Jeffrey P. Harris, MD, PhD, Guest editor

Quyen T. Nguyen, MD, PhD, Guest editor

The amount of information in the world has doubled in the past 10 years and is doubling every 18 months. Unfortunately, although nearly 150 years have passed since Prosper Ménière first described the constellation of symptoms that is called Meniere’s disease, conclusive etiology and curative treatments are still elusive. Some of the brightest and most productive scientists in the world are focused on understanding the underlying mechanisms giving rise to the auditory and vestibular phenomena that patients suffer yet we still do not have a clear grasp on whether or not this disease is metabolic, developmental, genetic, autoimmune, or infectious.

Reading through the content in this publication, written by leading experts in this field, there is strong experimental and clinical evidence to support each of these theories, and thus, the most likely explanation is that the disease is multifactorial.

Although endolymphatic hydrops has long been held to be the distinguishing pathologic derangement, which gives rise to Meniere’s disease, it is provocative to consider that, in blinded temporal bone studies, not all individuals with histopathologic evidence of endolymphatic hydrops had clinical histories consistent with Meniere’s disease. This suggests that there may be ameliorating factors even in the presence of histopathologically evident hydrops that can modulate patient symptoms. Even more perplexing is the finding that the surgical destruction of the endolymphatic sac seems to improve symptoms in these patients, contrary to what might be expected, and calls into question the role of the endolymphatic sac in maintaining inner ear homeostasis.

Ongoing research toward the development of individualized diagnosis and therapies based on cellular, molecular, and genetic markers may be the key toward successful treatment of this debilitating disease and provide answers to these perplexing observations.