Viral etiology of Meniere's Disease

UPDATE: Here is the most up-to-date version of the posting, with permanent links to the .pdf documents:
http://www.menieres.org/forum/index.php/topic,22821.msg403200.html#msg403200

This is the original posting:


Since MM is ideopathic (meaning, they don't know what causes it) treatment for MM has traditionally focused on reducing the symptoms. This often takes the form of low-salt diets, medication to suppress vestibular balance (valium, antivert, etc) and to deal with the anxiety (valium, xanax, anti-depressents). More aggressive treatment of symptoms include steroids (both oral and in-ear injections) and the most radical treatments include destroying the inner ear's functionality with Gent injections, or nerve resections.

It is likely that MM can occur for any of a number of reasons. I have come to believe, over the past week, that my problem is an allergy to wheat (not gluten, but wheat itself). For years, scientists have suspected a viral etiology (cause), usually with one of the Herpes Simplex Virus (HSV) or the Herpes Zoster Virus (VZV).

I have compiled a list of all of the studies I could find on PUBMED, a listing of scientific papers provided by the US National Institutes of Health. Being included on this list does not mean that the NIH approves of the conclusions that each study reaches, it's just a listing. Scientific studies are only as good as the care that goes into them. Just because a scientific paper says viruses may be the cause, or says that viruses aren't the cause, doesn't make them valid. You have to look at the methodology, which is beyond the scope of my list. However, if you take them as a group, far more studies support a viral etiology than the studies that find no evidence of a viral etiology.

In my list, there are 40 studies that support a viral etiology of MM. Five of them were equivocal (meaning, they neither prove nor disprove) and six were found to not support viruses as a cause. In it's entirety, I believe that a viral etiology is supported by the scientific literature, at least for some patients. It is important from a scientific viewpoint, if you plan to use this to convince your doctor, that you include the studies that don't support viral causes along with the ones that do.

Due to the posting limit, I'll post this list in two parts. The first part is a list of scientific studies that are equivocal and those that do not support a viral etiology of MM in some patients. The second part will be the studies that do support a viral etiology of MM.

In another week or so, I'll put together an entire document that contains both lists, plus the results of my anti-viral Poll http://www.menieres.org/forum/index.php/topic,22504.0/viewResults.html with a list of testimonials which will be suitable for sending to your doctor.

So far, the overwhelming majority of the poll-takers have found benefit from anti-virals. It does appear that anti-virals work best when prescribed early, before permanent damage occurs. No drug can reverse permanent damage, and long term sufferers may not see as much benefit from anti-virals.

Here are the Equivocal and Non-Supported studies:

EQUIVOCAL (5)


http://www.ncbi.nlm.nih.gov/pubmed/15577784
Randomized double-blinded, placebo-controlled clinical trial of famciclovir for reduction of Ménière's disease symptoms.
Otolaryngol Head Neck Surg. 2004 Dec;131(6):877-84
SIGNIFICANCE: Famciclovir may suppress the fluctuation of hearing in Meniere's disease, but had a minimal effect on vertigo or dizziness symptoms in this study. The probable multifactorial etiology in Meniere's disease requires that further studies be conducted to determine the effects of antiviral medications.

http://www.ncbi.nlm.nih.gov/pubmed/212928
Viral culture and electron microscopy of ganglion cells in Meniere's disease and Bell's palsy.
Acta Otolaryngol. 1978 Sep-Oct;86(3-4):269-75
At present there is no proof that viruses are present in Scarpa's or geniculate ganglions but the possibility remains that the inclusion bodies observed might be viruses inactivated inside the ganglion cells.

http://www.ncbi.nlm.nih.gov/pubmed/15235799
Incidence of virus infection as a cause of Meniere's disease or endolymphatic hydrops assessed by electrocochleography.
Eur Arch Otorhinolaryngol. 2005 Apr;262(4):331-4. Epub 2004 Jul 2.
In MD patients, the IgG titre against VZV and ADV were significantly higher than in the control (schwannoma) group. However, no correlation was found between the IgG levels against ADV and VZV with the SP/AP ratio. Neurotropic viruses such VZV and ADV may play a role in the pathogenesis of MD, despite the absence of association between the levels of IgG titres and the SP/AP ratio.

