHA), video-head impulse test (v-HIT), Gadolinium-enhanced inner-ear 3D-FLAIR MRI and pure tone audiometry were conducted in the patients. The function of the horizontal semicircular canal in these patients were analysed as well as its relationship with the degree of endolymphatic hydrops,clinical stage and duration. Light microscopy and transmission electron microscopy were used to observe the ultrastructure of horizontal semicircular canal crista ampullaris from six patients with refractory Meniere's disease who underwent labyrinthectomy. The number of type Ⅰ and type Ⅱ vestibular hair cells, the common pathophysiological changes of horizontal semicircular canal crista ampullaris were investigated in these patients. Statistical analysis was performed using SPSS 19.0. Results: With the increase of detection frequency, the abnormal rate decreased gradually. The abnormal rate of caloric test was 69.4% (50/72), SHA 51.4% (37/72), V-HIT 36.1% (26/72), comparation of the positive rate among the three tests showed statistically significant differences( P< 0.05).Neither caloric test nor SHA had correlation with the degree of hydrops( P> 0.05), but v-HIT( r= 0.434, P< 0.01).There was correlation with clinical stage to SHA and v-HIT( r= 0.338,0.462, P< 0.01), except caloric test( P> 0.05).No significant relation was found with caloric test, SHA, v-HIT and course of disease( P> 0.05).Morphological observation found abnormal monolayer epithelialization of the horizontal semicircular canal crista ampullaris significantly decreased number of type Ⅱ hair cells compared with type Ⅰhair cells. Hair cells showed perinuclear vacuolization, cytoplasmic vacuoles, mitochondrial electron density increasement and loss of stereocilia. Conclusions: The horizontal semicircular canal damage in the patients with Meniere's disease has a frequency-dependent characteristic, mainly occurres in low frequency area. With progress of the disease, the high frequency area of ampulla will be impaired gradually, and it is related to the degree of endolymphatic hydrops and hearing level. Hair cell injury would be observed,the frequency characteristics may be more associated with the disorder of type Ⅱ hair cells.

Objective: The aim of this study is to explore the characteristics of ocular muscle vestibular evoked myogenic potential （oVEMP） in patients with Meniere's disease and benign paroxysmal positional vertigo （BPPV-MD）, and to explore the clinical characteristics of oVEMP frequency amplitude ratio （FAR）. Methods: Forty-one patients with unilateral MD diagnosed in the outpatient clinic from January 2016 to April 2019 were selected, of which 15 patients with BPPV-MD were set as BPPV-MD group, and 26 patients with unilateral MD were set as MD group. During the same period, 30 healthy volunteers matched in age and gender were selected as the control group. All the individuals underwent oVEMP and cVEMP recording for 500 Hz and 1000 Hz tone burst. The oVEMP and cVEMP response rate, N1 and P1 waves latency, N1-P1 wave amplitude and 1000/500 Hz FAR of the affected and contralateral ears of the three groups were compared and analyzed by SPSS 20.0 software. The receiver operating characteristics curves were obtained for finding out the criterion point, sensitivity, and specificity of 1000/500 Hz FAR for the diagnosis of BPPV-MD. Results: In response to 500 Hz tone burst, oVEMP response rates in the affected lateral ears of BPPV-MD group, MD group and right ears of control group were 46.67%, 46.15% and 76.67%, respectively; the rates for the 1000 Hz-oVEMP of the three groups were 53.33%, 46.15% and 63.33%, respectively. By the 500 Hz air-conducted tone-burst stimulus, the oVEMP N1 and P1 latency of the affected ears in the BPPV-MD group was longer than that in the MD group and the control group（ P <0.05）. By the stimulus of 1000 Hz tone burst, the oVEMP N1 and P1 latency of the affected ears in BPPV-MD group and MD group was longer than that in control group（ P <0.05）. At 500 Hz, the oVEMP amplitude of the affected ears in BPPV-MD group and MD group was lower than that in the right ears of the control group（ P <0.05）. There was no statistically significant difference in the N1-P1 amplitudes of oVEMP in the three groups under the stimulation of 1000 Hz tone burst（ P >0.05）. The FAR for 1000/500 Hz of the affected ears in BPPV-MD group and MD group was higher than that in control group（ P <0.05）, but there was no significant difference between BPPV-MD group and MD group（ P >0.05）. Conclusion: When FAR is greater than 0.84, which indicates that the pathophysiologic factor is accumulation of excessive amounts of endolymph; when FAR is greater than 1.79, which suggests that the otolitic membrane of the elliptic cyst is damaged by the hydrops of the labyrinthus. The FAR of BPPV-MD can be used as one of the indicators to evaluate the function of the utricle., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To investigate the correlation between the clinical features of low-frequency sudden deafness and endolymphatic hydrops on gadolinium contrast in the inner ear. Methods: From July 2019 to January 2020, adult patients with unilateral low-frequency sudden deafness who were hospitalized in the outpatient clinic or ward of the Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University were selected and examined by audiology and gadolinium magnetic resonance (MR) angiography of inner ear. The same treatment plan was given, and the curative effect was recorded and followed up for more than 3 months. SPSS 20.0 software was used to analyze the correlation between the accompanying symptoms, deafness, and endolymphatic hydrops. Results: A total of 48 patients were included in the study, including 18 males and 30 females. The age ranged from 21 to 52 (37.3±10.0) years. All of them were unilateral, including 28 cases of left ear and 20 cases of right ear. The course of the disease was less than 2 weeks in all cases. The endolymphatic hydrops group included 14 cases, including vestibular hydrocele (6 cases), cochlear hydrops (2 cases), and cochlear and vestibular hydrops (6 cases). The incidence of dizziness in the endolymphatic hydrops group was higher than that in the non-hydrops group (6/14 vs 0/34, P <0.001). There was no significant difference in hearing values between the two groups at 125, 250, 500, 4 000 and 8 000 Hz (all P >0.05). The hearing in the endolymphatic hydrops group was worse than that in the non-hydrops group at 1 000 and 2 000 Hz. Conclusion: Compared with those without endolymphatic hydrops, patients with hydrops tend to have a higher incidence of dizziness, worse hearing at 1 000 and 2 000 Hz, and a worse prognosis.

