Immunological Considerations on Recurrent Episodes of Meniere's Disease Jiro Hozawa (Hirosaki Univ.) The reality of allergic endolymphatic hydrops as

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1 Immunological Considerations on Recurrent Episodes of Meniere's Disease Jiro Hozawa (Hirosaki Univ.) The reality of allergic endolymphatic hydrops as a cause of recurrent episodes of Meniere's disease was suggested from results of the following studies: 1) Clinical studies a) The skin test using 34 sorts of food antigen extracts and the glycerol test were performed for 23 patients with Meniere's disease. A positive rate of the glycerol test was higher in the group of positive skin reaction than in the negative group (P=0.05). b) In some cases, whose episodes were provocated by the challenge feeding test, the improvement of hearing loss was found after doing Portmann's endolymphatic operation. 2) Experimental studies a) Labyrinthine reactions induced by challenging the antigen through the left foram, stylomastoideum were observed for 4 groups of rabbits as follows: (A) rabbits sensitized by hen's serum, (B) control rabbits, (C) rabbits inoculated with BCG vaccine and (D) control rabbits. Among these 4 groups, a character of positional nystagmus observed in group A bore a striking resemblance to that of Meniere's attack. Moreover, electrocochleograph of group A showed a pattern of cochlear impairment and histological study revealed endolymphatic hydrops in the challenged ear side. This endolymphatic hydrops was not found in the other group. From these findings, endolymphatic hydrops does not appear to be induced by cell-mediated immunity, but by humoral immunity. b) To determine the place of antigen-antibody reaction, the labyrinths of guinea pigs sensitized by horseradish peroxidase (HRP) were investigated by electronmicroscopy after challenge with this antigen through the perilymphatic space. Particles of HRP could pass through the Reissner's membrane by intra-cellular transportation and clung to the surface of dark cells in the stria vascularis. These findings were not observed in the control study and suggest that hyper-permeability of the Reissner's membrane and hypersecretion of the stria vascularis induced by the antigen-antibody reaction are probable causes of endolymphatic hydrops.

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10 536 朴 沢 (左)ニ ワ トリ血 清 で 感 作 した兎 の 血 清 注 入側 蝸 牛. ラィ ス ネル膜 の膨 隆 著 明 で 内 リンパ 水 腫 が認 め られ 二 郎 耳鼻臨床 73: 3 (右)BCG接 種 兎の ツ ベル ク リン液 注 入 側蝸 牛. 内 リン パ水 腫 は起 って い な い. る. 図6 内耳組織 図8 図7 HRP感 で も抗原 抗 体反 応 が 考 え られ る. 作 モル モ ッ トの ラ イ ス ネル膜 ラィ スネル膜 の 著 明 な膨 隆 が認 め られ, HRPは 血 管 条 の 辺緑 細 胞 表 面 に 付着 したHRP. 特に ライ スネ ル膜 基 底 板 に沈 着 し, と ころ ど こ ろ に 集 積 し, 塊 状 を呈 した. 基 底 板 上 のHRPは 内 リンパ側 上 皮 細胞 に よ りup-takaさ れ, 細 胞 内 を輸 送 され て 内 リンパ腔 に放 出 され て い る. ここ

11 1) Bernstein, J.: Occurence of Episodic Vertigo and Hearingloss in Families Ann. Otol , ) Clemis, J. D.: Allergy of the inner ear Ann. allerg. 27: , ) Clemis, J. D,: Allergic cochleovestibular disturbances Trans. Amer. Acad. Ophthal, Otolaryng. 76: , ) Clemis, J. D.: Allergy as a Cause of Fluctuant Hearing Loss Otolaryng. Clin, of North America 8: , ) Duke, W. W.: Meniere's syndrome caused by allergy J. A. M. A 81: , ) Endicott, J. N.: Allergy in Meniere's disease related fluctuating hearingloss preliminary findings in a double-blind cross over clinical study Laryngoscope 87: , ) Goldstein L. T.: Meniere's disease, Twenty years later Eye, Ear, Nose, Thr. Monthly , 1967.

12 14) Powers, W. H.: The dizzy patient-allergic aspect Laryngoscope 79: , ) Powers, W. H.: Allergic phenomena in the inner ear Otolaryng. Clin. North America , ) Powers, W. H.: Allergic factors in Meniere's disease Trans. Amer. A. Acad. Ophthal. Otolaryng. 77: 22-29, ) Powers, W. H.: The role of allergy in fluctuating hearing loss Otolaryng. Clin. North America, 8: , ) Pulec, L, and House, W. F.: Meniere's disease study: Three year progress report Equilibrium Res. 3: , ) Pulec, J. L.: Meniere's disease: Results of a two and one-half year study of etiology, natuaral history and results of treatment Laryngoscope 82: , ) Shaver, E. F.: Allergic management of Meniere's disease Arch. Otolaryng. 101: 96-99, ) Stahle, J., Deuschl, H, and Johansson, S. G. cial reference to immunoglobulin E and IgE antibody in serum Equilibrium Res. 4: 22-27, ) Stable, J.: Allergy, immunology, psychosomaitc hypo and hypertonus Arch. Oto-Rhino- Laryng, 212: , ) Taub, S. J.: Allergy in relation to Meniere's syndrome Labyrinth and headache Eye, Ear, Nose and Thr. Monthly 48: , ) Wilson, W. H.: Episodic vertigo in vascular dysfunction of the vestibular labyrinth Laryngoscope, 77: , ) Wilson, W. H.: Antigenic excitation in Meniere's disease Laryngoscope, 82: , ) Williams, H. L.: A concept of allergy as autonomic dysfunction suggested as an improved working hypothesis Ann. Otol, 60: , ) Bryan, Wm. T. K, and Bryan, M. P.: The application of in vitro cytotoxic reactions to clinical diagnosis of food allergy Laryngoscope 70: , ) Lee, C. H.: Provocative testing and treatment for foods Arch. Otolaryng. 90: 8794, ) Rinkel, H. J. The management of clinical allergy Arch. Otolayng. 77: , ) Rinkel, H. L, et al: The diagnosis of food allergy Arch. Otolaryng. 79: 7179, ) Rowe, A. H.: Clinical allergy Philadelphia: Lea & Febiger , 40) Waickman, F. J.: Food hypersensitivity allergy or malabsorption Laryngoscope 87: , ) Wilson, W. H.: Hypersensitivty to foods. The

13 adaptation phenomenon Laryngoscope , ) Richardson, J. B.: Localization of antigen in experimental bronchoconstriction in guinea pigs J. Allergy Clin. Immunol. 52:

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