:: Dr.Wu-Vertigo :: 眩暈科-吳志賢醫師-耳鼻喉頭頸外科部 ::

‧美國哈佛大學‧麻州眼耳醫院‧研究員‧中國醫藥大學附設醫院‧耳鼻喉頭頸外科‧主任吳志賢醫師‧

【醫師專欄-耳科】 眩暈症(03-1) - 美尼爾病 - 介紹　Vertigo (03-1) - Meniere's disease - Introduction

～～ 相傳百年的眩暈科醫學諺語 ～～

～～ Proverbs of Vertigo Medicine ～～

～～ 眩暈不是疾病，而是一種症狀，如同發燒一樣，有數百種疾病會發生眩暈的情況 ～～

～～ Vertigo is not a disease but a symptom, like fever. There are hundreds diseases that can cause vertigo. ～～

～～ 人類的平衡系統主要有四個輸入與整合系統：視覺，內耳前庭，本體感覺，小腦。任何一個系統出現干擾，整個平衡系統就會出現紊亂，產生眩暈、頭暈、不平衡、步態不穩以及噁心、嘔吐、恐慌感 ～～

～～ The human balance system mainly has four input and integration systems: vision, inner ear vestibule, proprioception and cerebellum. If any one of the systems occur distaurbance, the entire balance system will be disordered, resulting in vertigo, dizziness, imbalance, unsteady gait, and nausea, vomiting, panic sensation. ～～

～～  頭暈一詞可細分成四種症狀：眩暈、接近昏厥、不平衡、只是頭暈 ～～

～～ The term dizziness can be broken down into four categories of symptoms: vertigo, near syncope, imbalance, just dizzy ～～

～～ 眩暈症可歸因為三類疾病：末稍性眩暈、中樞性眩暈、反射性眩暈 ～～

～～ Vertigo can be classified into three categories of diseases: peripheral vertigo, central vertigo, reflex vertigo ～～

～～ 要選擇哪一科的醫生，就診原則就是找「具有眩暈專長的醫生」，能把眩暈治好的就是好醫生 ～～

～～ Which department doctor should be selected, the principle of seeing a doctor is to find "a doctor with vertigo expertise". Whoever cures vertigo is a good doctor. ～～

～～ 眩暈治癒的關鍵就是：詳細檢查，確認病因，追根究柢，對症下藥 ～～

～～ The key to cure vertigo is to make a detailed inspection, confirm the cause, follow up evidence, and take appropriate management. ～～

～～ 經常眩暈/頭暈是不是腦部出問題了？如有以下症狀一定要立即就醫：臉歪嘴斜，手腳無力；臉麻手麻，說話不清楚；胸痛，心悸，呼吸急促；頭痛，昏厥，意識不清 ～～

～～ Often vertigo / dizzy, is there a brain problem? Seek medical treatment immediately if you have the following symptoms: face crooked, mouth slanted, paralyzed limbs; facial numbness, hand numbness, unclear speech; chest pain, palpitation, short of breath; headache, fainting, unclear consciousness ～～

美尼爾病的歷史註釋和術語

Historical note and terminology of Meniere’s disease

1861年，法國耳科醫生Prosper Meniere (1799-1862)描述了一組11名患者，其中大多數是30多歲和40多歲的年輕男性，伴有眩暈，耳聾和耳鳴的反復發作，伴有噁心，嘔吐，步態共濟失調和跌倒(Charcot 1881; M'Kenzie 1924; Williams 1949; Atkinson 1960; Gros 1967; Shapiro 1970; Pappas和Galanos 1982; Arenberg 1989; Beasley和Jones 1996; Moshtaghi等2016)。

In 1861 French otologist Prosper Meniere (1799-1862) described a group of 11 patients, mostly young men in their 30s and 40s, with recurrent episodes of vertigo, deafness, and tinnitus with associated nausea, vomiting, gait ataxia, and falls (Charcot 1881; M'Kenzie 1924; Williams 1949; Atkinson 1960; Gros 1967; Shapiro 1970; Pappas and Galanos 1982; Arenberg 1989; Beasley and Jones 1996; Moshtaghi et al 2016).

柏斯貝．美尼爾的肖像圖片：柏斯貝．美尼爾(1799-1862)

Portrait of Prosper Meniere    Image: Prosper Meniere (1799-1862)

間歇性眩暈發作伴有聽力減退和耳鳴增加。僅1例提及了耳壓和充盈，但美尼爾沒有將其作為臨床描述的一部分。隨著時間的流逝，聽力損失逐漸惡化。他將負責病變定位在周圍的前庭裝置，特別是半規管。

The intermittent attacks of vertigo were accompanied by diminution of hearing and increased tinnitus. Only 1 case had mention of aural pressure and fullness, but Meniere did not include this as part of the clinical description. Over time the hearing loss progressively worsened. He localized the responsible lesion to the peripheral vestibular apparatus, and specifically the semicircular canals.