Objective: To analysis the etiological characteristics of patients with vertigo in Xinjiang Uygur Autonomous Region. Method: The data of 1027 patients with vertigo and dizziness were collected and the etiology was analyzed. Result: The patients aged 51-60 years accounted for 27.95% of the total, followed by those aged 61-70 years accounted for 20.16% and those aged 41-50 years accounted for 17.33% s. There were 363 males and 664 females with a ratio of 1∶1.8. Benign paroxysmal positional vertigo （BPPV） was the most common cause in 233 cases （22.69%）, followed by vestibular migraine （VM） in 184 cases （17.92%）, Meniere's disease （MD） in 139 cases （13.53%）, sudden deafness with vertigo in 132 cases （12.85%）, and unknown cause in 114 cases （11.10%）. Conclusion: Among vertigo patients, women are significantly more than men. BPPV, VM, MD, and SHL are the most common vertigo causes. There are still some patients haven't received definite diagnosis., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

"Otogenic vertigo()" is a new disease name of modern traditional Chinese medicine(TCM), which is equivalent to otogenic vertigo of modern medicine.TCM has observed vertigo symptoms very early, and otogenic vertigo is included in many diseases recorded in ancient Chinese medicine, such as "xuanmao ()" , "diaoxuan()" , "vertigo()" , "wind vertigo()" , "true vertigo()" , etc. "True vertigo" is closer to the current otogenic vertigo than others. "Otogenic vertigo" is a new disease name created by experts of TCM otorhinolaryngology in the context of integrated Chinese and Western medicine.It was born in the 4th and 5th edition of Otorhinolaryngology of Traditional Chinese Medicine which is national unified textbooks of TCM. "Otogenic vertigo" has become a standard term , and it has been almost uniform definition, as its corresponding modern medicine diseases. The definition of vertigo in modern TCM internal medicine is broad, and otogenic vertigois also included.

Objective: To analyze the clinical features of Vestibular migraine（VM） and provide evidence for its accurate diagnosis and medical identification of flight personnel. Method: A total of 490 samples of VM patients were collected. Among them, 88 samples were secondary to benign paroxysmal positional vertigo（BPPV）, and 11 samples were co-occurring with Meniere's disease（MD）. All patients received drugs, lifestyle management, vestibular rehabilitation and other comprehensive treatment, and analyzed the clinical features and effect within 6 months. Result: ①The male-female ratio of VM patients was 1∶1.95, the average age was （50.2±14.3） years old, （48.7±15.0） years old for males and （51.0±13.9） years old for females. No statistically significant differences were found（ P >0.05）. The average duration was（54.5±84.8） months, （35.0±59.0） months for males and（64.7±94.0） months for females. The difference was statistically significant（ P <0.05）. ②The main clinical symptoms are dizziness, migraine or previous history of migraine, fear of sound/noisy environment sensitivity, photophobia/visual sensitivity, nausea/vomiting, vestibular posture symptoms, tinnitus, hearing loss, etc. , diarrhea during dizziness or headache was one special symptom of VM; ③The abnormal rate of vestibular autorotation test（VAT） in 118 VM patients was 72.3%, while the abnormal rate of caloric test in 170 VM patients was 32.9%; ④The effective remission rate within 6 months of VM patients with secondary BPPV and MD was 78.6% and 83.4%, while the VM patients without secondary benign paroxysmal positional vertigo（BPPV） and Meniere's disease（MD） was 93.3%. The difference was statistically significant（ P <0.05）. Conclusion: The clinical manifestations of VM patients were various. Female VM patients had higher incidence, the course of disease than male VM patients, diarrhea can be regarded as one of the clinical features distinguished from MD. The abnormal rate of VAT was higher in the common clinical examiniations of VM patients. VM patients treatment should focus on personalized prescription and lifestyle management, vestibular rehabilitation, and corresponding treatment at the same time should be given to patients with secondary BPPV and MD to improve the efficacy. The medical identification of flight personnel VM patients should be strictly controlled, pilots should be grounded, while flight combat personnel and flight technical personnel need chartered medical identification., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To investigate the prognostic factors of patients with low-frequency type of sudden sensorineural hearing loss. Methods: From February 2017 to February 2019, adult patients with unilateral low-frequency type of sudden sensorineural hearing loss in Department of Otological Medicine, Shandong Provincial ENT Hospital, Shandong University were selected. All patients were examined by audiology, vestibular function evaluation, imaging examination and serum thyroid function test; the same treatment program was given, the curative effect was recorded and followed up for more than 3 months. SPSS 20.0 software was used to analyze concomitant symptoms (tinnitus, ear tightness, echo, rotatory vertigo), degree of deafness, inducement of deafness, basic disease, vestibular function (caloric test), electrocochleogram, inner ear gadolinium enhanced MRI radiography and thyroid function on prognosis of patients. Results: Among the 155 patients, 76 cases were cured (49.0%), 1 case was markedly effective (0.6%), 19 cases were effective (12.3%), and 59 cases were ineffective (38.1%). The total effective rate was 61.9%. Among them, 24 cases (15.5%) had hearing fluctuations during follow-up, and 1 case (0.6%) developed Meniere's disease. Univariate analysis showed that vestibular function, electrocochleogram and inner ear MRI were correlated with prognosis. Multivariate logistic analysis showed that ear tightness, vestibular function, electrocochleogram and inner ear MRI were correlated with the prognosis of the patients. The two analyses showed that tinnitus, echo, rotational vertigo, degree of deafness, predisposing factors and underlying diseases were not significantly correlated with the prognosis of the patients (all P >0.05). Rotational vertigo was closely related to gender, and women had a high incidence. There was a significant correlation between the degree of deafness and prognosis in patients with course of less than 1 week ( P <0.05). The abnormal rate of vestibular function in patients with course of disease ≤ 1 week was significantly different from that>1-≤2 and>2-≤4 weeks ( P <0.05). The rate of abnormal thyroid function was significantly higher than that of normal people ( P <0.05), but there was no significant correlation between thyroid dysfunction and hearing prognosis (χ(2)=0.009, P =0.923) . Conclusions: The prognosis of low-frequency sudden sensorineural hearing loss is not related to clinical symptoms, inducements, underlying diseases and serological abnormalities of thyroid function, but the degree of deafness is positively related to the prognosis within 1 week from onset. Abnormal thyroid function is one of the risk factors of happening with low-frequency descending sudden deafness. Abnormal vestibular caloric test, electrocochleogram and endolymph hydrops are the factors of poor prognosis.

