|Year : 2003 | Volume
| Issue : 20 | Page : 29--34
Stress in hearing and balance in Meniere's disease
KC Horner, Y Cazals
Equipe Inserm EPI 9902, Laboratoire Otologie NeuroOtologie, Univ. Méditerranée Aix-Marseille II, Faculté de Médecine Nord, Marseille, France
Stress is an unavoidable every-day phenomenon. Physiological coping with stress depends on the appropriate release of stress hormones as well as their alleviation at the termination of the stress. Despite quite a body of research indicating that stress affects inner ear function, this concept has found little application in otolaryngology. Today's evidence clearly indicates that the inner ear is equipped to detect stress hormones and some of these hormones have been shown to affect the inner ear function.
Major stress control pathways shown to affect the inner ear include several third order axes, the hypothalamus-pituitary-adrenal axis, the hypothalamus-pituitary-thyroid axis and the hypothalamus-pituitary-gonadal axis whose functioning are interactive and inter-dependent. Less well-studied are the second order hypothalamus-pituitary control axis and its interaction with other hormones. To explore these we carried out a retrospective study on a series of Meniere's patients who had undergone a neurotomy of the vestibular nerve in the dept of ORL at the Hopital Nord, Marseille. Meniere's patients were particularly appropriate for this study since stress has long been recognised as a factor associated with the triggering of the symptoms of this pathology. Patients with acoustic neuroma and facial spasm were taken as a control population.
We investigated the level of a battery of stress hormones including prolactin (3-endorphin and growth hormone. The blood sample was taken on the morning before surgery. The most striking observation was the presence of hyperprolactinemia in 30% of the Meniere patients (more than 20 µµg/l) with confirmation of prolactinoma in 6 patients. The level of O-endorphin could also be elevated. Horner, K.C., Guieu, R., Magnan, J., Chays, A. and Cazal, Y. Neuropysychopharmacology, (2001) 26:135-138.
These observations suggest that neuroendocrinological feedback pathways controlling stress can be disturbed in Meniere's patients and depression of hypothalamic dopaminergic inhibition of prolactin secretion might be implicated. A further study on non-operated Meniere's patients presenting hyperprolactinemia and on dopamine agonist treatment, is needed in order to assess the role of stress in Meniere's patients. Progress in this domain could open the door towards integration of the stress concept into clinical management of various inner ear disorders.
K C Horner
Equipe Inserm EPI 9902, Laboratoire Otologie NeuroOtologie, Univ. Méditerranée Aix- Marseille II, Faculté de Médecine Nord, Boulevard Pierre Dramard, 13916 Marseille Cedex 20
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