Pathophysiology of the Meniere attack: facts and theories.

A pathophysiological interpretation is discussed of the clinical findings that in one out of three cases at the onset of Meniere's disease the cochlear and vestibular symptoms start simultaneously and that during the course of Meniere's disease most attacks show both cochlear and vestibular symptoms. It is concluded that the Meniere attack is not caused by a slowly expanding endolymphatic system that finally ruptures or leaks, but that the pathogenesis of the attack is different from that of the underlying endolymphatic hydrops.