A 38-year-old woman had suffered from recurrent vertigo, deafness and tinnitus for 2 years. After treatment for Meniere's disease, her symptoms did not improve. The threshold of pure tone audiometry was 68dBHL SNHL. High resolution CT of the temporal bone showed that a mass is behind the posterior semicircular canal. MRI showed that mixed signals are in the center of the mass and long T1T2 signal around the mass. The mass was surgically resected. Pathology report showed: endolymphatic sac tumor., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To investigate the long-term efficacy of semicircular canal occlusion in the treatment of refractory Meniere's disease. Method: Fifteen patients with Meniere's disease who underwent semicircular canal occlusion were reviewed. The preoperative and postoperative frequency of vertigo ,quality of life, hearing and tinnitus level were compared. All patients were followed for more than 24 months. Result: Postoperatively, vertigo was controlled effectively in all 15 cases, and the control rate was 100%, of which 11 cases were completely controlled（Grade A） and 4 cases were basically controlled（Grade B）. The improvement rate of quality of life was 100%. The hearing worse in 4 cases（26.7%） and stabilized in 11 cases（73.3%）. The tinnitus was relieved in 7 cases（46.7%）, unchanged in 7 cases（46.7%） and aggravated in 1 case（6.7%）. Conclusion: Semicircular canal occlusion can effectively control the vertigo symptoms of refractory Meniere's disease and improve the quality of life. The long-term efficacy of semicircular canal occlusion is definite, but there is a risk of hearing loss., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Inner ear disease is characterized by tinnitus, deafness and vertigo. The pathogenesis remains unknown. In the past, it is considered to be related to vascular disease such as thrombus and hemadostenosis.However, more and more researches indicate that it may be associated with multiple factors mediated by allergy. This paper reviews some possible pathogenesis of Meniere disease, including type Ⅰ allergy, autoimmunity, circulating immune complex and immune genetic.

Objective: To study the shift of oVEMP frequency tuning of unilateral Meniere's disease, by analyzing oVEMP of air-conducted tone bursts in various frequencies. Methods: From May 2016 to October 2017, 33 patients with unilateral Meniere's from Aerospace Center Hospital were tested for oVEMP in 500 Hz and 1 000 Hz air-conducted tone bursts respectively, and 20 healthy subjects(40 ears), matched for age and sex, were used as healthy control. The amplitudes of the N1-P1 wave and the frequency amplitude ratios of 500/1 000 Hz in affected ears, unaffected ears and normal ears were compared; and receiver operating characteristic curve was analyzed for frequency amplitude ratios of 500/1 000 Hz. Results: By the 500 Hz tone-burst stimulus, the provocation rates of the oVEMP were 84.9%(28/33), 93.9%(31/33) and 97.5%(39/40) in affected ears, contralateral ears and the ears of normal controls, respectively. By the stimulus of 1 000 Hz tone-burst, the provocation rates of the oVEMP were 81.8%(27/33), 87.9%(29/33) and 82.5% (33/40) in affected ears, contralateral ears and normal control ears, respectively. Amplitudes of N1-P1 waveforms in 500 Hz air-conducted tone bursts in affected ears were under normal control ears and contralateral ears. There was significant difference between affected ears and healthy control ears ( P <0.05). Amplitudes of N1-P1 waveforms in contralateral ears were also significantly smaller than those in normal control ears ( P <0.05). There were no significant differences in amplitudes of N1-P1 waveforms between affected ears, contralateral ears and normal control ears in 1 000 Hz tone bursts stimulus( P >0.05). Frequency amplitude ratios of 500/1 000 Hz in affected ears were significantly under contralateral and normal control ears ( P <0.05). According to ROC, the frequency amplitude ratio critical value of frequency tuning was set as 1.17, the positive rate of frequency tuning shift in affected ears was 54.5%(18/33) and significantly higher than in contralateral ears(18.2%, 6/33, χ(2)=9.429, P =0.002) and normal control ears (7.5%, 3/40, χ(2)=19.530, P =0.000). In contrast, there was no significant difference in the incidence of frequency tuning shift between contralateral ears and normal ears(χ(2)=1.909, P =0.167). Conclusions: Frequency tuning oVEMP with Meniere's disease will be changed.Frequency tuning of oVEMP with Meniere's disease shifts from low frequency region to high frequency region in comparison with healthy people. Frequency amplitude ratio is helpful for diagnosis of Meniere's disease.

