Pathology of Meniere's disease.

From review of recent findings, the pathology of Meniere's disease is described and correlated with clinical signs. Since Meniere's disease can be seen only in humans, assessing its natural history is important. A recent survey of 500 patients demonstrated the three major symptoms to be vestibular, auditory, and aural pressure. Meniere's disease (idiopathic) is distinguished from Meniere's syndrome (symptoms with likely cause), which accounted for approximately one fourth of the patients. Atypical forms include vestibular and cochlear Meniere's disease. A recent review of our temporal bone collection and detailed study of the pathological conditions of 134 temporal bones described in the literature revealed characteristic pathological findings. Patients with clear-cut histories of Meniere's disease may demonstrate little or no endolymphatic hydrops at death. Nevertheless, hydrops of the pars inferior remains the most significant pathological correlate of Meniere's disease. On the basis of these findings, the pathogenesis of the disease (malabsorption of endolymph) and the pathophysiology of the symptoms (physical and chemical) are discussed.