Cochlear and vestibular epithelia from a patient with Menière's disease: a case study.

Scanning electron microscopy observations were carried out on the cochlear and vestibular epithelia of the left temporal bone of a Menière's patient. There was almost complete absence of hair cells in the basal turn of the cochlea. The outer hair cells of the second turn presented an abnormal shortening of the shorter stereocilia within a tuft, reminiscent of the specific atrophy of the short and middle stereocilia in the ciliary tufts of outer hair cells in the guinea pig with experimental hydrops. The cilia of the inner hair cells showed fusion and giant cilia formation. Hair cells were observed in the apical turn which showed no pathological features in particular. In the saccular epithelium there were a number of striking features including, loss of the kinocilium, loss of ciliary tufts, swelling of the sensory cells, holes in the epithelium, and sensory cells pushed out and lying on the surface. The utricular epithelium was less perturbed and showed only relatively small protrusions from the epithelial surface. Similar observations have earlier been made on the vestibular epithelium in experimental hydrops. After taking into consideration the relatively long delay to fixation (12 hours) it appeared that the sacculus was more fragile and prone to autolysis than the other organs suggesting that the in-vivo pathology was manifested in particular in that organ as would be predicted from Menière's symptoms.