Objective: To study the relationship between the average hearing of different frequencies and the audiometry staging in patients with Meniere's disease. Methods: A total of 259 patients from 1996 to 2016 were collected .All patients underwent pure tone audiometry, of which 93 patients underwent 3 000 Hz audiometry. The patients were divided into five groups according to the frequencies of hearing(Ⅰ: 500, 1 000, 2 000, 3 000 Hz; Ⅱ: 250, 500, 1 000, 2 000, 3 000 Hz; Ⅲ: 250, 500, 1 000, 2 000; Ⅳ: 500, 1 000, 2 000, 4 000 Hz; Ⅴ: 500, 1 000, 2 000 Hz), then calculated the average audiometry and made the hearing staging. The obtained data were analyzed by chi-square test and Bonferroni correction was performed among the groups, P <0.05 was defined as a statistically significant criterion. Result: There were no significant difference between the five groups( P =0.441>0.05). Conclusions: The choice of different pure tone audiometry frequency has no significant effect on the hearing staging. It would be more likely upstaging when plus 250 Hz. There is no statistically significant difference in staging between the latest guidelines and the 1995 guidelines.500, 1 000 and 2 000 Hz are recommended when 3 000 Hz examine is not available.

Objective: To analyze the clinical features and imaging characteristics of Meniere's disease (MD)verified by intravenous gadolinium contrast-enhanced magnetic resonance imaging(MRI). Methods: A total of 174 patients with Meniere's disease were involved in this study between March 2016 and October 2017. All of them underwent 3D-fluid attenuated inversion recovery (FLAIR) MRI and presented endolymphatic hydrops and clinical characteristics of suspected Meniere's disease. The clinical characteristics, the grades of endolymphatic hydrops (EH) using Nakashima grading standard were analyzed, and the correlation between grade and clinical features was evaluated. Results: There were totally 174 patients (88 males, 86 females), with the age of 7-83 years [mean age of (51.0±15.0)] years. Age of onset and disease course was 7-83 years [mean age of (44.6±16.6) years], 36.0 (12.0, 111.0) months (from 2 days to 70 years), respectively. EH was found in all the patients, and 169 cases (97.1%) manifested as modest or severe hydrops. Among the 174 patients, 139 cases (79.9%) presented unilateral EH, and 35 cases (20.1%) presented bilateral EH. The degree of EH in the latter was more serious than the former. For 174 patients, clinical characteristics were inconsistent, which was not in accord with the existing diagnostic criteria. Furthermore, there was a correlation between degree of hydrops and degree of hearing loss ( P <0.05). Conclusions: EH in Meniere's disease can be measured objectively by intravenous gadolinium contrast-enhanced MRI. Clinical characteristics in MD verified by EH are not accordant with the existing criteria, which means the significance of EH in diagnosis of MD. Moreover, there's a correlation between degree and distribution of hydrops and degree of hearing loss.

Objective: To explore the spectrum of causes for patients with vertigo or dizziness in the Department of Neurology, and provide a reference for diagnosis and treatment of patients with vertigo or dizziness. Methods: Clinical data of patients in the Department of Neurology, Baotou Central Hospital between January 2016 and September 2017 was retrospectively analyzed. The target group under study was diagnosed based on the uniform diagnostic criteria. Results: A total of 9 200 patients with a chief complaint of vertigo or dizziness were included. The ratio of male to female was 1∶1.8, with an age range of 19 to 85 years. The different etiology was as follows: benign paroxysmal positional vertigo (BPPV) (3 148 cases, 34.22%), persistent postural-perceptual dizziness (PPPD) (2 006 cases, 21.80%), vertigo caused by cerebrovascular diseases (1 463 cases, 15.90%), vestibular neuritis (741 cases, 8.05%), vestibular migraine (536 cases, 5.83%), vestibular paroxysmia (336 cases, 3.65%), Ménière disease (187 cases, 2.03%), drug-induced vertigo (96 cases, 1.04%), neurological degenerative diseases (74 cases, 0.80%), sudden sensorineural hearing loss (51 cases, 0.55%), multiple sclerosis and neuromyelitis optica (21 cases, 0.23%), other reasons (22 cases, 0.24%), unknown reasons (519 cases, 5.64%). Conclusions: Dizziness is resulted from various causes, and BPPV is the most common reason. Vertigo caused by cerebrovascular diseases appears to gradually increase along with age. PPPD is very common in clinical practice, so clinicians needs to be highly aware of BPPV and PPPD. Although those dizziness diseases have a low incidence, they should not be ignored. There are still certain proportion of vertigo patients whose diagnosis are undetermined.

