It was with great interest that I read the article by Arnold and Niedermeyer1 in the Archives. The article supports the idea that at least some patients with Ménière disease developed endolymphatic hydrops as a result of a herpes infection of the inner ear.
We began identifying inflammation of the inner ear on magnetic resonance images with gadolinium contrast in the late 1980s. These patients were being evaluated for sudden hearing loss and most were caused by either viral infections or immune-mediated inner ear disease. We recently published an article2 with findings of magnetic resonance imaging that seemed to confirm the presence of inflammation of the endolymphatic system in some patients with Ménière disease. Other patients with this enhancement, however, did not have the full complement of Ménière disease symptoms. Our suspicion is that we are seeing evidence of early inflammatory damage to the inner ear and that
Fitzgerald DC, Mark AS. Ménière Disease. Arch Otolaryngol Head Neck Surg. 1997;123(7):768. doi:10.1001/archotol.1997.01900070112020