[The pathogenesis of the acute symptoms of Menière's disease (author's transl)].

The pathogenesis of vertigo attacks and hearing fluctuations in Menière's disease is discussed on the basis of new electronmicroscopic observations on the perilymph endolymph barrier. The zonulae occludentes (z.o.) of the epithelial cells lining the endolymphatic space are the main sealing elements which control the passive ion transport. They consist of parallel running intramembranous fibrils (cell membrane fusion lines). Recent investigations demonstrated conditions which partially destruct some of such fibrils (e.g. increased osmotic pressure, endocrine disorders). This also may be true in Menière's attacks: tight z.o. are transformed to leaky z.o. such that a high transepithelial ion exchange developes. This would result in reduced generation of the receptor potentials as well as in decreased activities of the first order afferent neurons as it was supposed earlier by other authors. This mechanism may be combined with a decompensation of active ion transport processes due to microcirculation disturbances. Finally it will be pointed out that true ruptures of the endolymphatic walls cannot be the usual mode of reversible lesions in Menières disease but a diffuse leakage of the perilymph-endolymph barrier.