Symposium on meniere's disease.: Iv. Antigenic excitation in meniere's disease

Decision as to the presence of Ménière's disease requires strict adherence to established diagnostic criteria. An etiologic diagnosis becomes mandatory upon determining existence of the disorder. Among several etiologic factors to be considered is antigenic excitation of labyrinthine dysfunction. A primary patho‐physiologic process in Ménière's disease is probably often an abnormal response of select, genetically predisposed cochlear arterioles to systemic stress. Local hypoxia resulting from arteriolar constriction through abnormal catacholamine stimuli may induce a persisting neosynthesis of histamine at the precapillary loop sphincters, as described by Schayer. 3 Majno, et al. , 4 have demonstrated that the ensuing dilation of the precapillary loops causes an increase in capillary and venule volume with stasis, endothelial cell separation and greater permeability of capillary and venule walls to plasma protein and fluid. Imbalance of circulatory homeostasis in stria vascularis conceivably could result in auditory and vestibular dysfunction. The role antigenic excitation may play in this perverse vascular response deserves exploration.