美尼爾的負責病理學定位於半規管顯然是部分基於有爭議的屍體解剖(M'Kenzie 1924； Atkinson 1945； Williams 1949； Shapiro 1970； Pappas 1982)。 Meniere似乎建議將半圓形管腔內出血作為負責任的病理，但隨後的歷史學家已仔細審查了他的1861年報告(以及較早發表的評論)，並得出結論，Meniere正在使用另一例半圓形管腔內出血來支持他的論點。認為該病只局限於周圍的耳蝸－庭皮系統而不是中樞神經系統(Pappas and Galanos 1982)。

Meniere's localization of responsible pathology to the semicircular canals was apparently based in part on a controversial autopsy (M'Kenzie 1924; Atkinson 1945; Williams 1949; Shapiro 1970; Pappas 1982). Meniere seemed to suggest hemorrhage into the semicircular canals as the responsible pathology, but subsequent historians have carefully reviewed his 1861 report (and an earlier published comment) and have concluded that Meniere was using a separate case of hemorrhage into the semicircular canals to support his contention that the disease was localized to the peripheral cochleo-vestibular system rather than the central nervous system (Pappas and Galanos 1982).

1874年，法國神經病學家讓·馬丁·沙科特(Jean Martin Charcot) (1825-1893)將疾病標記為“ Maladie de Meniere”，並指出，耳聾完全發作時，發作性症狀就停止了(Charcot 1881)。

In 1874 French neurologist Jean Martin Charcot (1825-1893) labeled the disease “Maladie de Meniere” and noted that episodic symptoms ceased when the deafness became complete (Charcot 1881).

法國神經科醫生讓·馬丁·夏科特(Jean-Martin Charcot)圖像：讓·馬丁·夏科特(Jean Martin Charcot) (1825-1893)

French neurologist Jean-Martin Charcot Image: Jean Martin Charcot (1825-1893)

美尼爾病的外科治療始於1900年代。 1904年，倫敦皇家耳醫院的理查德·雷克(Richard Lake)對一名21歲的女性進行了迷路切除術和根治性乳突切除術，該病有5年的發作性眩暈，噁心，嘔吐，耳聾和耳鳴。 1928年，美國神經外科醫生沃爾特·丹迪(Walter Dandy，1886-1946)描述了9例梅尼埃病顱內聽神經節病例：所有病例倖存下來，所有症狀均得到緩解(Dandy 1928)。

Surgical treatments for Meniere disease began in the 1900s. In 1904 Richard Lake at the Royal Ear Hospital in London performed a labyrinthectomy and radical mastoidectomy on a 21-year-old woman with a 5-year history of episodic vertigo, nausea, vomiting, deafness, and tinnitus. In 1928 American neurosurgeon Walter Dandy (1886-1946) described 9 cases of intracranial auditory nerve section for Meniere disease: all of the cases survived and all had symptomatic relief (Dandy 1928).

1938年，發現內淋巴水腫是美尼爾綜合症的病理相關因素(Hallpike和Cairns 1938； Paparella 1992)，隨後的其他研究者證實了這一發現(Hallpike和Wright 1939； Halrpike和Wright 1940； Paparella 1992)。最初的發現是由英國耳科醫生Charles Skinner Hallpike (1900-1979)和澳大利亞出生的神經外科醫生Hugh Cairns (1896-1952)在英國，以及日本耳鼻喉科醫生Kyoshiro Yamakawa (1891-1980)在日本(Paparella 1992)獨立進行的。

In 1938 endolymphatic hydrops was found to be the pathological correlate of Meniere syndrome (Hallpike and Cairns 1938; Paparella 1992), a finding subsequently confirmed by other investigators (Hallpike and Wright 1939; Hallpike and Wright 1940; Paparella 1992). The initial discovery was made independently by English otologist Charles Skinner Hallpike (1900-1979) and Australian-born neurosurgeon Hugh Cairns (1896-1952) in England, and Japanese otolaryngologist Kyoshiro Yamakawa (1891-1980) in Japan (Paparella 1992).

美尼爾氏病通常被定義為內淋巴水腫的特發性綜合徵，而術語美尼爾氏綜合徵通常用於具有相同臨床特徵但已查明病因的患者。但是，其他作者在特發性和繼發性病例中都使用了“美尼爾病”一詞(Paparella 1985； Paparella 1991)。

Meniere disease is generally defined as the idiopathic syndrome of endolymphatic hydrops, whereas the term Meniere syndrome is generally used for patients with the same clinical features but who have an identified cause. Other authors, however, use the term Meniere disease for both idiopathic and secondary cases (Paparella 1985; Paparella 1991).

所謂的遲發性內淋巴水腫通常在細菌或病毒感染導致的耳部受損之前發展。還提出了多種美尼爾氏病變體，包括前庭和耳蝸美尼爾氏病(分別以孤立的眩暈發作或聽力喪失為特徵，而沒有完整的美尼爾氏症)。但是，尚無臨床病理學研究將孤立的前庭和聽覺障礙與前庭和聽覺迷宮的選擇性內淋巴水腫相關聯。

So-called delayed endolymphatic hydrops develops in an ear that was previously damaged, usually from a bacterial or viral infection. A number of variants of Meniere disease have also been proposed including vestibular and cochlear Meniere disease (characterized, respectively, by isolated episodes of vertigo or hearing loss, without the complete Meniere syndrome); however, there are no clinical-pathologic studies correlating isolated vestibular and auditory disorders with selective endolymphatic hydrops of the vestibular and auditory labyrinth.Historical note and terminology

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