The Progressive Nature of Menière's Disease: Stress Projections and Lesion Analysis

Hypothesis: An engineering model of the labyrinth can provide a mechanism that accounts for the pattern of lesion development observed in Menière's disease. Background: Membrane lesions in Menière's disease can occur in virtually every part of the membranous labyrinth. How these lesions are induced is unclear and their mode of distribution uncertain. Pressure induced stress in the membranous labyrinth may play a mechanistic role in lesion formation and distribution. Methods: An engineering model of the labyrinth was used to provide membrane stress formulations and projections for lesion induction in the several chambers using membrane theory. These were compared with an analysis of actual lesions observed in Menière's disease to evaluate the model's accuracy. Results: The model projects that lesions in the membranous labyrinth will be induced progressively because of stress differentials among the chambers, with a chain of lesion pattern that follows the serial anatomic order and occurs with a frequency commensurate with chamber stress level. An analysis of lesions observed in actual cases of Menière's disease reveals a pattern of lesion development that is progressive, sequential, commensurate, and concordant with the model's stress projections. Conclusions: The concordance between the stress projections and the lesion analysis strengthens the hypothesis that Menière's is a progressive disease that follows a chain of lesions paradigm based on pressure-induced stress differentials in the variously configured chambers of the membranous labyrinth.

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