Objective: To investigate the long-term efficacy of endolymphatic sac mastoid drainage for Ménière disease. Method: Data from 26 patients diagnosed with MD strictly meeting the criteria issued by " Guideline of diagnosis and treatment of Meniere disease(2017)" from 2006 to 2015 were analyzed in this study.Endolymphatic sac mastoid shunt surgery was performed for each patient.The therapeutic effect was evaluated against the " Guideline of diagnosis and treatment of Meniere disease(2017)".Vertigo control and auditory function were measured after at least two years follow up. Result: In 26 cases,16 cases were male and 10 cases were femaleThe age ranged from 24 to 71 years old,with an average of 52.04 years.The disease duration ranged from 1 to 32 years.22 cases were diagnosed as unilateral Ménière disease,and bilateral involvement was identified in 4 cases,thus a total of 30 ears were included.According to the preoperative staging of hearing,there were 0 cases in stage one,5 cases in stage two,16 in stage three and 9 cases in stage four.15 cases(57.7%)achieved class A vertigo conrol(complete control),9 cases(34.6%)class B(substantial control)and 2 cases(7.7%)class D(no control).The severity of vertigo and its impact on daily life were improved in 24 cases(92.3%)with a score of 0 point,and 2 cases(7.7%)scored 2 points.Post-operative hearing was improved in 3 cases(11.5%),unchanged in 16 cases(61.6%)and worsened in 7 cases(26.9%).After operation,tinnitus disappeared in 5 cases(19.2%),reduced in 13 case(50%)and unchanged in 8 cases(30.8%). Conclusion: Endolymphatic sac mastoid drainage was an effective and safe management for intractable Ménière disease patients with pre-operative residual hearing.The occurrence of complication was unsual.The patients who are in stage four could gain benifits from the surgery.

Objective: To evaluate the difference in c/oVEMPs between patients with MD and normal controls. Method: Twenty-two patients with unilateral MD and 21 healthy subjects (as normal controls) were prospectively examined with c/oVEMPs. The results were compared between these two groups. MD group were divided into two groups according to the pure tone average threshold: group1 PTA≤40 dBnHL,group2 PTA>40 dBnHL,and then compared their results. A commercially available software package SPSS 19.0 was used for statistical analysis. Result: The latency and amplitude of cVEMP and oVEMP in the affected side and contralateral side of the MD group were no significant difference. Compared with normal controls,the latency of P1 and N1 was prolonged,the amplitude was decreased in the MD group's cVEMP. The amplitude was decreased in the MD group's oVEMP,but the latency was not prolonged. Group 2's extraction rate of cVEMP was significantly lower than group 1. Conclusion: An increased occurrence of abnormal c/oVEMP recordings appeared in MD patients,possibly as a result of hydrops of the otolith. The saccular dysfunction may be more common than utricular dysfunction. Furthermore,that otolith damage is gradually increasing with the aggravation of cochlear injury in MD., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To observe the features of air-conducted sound elicited ocular vestibular-evoked myogenic potential(ACS-oVEMP) and cervical vestibular-evoked myogenic potential(ACS-cVEMP) in patients with Meniere disease (MD). To analyze the relationship between air-conducted sound elicited vestibular-evoked myogenic potentials (ACS-VEMP) responses and clinical stages of disease, as well as its clinical application of cervical and ocular vestibular evoked myogenic potentials in MD. Method: Fifty six patients with MD and 50 normal subjects (100 ears) were recruited for conventional cVEMP and oVEMP examinations. Grades of vestibular function were also collected for patients with MD. The relationship between VEMPs abnormity, grades of vestibular function and clinical stages of MD were analyzed. Results: The abnormal rates of cVEMP and oVEMP in MD patients were 57.1% (32/56) and 64.3% (36/56), which were significantly higher than those in normal subjects respectively (χ 2 =22.286, P =0.000; χ 2 =15.217, P =0.000). The abnormal rates of cVEMP and oVEMP in MD patients of stage Ⅰ to stage Ⅳ were 20.0% (1/5) and 40.0% (2/5), 50.0% (9/18) and 50.0% (9/18), 59.3% (16/27) and 70.4% (19/27), and 100.0% (6/6) and 100.0% (6/6) respectively. There was a significant difference in cVEMP abnormity between four stages of MD patients ( P =0.046). Significant correlation was found between clinical stages and the grades of vestibular dysfunction ( r s =0.417, P =0.001). Conclusions: Dysfunction of vestibular otolithic organs and their input pathways in patients with MD can be detected by cVEMP and oVEMP tests. The abnormal rates of VEMP could show an gradually increasing trend with the development of MD stages. And the extent of vestibular lesions could be detected by cVEMP and oVEMP tests, which may provide a reference for clinical staging of MD.

Meniere disease is a unique, progressive disease of the inner ear. The complex manifestation presents diagnostic challenges. It is difficult to diagnose due to the absence of typical presentations especially in the early stages. The cochlear symptoms often present prior to vertigo and tend to be ignored. Therefore, focusing on the cochlear symptoms and functions may provide information for early diagnosis and may protect the patients from acquiring a hearing disability. This review focused on the pure-tone audiometry, glycerin test, distortion product otoacoustic emissions, auditory brainstem response, electrocochleogram, multifrequency tympanometry, and speech audiometry, which hopefully could emphasize the importance of the symptomatic and functional findings of cochlear, and be helpful in diagnosis for Meniere disease.

