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J Neurol. 2017 Oct;264(Suppl 1):48-54. doi: 10.1007/s00415-017-8452-9. Epub 2017 Mar 20.

Do patients with Ménière's disease have attacks of syncope?

Author information

Hearing and Balance Research Unit, Department of Otolaryngology, University of Tampere, Tampere, Finland.
Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.
Department of Behavioral Science and Learning, Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
Audiology India, Mysore, Karnataka, India.
Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Karnataka, India.
Hearing and Balance Research Unit, Department of Otolaryngology, University of Tampere, Tampere, Finland.
Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head and Neck Surgery of Chinese PLA, Changhai Hospital, Second Military Medical University, Shanghai, China.
Department of Otolaryngology, University of Helsinki, Helsinki, Finland.


The aim of the present study was to evaluate the prevalence and associated factors for syncope among patients with Ménière's disease (MD). An attack of syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously and without a localizing neurological deficit. The study used an across-sectional survey design. Information from a database consisting of 961 individuals was collected from the Finnish Ménière Association. The data contained case histories, general health-related quality of life (HRQoL), and impact measurements of the complaints. In the current study sample, syncope occurred in 12.3% of the patients with MD. It was more prevalent among elderly persons and among those with a longer duration of MD. Syncope was significantly associated with disturbances of otolith function reflected as Tumarkin attacks, gait and balance problems, environmental change of pressure, and physical strain. It was also associated with visual blurring; in fact, patients with otolith dysfunction in MD often experience visual field changes. It was also associated with headache, but not with migraine. Syncope was experienced as frightening and HRQoL was significantly worsened. The patient had higher anxiety scores, and suffered more from fatigue. The results demonstrate that neurally mediated syncope occurs in patients with an advanced form of MD who suffer from Tumarkin attacks due to failure in otolith function. The mechanism seems to be triggered through the vestibular sympathetic reflex when the otolith system fails due to disrupted utricular otolithic membrane mediate erroneous positional information from the otolith organ to the vasomotor centres in the brain stem and medulla.


Drop attack; Fainting vestibular disorder; Ménière’s disease; Otolith organ; Syncope; Tumarkin attacks

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