An Explanation of Divergent Test Results in Ménière’s Disease

Ménière’s disease is a disorder that causes symptoms including dizziness, hearing loss, and ringing in the ears. The cause of this disease is not well understood. To learn more about Ménière’s disease, our team used tissue samples taken from the ears of people who had Ménière’s disease during their lifetime and compared them to samples from people who did not have the condition.

Many patients with Ménière’s disease have abnormal results in a test of the inner ear called the caloric test, but another test called video head impulse testing often shows typical results, despite both tests being done on the same part of the inner ear.

Our results, published in the Journal of the Association for Research in Otolaryngology (JARO) in December 2022, found that in the ears of people with Ménière’s disease, there was a specific problem in the horizontal semicircular canal which is a part of the inner ear that helps with balance. This problem, called otolith membrane herniation, was found in 69 percent of the Ménière’s disease ears studied and was linked to abnormal results in the caloric test.

We also found that there was no evidence of a condition called endolymphatic hydrops in the horizontal semicircular canal, which had been previously suggested as a potential cause of the dissociation between the two test results. Additionally, we found that the size of the semicircular canal in some Ménière’s disease ears was smaller than the control ears. This suggests that the relative size of the inner ear structures may play a role in the development of the condition.

Taken together, this study refines hypotheses on the vestibular test dissociation in Ménière’s disease, holding diagnostic implications and expanding our understanding of the mechanisms underlying this enigmatic disease.

—Bryan K. Ward, M.D.

A 2020 Emerging Research Grants (ERG) scientist, Bryan K. Ward, M.D., is an associate professor of otolaryngology–head and neck surgery at Johns Hopkins University School of Medicine.

Top: These images in the JARO study by coauthor John P. Carey, M.D., are based on a 3D model that was then manipulated to look like the histology.

Above: This image from Bryan K. Ward, Ph.D., illustrates the otolith membrane herniation that was found in 69 percent of the Ménière’s disease patients in the JARO study. The image, from a separate study, was adapted from histology specimens included in the study as part of the NIDCD National Temporal Bone, Hearing and Balance Pathology Resource Registry.