Objective: To evaluate semicircular canal damage and its frequency characteristics in Meniere disease patients. Methods: Sixty-seven Meniere disease patients accepted the video-head impulse test(vHIT)which responses to semicircular canal function of high frequency area, head shaking test(HST) which responses to semicircular canal function of middle frequency area, and caloric test(CT) which responses to semicircular canal function of low frequency area.Preferences were recorded including the video head impulse test gain (vHIT-G), head shaking nystagmus (HSN) and parameters of the unilateral weakness (UW) as observation index, and results of all the three tests were analyzed according to Meniere disease patients. SPSS 17.0 software was used to analyzed the data. Results: The positive rate of CT, HSN and vHIT were 70.1%(47/67), 41.8%(28/67) and 23.9%(16/67) respectively. Comparation of the positive rate among CT, HST and vHIT showed statistically significant difference (χ 2 =10.93, P =0.001; χ 2 =28.79, P =0.000). Comparation of the positive rate between HST and vHIT showed statistically significant difference(χ 2 =4.87, P =0.027). Conclusions: Semicircular canal function damage in Meniere disease patients mainly presents in the low frequency area, which indicates a characteristic phenomenon that low-frequency function area (caloric test results) is more predisposed to be involved than that of middle-frequency function area (head shaking testing)and high-frequency function area (video head impulse testing) in Meniere disease patients.

Objective: To investigate the efficacy of semicircular canal occlusion in the treatment of intractable Ménière's disease in stage 3 or 4. Method: Retrospective analysis of clincal date of twenty-nine patients who were referred to our institute and diagonsed with Ménière's disease. According to the preoperative staging of hearing, there were 12 cases in stage 3 and 17 cases in stage 4, and all patients underwent semicircular canal occlusion. The preoperative and postoperative frequency of vertigo, hearing, caloric test, functional level and tinnitus level were compared. Postoperative following-up period was 6-23 months, with an average of 13 months. Result: Postoperatively, vertigo was controlled effectively in all 29 cases, of which 26 cases(89.7%) were completely controlled and 3 cases(10.3%) were basic controlled. The hearing stabilized in 25 cases(86.2%), worse in 2 cases(6.9%) and improved in 2 cases(6.9%). The semicircular canal function of all patients were in low status by caloric test. The rate of tinnitus relief and functional improvement was 41.4%(12/29) and 96.6%(28/29). Conclusion: Semicircular canal occlusion is an effective measure for treatment of Ménière's disease in stage 3 or stage 4, especially in controlling vertigo and improving functional level, but the long-term follow-up is necessary., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Starting from rational bases for a genetic approach to Ménière's disease (MD), we explored the numerous reports published in literature and summarized the recent advances in understanding of the genetic fundaments of the disease. The research advances related to the genetic fundaments of MD were reviewed. The incidence of MD presents as familial clustering and hasdifference in geographical and racial, no certain gene associated with MD was found. At present, studies concentrate on those genes, such as human leukocyte antigen (HLA), DFNA9, chromosome 12, macrophage migration inhibitory factor(MIF), KCNE, and heat shock protein (HSP). However, there have much arguments in diagnose, classify and pathophysiology of MD, resulting in different conclusion and prospect. The characteristics of MD strongly suggest a certain role for genetic factors in the development of MD, no convincing evidence for an association with any gene exists. To make a more strict quality control and continue explore the genetic factors of MD, will be meaningful in the future., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To evaluate the correlation between type Ⅰ allergic reaction and pathogenesis of Meniere's disease. Methods: A total of 35 (10 male vs. 25 female) patients aged between 21-66 years diagnosed with Meniere's disease were recruited to this study, mean age of them was (47.3±13.6) years. The control group consisted of 15 inpatients (5 male vs. 10 female) with pharyngolaryngeal diseases but without otologic and rhinologic abnormity, mean age was 45.4±12.8 years. Allergic prevalence, serous total immunoglobulin E( tIgE ) levels, serous specific immunoglobulin E( sIgE ) levels and subtypes of T lymphocytes were measured and compared in patients with Meniere's disease and the control group. Severity of vertigo, tinnitus and sensation of fullness were compared between Meniere ' s disease patients with or without allergy. Results: Allergic prevalence were significantly different ( Pearson chi - square 5.832, P <0.05) between patients with Meniere ' s disease and the control group(57.1% vs . 20.0%). Patients with Meniere's disease report higher level of serous tIgE compared with controls, the difference is statistically significant ( Z =168.000, P <0.05). However, positive rates of sIgE of food allergens and inhalant allergens were not significantly different between patients with Meniere's disease and the control group. Scores of vertiginous severity, dizziness handicap inventory (DHI) and tinnitus handicap inventory (THI) were significantly different between Meniere's disease patients with or without allergy ( P <0.05). Treg and Treg/Th17 levels ( Z =26.000) were much higher in Meniere's disease patients with allergy than in the controls( P <0.05). Conclusions: Patients with Meniere's disease report higher rate of allergy than the control group. Type Ⅰ allergic reaction is thought to be one of the possible reasons that may induce endolymphatic hydrops and lead to Meniere's disease.

