Skip to main content

Increased intracranial tension and cochleovestibular symptoms: an observational clinical study

Abstract

Objectives

Meniere’s disease is thought to be pathophysiologically due to increased pressure in the endolymphatic spaces leading to distortion of the sensory elements. As the inner ear fluids are in direct and indirect contact with cerebrospinal fluid (CSF), it was hypothesized that changes in CSF hydrodynamics could affect inner ear fluid pressures.

Patients and Methods

This study was conducted on 150 patients presenting with benign increased intracranial tension diagnosed by Dandy’s criteria and by radiological data. All patients were subjected to a detailed vertigo questionnaire and underwent comprehensive clinical, audiological, and vestibular testing to detect any vestibular abnormalities.

Results

Of the studied patients, 38 (25.3%) (34 females and four males) presented with audiovestibular symptoms: ear fullness and/or hearing loss, tinnitus, attacks of vertigo, and instability. Some patients reported atypical positional or motion-induced vertigo. A total of 13 patients presented with sensorineural hearing loss (SNHL). Clinical head impulse test (HIT) was positive in 30 patients, abnormal caloric test results in 24 patients, and 12 had positive Dix–Hallpike test results. All patients with audiovestibular symptoms were previously treated with betahistine (24 mg, three times a day) with poor response. Patients with abnormal test results were shifted to acetazolamide+betahistine. Thirty patients had a dramatic response on both audiological and vestibular manifestations.

Conclusion

Changes in CSF pressure significantly affect inner ear fluids in some patients. Symptoms and tests may mimic Meniere’s disease, and we recommend evaluating patients with atypical Meniere’s disease (MD), especially early bilateral affection and/or poor response to conventional therapy, for increased intracranial tension (ICT). Further testing of other cochlea-vestibular functions in these patients is under way.

References

  1. 1

    Merchant SN, Adams JC, Nadol JB. Pathophysiology of Meniere’s syndrome:are symptoms caused by endolymphatic hydrops. Otol Neurotol 2005; 26:74–81

    Article  Google Scholar 

  2. 2

    Macrae JH. Effects of body position on the auditory system. J Speech Hear Res 1972; 15:330–333.

    CAS  Article  Google Scholar 

  3. 3

    Yoshida M, Uemura T. Transmission of cerebrospinal fluid pressure changes to the inner ear and its effect on cochlear microphonics. Eur Arch Otorhinolaryngol 1991; 248:139–143.

    CAS  Article  Google Scholar 

  4. 4

    Salt AN, DeMott JE. Longitudinal endolymph movements and endocochlear potential changes induced by stimulation at infrasonic frequencies. J Acoust Soc Am 1999; 106:847–856.

    CAS  Article  Google Scholar 

  5. 5

    Franz B, Anderson C. Effect of static middle-ear and intracranial pressure changes on differential electrocochleographic response. Int Tinnitus J 2008; 14:101–107.

    PubMed  Google Scholar 

  6. 6

    Traboulsi R, Poumarat G, Chazal J, Avan P, Mom T, Ranchon-Cole I, Traboulsi S. The estimation of the time constant of the human inner ear pressure change by noninvasive technique. Model Simul Eng 2009; 2009:8.

    Google Scholar 

  7. 7

    Voss SE, Agedoke MF, Sheth KN, Horton NJ, Rosand J, Shera CA. Detecting changes in intracranial pressure using ear-canal reflectance and otoacoustic emissions. Hearing Research as part of the MEMRO group of manuscripts 2009; 1–28.

  8. 8

    Nakashima T, Watanabe Y, Yanagita N. The effect of round window membrane rupture on endolymphatic and perilymphatic pressures. Arch Otorhinolaryngol 1987; 244:236–240.

    CAS  Article  Google Scholar 

  9. 9

    Takeuchi S, Takeda T, Saito H. Pressure relationship between perilymph and endolymph in guinea pigs. Acta Otolaryngol 1990; 109:93–100.

    CAS  Article  Google Scholar 

  10. 10

    Hara A, Salt AN, Thalmann R. Perilymph composition in scala tympani of the cochlea: influence of cerebrospinal fluid. Hear Res 1989; 42:265–272.

    CAS  Article  Google Scholar 

  11. 11

    Carlborg BIR, Konradsson KS, Carlborg AH, Farmer JC, Densert O. Pressure transfer between the perilymph and the cerebrospinal fluid compartments in cats. Am J Otol 1992; 13:41–48.

