Brown D H, McClure J A, Downar-Zapolski Z
Department of Otolaryngology, University of Western Ontario, London, Canada.
Laryngoscope. 1988 Jun;98(6 Pt 1):599-601.
The Membrane Rupture Theory states that the acute attack of Menière's disease occurs when endolymph, with its high potassium ion concentration, escapes into the perilymph and surrounds the first-order neuron. Initially, this causes partial depolarization of the nerve and an increased resting discharge, followed by complete depolarization. Clinically, one would expect an initial irritative nystagmus (toward the affected side) followed by a paralytic nystagmus (toward the unaffected side). To confirm this, the guinea pig perilymphatic space was perfused with an artificial endolymph solution. The results confirmed an irritative/paralytic sequence of nystagmus that differs from the pattern of spontaneous nystagmus observed with ENG monitoring during the acute attack of Menière's disease. Early in the attack, one observes a paralytic nystagmus followed by a secondary nystagmus beating toward the affected side (similar to an irritative nystagmus) as the patient recovers. This raises questions about the validity of the Membrane Rupture Theory.
膜破裂理论认为，当高钾离子浓度的内淋巴液漏入外淋巴液并包围一级神经元时，梅尼埃病的急性发作就会发生。最初，这会导致神经部分去极化并增加静息放电，随后是完全去极化。临床上，人们预期最初会出现刺激性眼球震颤（朝向患侧），随后是麻痹性眼球震颤（朝向未受影响的一侧）。为了证实这一点，用人工内淋巴液灌注豚鼠的外淋巴间隙。结果证实了眼球震颤的刺激性/麻痹性序列，这与梅尼埃病急性发作期间通过眼震电图监测观察到的自发性眼球震颤模式不同。在发作早期，人们观察到麻痹性眼球震颤，随后随着患者恢复，出现向患侧跳动的继发性眼球震颤（类似于刺激性眼球震颤）。这引发了关于膜破裂理论有效性的质疑。