Objective: To evaluate the feasibility of combining simultaneous triple semicircular canal plugging (TSCP) and cochlear implantation (CI) to treat vertigo and hearing loss in advanced Meniere's disease(MD) patients, so as to provide an alternative surgical procedure for treating this disorder. Methods: Data from seven patients, who were referred to our hospital and diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee (2006), from Jan. 2015 to Jan. 2016, were retrospectively analyzed in this work. Seven patients, in whom the standardized conservative treatment had been given for at least one year and frequent vertigo still occurred, underwent simultaneous TSCP and CI under general anesthesia via mastoid approach. Postoperative follow-up time was more than six months. Vertigo control and auditory function were measured. Pure tone audiometry, speech perception scores, caloric test, head impulse test (HIT), and vestibular evoked myogenic potential (VEMP) were performed for evaluation of audiological and vestibular functions. Results: All patients had bilateral severe sensorineural hearing loss preoperatively. One side hearing loss was due to MD and another side was due to reasons including sudden sensorineural hearing loss, mumps and other unknown reason. The total control rate of vertigo in seven MD patients was 100.0% in the six-month follow-up, with complete control rate of 85.7% (6/7) and substantial control rate of 14.3% (1/7). Improved hearing threshold and speech perception scores were observed in all study participants. Postoperative average aided hearing threshold was 32.5 dBHL, the average monosyllabic word score was 42.6% and speech perception scores of sentences tested in quiet was 52.3%. Tinnitus improved in five cases, and no significant change in two patients. Post-operatively, all patients suffered from temporary vertigo and balance disorders. Vertigo was disappeared in all patients within 3-5 days, while, an average recovery time of balance disorders was 19.7 days. Six months after treatment, loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in cVEMP or oVEMP test was noted. All patients had no facial paralysis, cerebrospinal fluid leakage, and other complications. Conclusions: A combined approach of TSCP and CI which could control vertigo effectively and improve hearing loss and tinnitus represents an effective and safe therapy for some advanced MD patients.

Objective: Department of Otolaryngology Head and Neck Surgery,Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai Jiaotong University Ear Institute,Shanghai,200092,China This study was designed to study the correlation between endolympahatic hydrops image results and auxiliary examinations by magnetic resonance imaging after intratympanic administration of gadolinium in both ears in unilateral Meniere's disease patients.Meanwhile,the contralateral endolympahatic hydrops of the "asym ptomatic " ear in patients with unilateral Meniere's was also observed. Method: Thirty-one patients with unilateral Meniere's disease were enrolled in this study.All the patients underwent pure tone audiometry,electrocochleography(ECochG),cervical-vestibular evoked myogenic potentials(cVEMP) before intratympanic gadolinium contrast agents injected.All the patients underwent three-dimensional fast fluid attenuated inversion recovery sequence magnetic resonance imaging(3D-FLAIR MRI) after intratympanic gadolinium contrast agents injected 24 hours.The images were graded in accordance with the severity of endolympatic hydrops.Spearman correlation analysis was performed between the scores of the images and results of auxiliary examination results.Meanwhile,Student's t test was performed for the significance test of the age,duration of the disease and the hearing level of the affected ears between the group with contralateral endolympatic hydrops and the group without contralateral endolympatic hydrops. Result: Pure tone average and the degree of the cochlear hydrops( r =0.383, P <0.05),the SP/AP ratio and the degree of the cochlear hydrops( r =0.496, P <0.01),and interaural amplitude difference and the degree of the vestibular hydrops( r =0.635, P <0.01) showed a significant correlation.The duration of the disease[(6.7±6.3) years vs(2.9±3.1) years, P <0.05] and the hearing level of the affected ear[(70.3±7.4)dB vs(52.5±3.8)dB, P <0.05)] showed a significant difference between the group with contralateral endolympatic hydrops and the group without contralateral endolympatic hydrops. Conclusion: Pure tone average and the degree of the cochlear hydrops,-SP/AP ratio and the degree of the cochlear hydrops,and interaural amplitude difference and the degree of the vestibular hydrops also showed a significant correlation,which suggesting that MRI image can reflect the auditory-vestibular function in patients with Meniere's disease.Endolympatic hydrops and hearing loss are closely related,but not necessarily result in Meniere's disease symptoms.Patients with longer duration of the disease and worse hearing in the affected ears are more likely to develop bilateral endolympatic hydrops., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To study the effect of low-dose gentamicin intratympanic therapy on intractable Meniere's disease on hearing. Method: One hundred and forty cases of patients with ENT intractable Meniere's disease were selected in this clinical trial study,all patients were enrolled in the drum line intraventricular injection of low-dose gentamicin treatment.After two weeks' treatment in hospital,the patients followed-up for 1 years,all patients did pure tone audiometry,speech audiometry and on hearing threshold changes before and after treatment were comparatively analyzed; continu followed-up for 1 year and the patients' Meniere's disease therapeutic effect were analyzed. Result: After treatment,the follow up within a year of 120 patients(140 cases,20 cases were lost),36 cases never attack of vertigo symptoms,the total effective rate was 91.7%; all patients before treatment speech frequency was(67.2±2.1) dB after treatment(65.5±2.0) dB,the difference was not statistically significant( P >0.05); In the group of gentamicin treatment,all patients 1-3 kHz compare hearing thresholds and changes of 8 kHz before and after injection,the difference was not statistically significant( P >0.05); tinnitus,ear fullness episodes of a significant reduction in the overall incidence rate dropped to 2% from 7% after treatment,the difference was statistically significant( P <0.05) . Conclusion: For intractable Meniere's disease,a small dose of gentamicin intratympanic have a positive clinical effect,and no significant effect on hearing Thus,it is a worthy of promotion and application for low dose gentamincin intratympanic injection in intractable Meniere's disease., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To investigate the effect of prophylactic migraine therapy in controlling vertigo episode of Meniere's disease. Method: We prospectively collected 16 cases of familial Meniere' disease diagnosed in our vertigo outpatient. The patients were divide into without migraine group (WOM) and with migraine group (WM). Give WM group a prophylactic therapy for migraine and compare within groups about the follow-up results of vertigo episodes. Result: WOM group had better results in controlling vertigo, then the controlling effect equaled after we added a prophylactic therapy for migraine. Conclusion: Combined with prophylactic migraine therapy may have better effect in accompanying migraine patients when controlling familial Meniere's disease., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To observe the ocular vestibular evoked myogenic potential (oVEMP) and the cervical vestibular evoked myogenic potential (cVEMP) in patients with vestibular diseases., Method: From March, 2011 to March, 2012, 13 patients (14 ears) with peripheral vestibular diseases were recruited. Each patient underwent conventional oVEMP and cVEMP examinations elicited by intensive air conducted sound (short tone burst, 500 Hz) in bilateral ears., Result: Thirteen cases (14 ears) were included in this study. They were 3 cases (3 ears) with Ramsay Hunt syndrome, 3 cases (4 ears) with acoustic neuroma, 1 case (1 ear) with VII and VIII cranial nerve trauma after head injury, 2 cases (2 ears) with vestibular neuritis, 3 cases (3 ears) with Meniere's disease, and Icase (1 ear) with unilateral hypoplasia of the internal auditory canal. Altogether, oVEMP could be elicited in only 2 ears (14. 3%) and cVEMP were found abnormal in 11 ears (78. 6%)., Conclusion: The otolithic vestibular end organs and their input pathways could be examined by cVEMP and oVEMP examinations in patients with peripheral vestibular disorders.

