若年で発症したメニエール病・遅発性内リンパ水腫症例の臨床的検討

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  • Juvenile Ménière's disease and delayed endolymphatic hydrops

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<p>　Symptoms in Ménière's disease (MD) usually start in middle age, predominantly between 30 and 50 years of age. Classical MD is rarely found in children and reports are scarce. In general, the frequency of occurrence of MD in children is only 0.4-7.0% of that in adults. Here, we selected 7 cases of juvenile MD and 1 case of delayed endolymphatic hydrops (DEH) among 57 pediatric patients with vertigo who were referred to the neuro-otological clinic of Aichi Medical University Hospital between January 2015 to December 2017. The children varied in age from 13 to 18 years (mean, 14.6 years). The 8 patients comprised 1 male and 7 females. Diagnosis of MD was based on the criteria of the Japan Society for Equilibrium Research for Meniere's Disease. The clinical features of the juvenile MD patients were as follows. Most MD patients complained of intensive frequent headache, ear fullness, nasal symptoms and sleep disorder except vertigo, especially were needed for treatment of headache.</p><p></p><p>　Among the 7 MD patients with fluctuating hearing loss, 5 showed a positive response to the glycerol test. Based on this finding, benign paroxysmal vertigo (BPV) was distinguished from migraine-related dizziness and other pathologies.</p><p></p><p>　In general, juvenile MD patients often complain of persistent headache, whereas dizziness and hearing loss usually show good progress. Actually, all of our cases showed hearing improvement, but the vertiginous attacks persisted for a long period of time in 2 cases, and transtympanic ventilation was subsequently performed. Following this, the frequency of vertigo reduced in one case, but remained unchanged in the other.</p><p></p><p>　In juvenile MD, insomnia and refusal to attend school can occur due to dizziness, frequent headaches and other symptoms; therefore, interventions such as child psychiatry referral and counseling may be necessary, depending on the case.</p>

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