Changes of endolymphatic hydrops accompanied with progress and improvement of Meniere's disease

2006年にメニエール病(以下メ病)の臨床研究を 目的に当施設を開設し,2020年に初診累計が1,500 名を超えた。患者は我慢強く仕事熱心で,周囲の評 価を満足とする特異な行動特性を示し,我慢や奉 仕が報われないと(報酬不足)発症する,ストレス 病と判明した。さらに,連日の有酸素運動の実 践が,めまい消失ばかりでなく聴力改善に有効なこ とをを報告してきた。ストレス病であれば,発 症誘因の解消で症状は改善,消失するはずである が,メ病の難聴は自律的に進行する。今回,有酸 素運動による症状別の予後,改善までの期間を集 計,分析した結果,内リンパ水腫の病態変化が予後 を左右する要因と判明したので報告する。 対象と方法 7年間に受診し,6カ月以上観察したメ病確実例 To clarify the dynamic changes in the membranous lesions of Meniere’s disease, the effects of aerobic exercise on different symptoms were analyzed. Out of a total of 351 patients with Meniere’s disease who performed aerobic exercises for 6 months or longer who were enrolled, 338 showed improvement of one or more symptoms: disappearance of vertigo in 97.6% of cases; complete resolution of ear fullness in 60.1% of cases; improvement of hearing impairment in 38.5% of cases; complete resolution or marked decrease of tinnitus in 29.6% of cases. On the other hand, complete recovery of hearing was noted in 29.5% of the 78 patients with low-tone loss, 12.5% of the 96 patients with high-tone loss, and only 4.1% of the 170 patients with hearing loss across all frequencies. More than half of the patients with high-tone hearing loss and hearing loss across all frequencies failed to show any change in the degree of hearing loss. Considering the findings of temporal bone pathology, it seems probable that the Reissner’s membrane, being ballooned and highly distended by endolymphatic hydrops, disturbs conduction of low-frequency waves by the perilymph, and the membrane, once it loses tension, is not resonant with either high-frequency waves or indeed waves of any frequency. Although aerobic exercise is effective to cure hydrops and improve membranous tension by activating homeostasis, its effect worsens with decreasing membranous tension. 原 著