Paparella M M, Kimberley B P
Department of Otolaryngology, University of Minnesota, Minneapolis.
J Vestib Res. 1990;1(1):3-7.
While endolymphatic hydrops is a characteristic pathologic feature of Menière's disease, there are exceptions to this rule. There is evidence that hydrops develops as a result of malabsorption of endolymph. This implies dysfunction of the endolymphatic sac and duct, which normally absorb endolymph. In approximately 20% of cases of Menière's disease, a specific pathologic condition in the temporal bone can be associated as a cause of endolymphatic hydrops. Syphilis, fractures of the temporal bone, otosclerosis, and preceding chronic otitis media are some of the more commonly encountered pathologic conditions so associated. Hypoplasia of the mastoid air-cell system and of periaqueductal air cells, and especially displacement medially but also anteriorly of the sigmoid (lateral) sinus are commonly observed in patients with Menière's disease. Evidence is available to substantiate the etiologic bases of Menière's disease as including multifactorial inheritance (1). The clinical symptoms and findings result from both chemical and physical mechanisms. Pathogenesis appears to be due to malabsorption of endolymph in the environment of the endolymphatic sac, primarily affecting longitudinal flow. The possible role of such processes as autoimmune reactions and viral inflammation, especially in the endolymphatic sac, should be further investigated in the future.
虽然内淋巴积水是梅尼埃病的特征性病理表现，但也有例外情况。有证据表明，积水是内淋巴吸收不良的结果。这意味着内淋巴囊和导管功能异常，而它们通常负责吸收内淋巴。在大约20%的梅尼埃病病例中，颞骨的特定病理状况可能是内淋巴积水的病因。梅毒、颞骨骨折、耳硬化症以及既往慢性中耳炎是一些较为常见的相关病理状况。梅尼埃病患者通常可见乳突气房系统和导水管周围气房发育不全，尤其是乙状窦（外侧）窦向内侧但也向前移位。现有证据证实梅尼埃病的病因包括多因素遗传（1）。临床症状和表现是由化学和物理机制共同导致的。发病机制似乎是由于内淋巴囊环境中内淋巴吸收不良，主要影响纵向流动。自身免疫反应和病毒炎症等过程，尤其是在内淋巴囊中的作用，未来应进一步研究。
