Portal de Periódicos da CAPES

Ménière's disease

2006; Elsevier BV; Volume: 367; Issue: 9515 Linguagem: Inglês

10.1016/s0140-6736(06)68419-5

1474-547X

A. G. Gordon,

Hallucinations in medical conditions

With reference to the Eponym on Ménière's disease (Dec 17, p 2137),*1Thorp MA James AL Prosper Ménière.Lancet. 2005; 366: 2137-2139Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar it is important to establish when the classic triad of deafness, tinnitus, and vertigo was first given Ménière's name. The term Ménière's disease was indeed used by Charcot in 1874, but also by Knapp*2Knapp H A clinical analysis of the inflammatory affections of the inner ear.Arch Ophthalmol Otol. 1871; 2: 204-283Google Scholar and Brunner*3Brunner G On vertigo occurring in affections of the ear (auditory vertigo).Arch Ophthalmol Otol. 1871; 2: 293-341Google Scholar in 1871 (and possibly Politzer4Politzer A Ueber läsion des labyrinthes.Archiv für Ohrenheilkunde. 1867; 2: 88-99Crossref Scopus (9) Google Scholar in 1867). These authors should still be read today: their clinical descriptions and discussions were far better than those of Ménière himself, and clearly relevant to the modern understanding of this distressing disorder. They described a clear distinction between irritation (eg, tinnitus) and paralysis (eg, deafness),*2Knapp H A clinical analysis of the inflammatory affections of the inner ear.Arch Ophthalmol Otol. 1871; 2: 204-283Google Scholar as well as symptoms unmentioned by Ménière, including: audiosensitivity, sometimes painful or disagreeable; diplacusis; abnormal sensations in the ear*3Brunner G On vertigo occurring in affections of the ear (auditory vertigo).Arch Ophthalmol Otol. 1871; 2: 293-341Google Scholar (closure, fullness, or pressure) shortly before the paroxysms (not to be confused with closure of the Eustachian tube); sympathetic arousal;*2Knapp H A clinical analysis of the inflammatory affections of the inner ear.Arch Ophthalmol Otol. 1871; 2: 204-283Google Scholar and obscuration of the visual field. In my experience, diplacusis, audiosensitivity, and fullness are more useful in detecting fluctuating endolymphatic hydrops or early Ménière's disease than the classic triad. Knapp also noted characteristic contraction of the range of audition (peaked audiogram) whereby patients were able to hear the middle octaves of a piano most distinctly, the lower ones less so, and the higher octaves least. To Knapp this was proof positive that the disease involved the cochlea, not just the semicircular canal as Ménière and aurists*3Brunner G On vertigo occurring in affections of the ear (auditory vertigo).Arch Ophthalmol Otol. 1871; 2: 293-341Google Scholar said, nor the acoustic nerve nor brain centres. It was thought at the time,*2Knapp H A clinical analysis of the inflammatory affections of the inner ear.Arch Ophthalmol Otol. 1871; 2: 204-283Google Scholar, *3Brunner G On vertigo occurring in affections of the ear (auditory vertigo).Arch Ophthalmol Otol. 1871; 2: 293-341Google Scholar and probably still is, that intralabyrinthine pressure is high, but Knapp noted that vertigo in Greene's classic 1869 case was relieved by middle ear inflation, which is more likely to raise than lower perilymph pressure. Careful review*5Gordon AG “Hyperacusis” and origins of lowered sound tolerance.J Neuropsychiatry Clin Neurosci. 2000; 12: 117-118PubMed Google Scholar suggests that hydrops is due to low, not high, perilymph pressure (or to linked*3Brunner G On vertigo occurring in affections of the ear (auditory vertigo).Arch Ophthalmol Otol. 1871; 2: 293-341Google Scholar cerebrospinal fluid hypotension). Otogenic musical hallucinations are nowadays usually attributed to deafness—ie, sensory deprivation. But Knapp saw a 6-year-old boy with meningitis who complained of music playing shortly before becoming totally deaf. For Knapp, this observation was proof that the subjective sensation was due to acoustic nerve excitation, not paralysis—a conclusion supported by a modern literature review.*5Gordon AG “Hyperacusis” and origins of lowered sound tolerance.J Neuropsychiatry Clin Neurosci. 2000; 12: 117-118PubMed Google Scholar Knapp also used an early example of consecutive numbered referencing in his text, as later adopted by the Vancouver system. Most interesting is his comment introducing the numbered list at the end of his paper: “The papers marked with * have been read by me in the original, the others in extracts”. Had this system been implemented as well, the major type of scientific misconduct—failure to read primary sources, with error propagation and claim to false scholarship—could have been stopped. Perhaps The Lancet can lead the way. I declare that I have no conflict of interest.