    CAS  PubMed  Google Scholar 

  12. 12

    Valk WL, Wit HP, Albers FW. Effect of acute inner ear pressure changes on low-level distortion product otoacoustic emissions in the guinea pig. Acta Otolaryngol 2004; 124:929–936.

    CAS  Article  Google Scholar 

  13. 13

    Warmerdam TJ, Schroder FH, Wit HP, Albers FW. Perilymphatic and endolymphatic pressures during endolymphatic hydrops. Eur Arch Otorhinolaryngol 2003; 260:9–11.

    CAS  Article  Google Scholar 

  14. 14

    Ciuman RR. Communication routes between intracranial spaces and inner ear: function, pathophysiologic importance and relations with inner ear diseases. Am J Otolaryngol 2009; 30:193–202.

    Article  Google Scholar 

  15. 15

    Marchbanks JC. Hydrodynamical interactions of the intracranial and intralabyrinthine fluids. In: Ernest A, Marchbanks R, Samii M, editors. Handbook of intracranial and intralabyrinthine fluids: basic aspects and clinical applications. Berlin, Germany: Springer; 1995.

    Google Scholar 

  16. 16

    Carlborg BI, Farmer JC Jr. Transmission of cerebrospinal fluid pressure via the cochlear aquaduct and endolymphatic sac. Am J Otolaryngol 1983; 4:273–282.

    CAS  Article  Google Scholar 

  17. 17

    Portier F, de Minteguiaga C, Racy E, Huy PT, Herman P. Spontaneous intracranial hypotension: a rare cause of labyrinthine hydrops. Ann Otol Rhinol Laryngol 2002; 111:817–820.

    Article  Google Scholar 

  18. 18

    Nakashima T, Sone M, Teranishi M, Yoshida T, Terasaki T, Kondo M, et al. A perspective from magnetic resonance imaging findings of the inner ear: relationships among cerebrospinal, ocular and inner ear fluids. Auris Nasu Larynx 2012; 39:345–355.

    Article  Google Scholar 

  19. 19

    McCall AA, Ishiyama GP, Lopez IA, Bhuta S, Vetter S, Ishiyama A. Histopathological and ultrastructural analysis of vestibular endorgans in Meniere’s disease reveals basement membrane pathology. BMC Ear Nose Throat Disord 2009; 9:4.

    Article  Google Scholar 

  20. 20

    De Kleine E, Wit HP, van Dijk P, Avan P. The behavior of spontaneous otoacoustic emissions during and after postural changes. J Acoust Soc Am 2000; 107:3308–3316.

    Article  Google Scholar 

  21. 21

    Saxena RK, Tandon PN, Sinha A, Kacker SK. Auditory functions in raised intracranial pressure. Acta Otolaryngol 1969; 68:402–410.

    CAS  Article  Google Scholar 

  22. 22

    Gordon AG. Endolymphatic hydrops and CSF pressure. J Neurosurg 1984; 60:1332–1334.

    CAS  PubMed  Google Scholar 

  23. 23

    Chomicki A, Sakka L, Avan P, Khalil T, Lemaire JJ, Chazal J. Derivation of cerebrospinal fluid: consequences on inner ear biomechanics in adult patients with chronic hydrocephalus. Neurochirurgie 2007; 53:265–271.

    CAS  Article  Google Scholar 

  24. 24

    Pogodzinski MS, Shallop JK, Sprung J, Weingarten TN, Wong GY, McDonald TJ. Hearing loss and cerebrospinal fluid pressure: case report and review of the literature. Ear Nose Throat J 2008; 87:144–147.

    Article  Google Scholar 

  25. 25

    Ferrary E, Sterkers O. Mechanisms of endolymph secretion. Kidney Int Suppl 1998; 65:S98–S103.

    CAS  PubMed  Google Scholar 

  26. 26

    Thirlwall AS, Kundu S. Diuretics for ’Ménière’s disease or syndrome. Cochrane Database Syst Rev 2006; 3:CD003599.

    Google Scholar 

  27. 27

    Van de Heyning PH, de Valck CFJ, Boudewyns A, Cammaert T, Casteleyn S, Deggouj N, et al. Meniere’s disease. B-ENT 2007; 3(Suppl 6):11–20.

    PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Badr E. Mostafa MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mostafa, B.E., El-Sersy, H.A.A. & Hamid, T.A. Increased intracranial tension and cochleovestibular symptoms: an observational clinical study. Egypt J Otolaryngol 34, 191–193 (2018). https://doi.org/10.4103/ejo.ejo_5_18

Download citation

Keywords

  • crebrospinal fluid
  • intracranial tension
  • Meniere’s disease
  • vertigo