Objective: To explore the causes of emergency dizziness stratified to improve the diagnostic efficiency., Methods: A total of 1 857 cases of dizziness at our emergency department were collected and their etiologies stratified by age and gender., Results: The top three diagnoses were benign paroxysmal positional vertigo (BPPV, 31.7%), hypertension (24.0%) and posterior circulation ischemia (PCI, 20.5%). Stratified by age, the main causes of dizziness included BPPV (n = 6), migraine-associated vertigo (n = 2), unknown cause (n = 1) for the group of <18 years; BPPV (51.5%), migraine-associated vertigo (14.5%) and neurosis (7.3%) for 18-44 years; BPPV (36.8%), hypertension (22.4%) and migraine-associated vertigo (11.2%) for 45-59 years; hypertension (30.8%), PCI (29.8%) and BPPV (22.9%) for 60-74 years; PCI (30.7%), hypertension (28.6%) and BPPV (25.5%) for 75-92 years. BPPV, migraine and neurosis were more common in females while hypertension and PCI predominated in males (all P < 0.05)., Conclusion: As the main causes of emergency dizziness, BPPV, PCI, hypertension, neurosis and migraine showed the following significant demographic features: BPPV, PCI, hypertension, neurosis and migraine may be the main causes of dizziness. BPPV should be considered initially when vertigo was triggered repeatedly by positional change, especially for young and middle-aged women. And the other common causes of dizziness were migraine-associated vertigo, neurosis and Meniere's disease.Hypertension should be screened firstly in middle-aged and elderly patients presenting mainly with head heaviness and stretching. In elders with dizziness, BPPV is second in constituent ratio to PCI and hypertension.In middle-aged and elderly patients with dizziness, psychological factors should be considered and diagnosis and treatment should be offered timely.

Objective: To investigate and analyze the status of anxiety and depression among patients with four types of peripheral vertigo., Method: The clinical data of patients with one of the four types of peripheral vertigo, namely benign paroxysmal positional vertigo (BPPV), vestibular migraine (VM), Menière's disease (MD), and vestibular neuritis (VN), were collected. Thorough otological and neuro-otological examinations were performed on these patients, and their status of anxiety and depression were assessed using self-rating anxiety scale (SAS) and self-rating depression scale (SDS)., Result: A total of 129 patients with one of the four types of peripheral vertigo(49 cases of BPPV, 37 cases of VM, 28 cases of MD and 15 cases of VN) were included in the study. The scores of SAS and SDS were higher in the patients with VM or MD than those with BPPV or VN (P < 0.05), and the incidence of anxiety (VM = 45.9% MD = 50.0%) and depression (VM = 27.0% MD = 28.6%) were higher in the patients with VM or MD than those with BPPV or VN (P < 0.05). Paired comparisons showed the differences between the incidences of BPPV and MV groups, BPPV and MD groups, and MD and VN groups were statistically significant (P < 0.05)., Conclusion: Among patients with different types of peripheral vertigo, anxiety/depression is more common in patients with VM or MD. This may be due to the different mechanisms involved in different types of vertigo, as well as differences in the prevention and self-control of the patients against the vertigo.