http://www.ncbi.nlm.nih.gov/pubmed/11796944
Peripheral vestibular disorders with acute onset of vertigo.
Curr Opin Neurol. 2002 Feb;15(1):5-10.
In acute vestibulopathy, suspicions of the activation of herpes virus infections as a causative agent are increasing, but no reports on the treatment of such infections are yet available.

http://www.ncbi.nlm.nih.gov/pubmed/11694075
Herpesvirus DNA in peripheral blood mononuclear cells of some patients with Meniere's disease.
Microbiol Immunol. 2001;45(9):635-8.
These findings may imply that reactivation of HSV- 1 or VZV may be associated with the development of some cases of Meniere's disease.

http://www.ncbi.nlm.nih.gov/pubmed/8470506
Viruses and vestibular neuritis: review of human and animal studies.
Acta Otolaryngol Suppl. 1993;503:70-3
However, animal studies have demonstrated that several human viruses including rubeola, herpes simplex, reovirus, mouse and guinea pig cytomegalovirus, and neurotropic strains of influenza A and mumps virus, can infect the vestibular nerve and the vestibular membranous labyrinth.


NOT SUPPORTED (6)


http://www.ncbi.nlm.nih.gov/pubmed/18235203
Herpes virus and Ménière's disease.
ORL J Otorhinolaryngol Relat Spec. 2008;70(1):28-31; discussion 31. Epub 2008 Feb 1
Based on these results, reactivation of HSV1 and VZV in the vestibular ganglion does not seem to play a role in the pathogenesis of MD. (c) 2008 S. Karger AG, Basel

http://www.ncbi.nlm.nih.gov/pubmed/18235202
Intratympanic application of an antiviral agent for the treatment of Ménière's disease.
ORL J Otorhinolaryngol Relat Spec. 2008;70(1):21-6; discussion 26-7. Epub 2008 Feb 1
In conclusion, most patients were improved after the intratympanic injections, but there was no obvious difference between the treated and control groups. The benefit might be due to the middle ear ventilation or reflect an improvement in the patients' emotional state. (c) 2008 S. Karger AG, Basel

http://www.ncbi.nlm.nih.gov/pubmed/18229786
Viral infection and serum antibodies to heat shock protein 70 in the acute phase of Ménière's disease.
Int Tinnitus J. 2007;13(2):90-3.
We found no relationship between the presence of antibodies to HSP70 and immunological or viral testing.

http://www.ncbi.nlm.nih.gov/pubmed/9391669
Detection of viral DNA in vestibular ganglia tissue from patients with Menière's disease.
Am J Otol. 1997 Nov;18(6):734-7.
CONCLUSIONS: In patients with MD requiring surgical intervention, infection with herpes simplex virus, cytomegalovirus, or varicella zoster virus of the vestibular ganglia does not appear to play a major role in the pathoetiology of the disease.

http://www.ncbi.nlm.nih.gov/pubmed/3771296
[Does virus diagnosis open new ways for the classification and treatment of sudden deafness, unilateral vestibular loss and idiopathic facial paralysis?]
HNO. 1986 Sep;34(9):376-8.
So viral etiology of sudden deafness, acute vestibular loss and Bell's palsy seems to be unlikely and does not change the assignment and therapy of this disease.

http://www.ncbi.nlm.nih.gov/pubmed/7345293
[Possible viral etiology of inner ear diseases (author's transl)]
Laryngol Rhinol Otol (Stuttg). 1981 Nov;60(11):591-2
Therefore we refute a relation between viral infection and inner ear troubles; for a practical point of view virological diagnostics is not indicated.

Here is the rest of the info:

Papajoe's three-part list of scientific studies on the relationship between Meniere's and viruses:

Part I:
http://www.menieres.org/forum/index.php/topic,22570.0.html

Part II:
http://www.menieres.org/forum/index.php/topic,22571.0.html

Part III:
http://www.menieres.org/forum/index.php/topic,22572.0.html

This information is also available in PDF format:

http://www.papadisc.com/Menieres_Etiology_Viral.pdf

http://www.papadisc.com/Menieres_Efficacy_AntiViral.pdf