| Meniere's Disease remains today a difficult to manage inner ear problem. The primary defect of the afflicted ear is the formation of endolymphatic hydrops. The unique ionic concentration of endolymph depends on active ion transport. A disturbance in the Na$sp{+}$, K$sp{+}$ ATPase activity of the stria vascularis will affect fluid balance. Biochemical abnormalities associated with ATP production were investigated in 16 Meniere's patients. Each had a 6 hour glucose tolerance test with simultaneous insulin response. Lipoprotein phenotyping and percent body fat were monitored during the study. The biochemical data revealed hyperinsulinemia (p =.007), hyperlipoproteinemia and an increased amount of body fat. In view of the biochemical connections between hyperinsulinism, hyperlipoproteinemia and percent body fat, a low carbohydrate diet (148g/da) was implemented. After three months on dietary treatment, percent body fat and triglyceride levels decreased significantly (p =.007, p $<$.0001). Vertigo was successfully controlled in 62.5% of the patients and in the remaining subjects both severity and duration of the vertigo attack decreased. Hyperinsulinism appears to be the basic abnormality of Meniere's Disease. A pathophysiologic model for insulin induced endolymphatic hydrops is presented demonstrating the effect of insulin on non-oxidative glucose disposal and ATPase activity. |
