Inner ear dysfunction of uncertain origin: A multidisciplinary approach could give something more

In order to find out any possible cause of an alteration of the vasomotor reactivity which can be responsible for a more or less severe sufferance of the inner ear, announced by the onset or the enhancement of sensorineural hearing loss, tinnitus, and some kind of dizziness and vertigo, a multidisciplinary approach should be considered. The possibility of an influence of hemodynamic imbalance due to hypotensive changes followed by vasomotor changes affecting the microcirculation of the inner ear has already been widely discussed; moreover, an increase in prevalence of tinnitus (which in many cases can be considered as a symptom of sufferance of the inner ear) has been found in subjects submitted to an "aggressive" antihypertensive therapy as well as in patients with severe heart failure, thus demonstrating a relationship between hemodynamic changes and inner ear dysfunction. For the same reason, the research for this mechanism of imbalance could concern other conditions possibly activating an abnormal response of the autonomic nervous system, which could in turn lead to a circulatory impairment of the labyrinth: among these, affections concerning central nervous system, endocrine system, metabolism, renal apparatus and even gastroenteric diseases with a functional component and any other factor which could interfere with vasomotor regulation should be considered. Thus, the absence of reliable causes for a sufferance of the inner ear should not lead to catalogue it as a disorder of "idiopathic" nature, but should represent a reason for a multidisciplinary investigation on all the possible causes of hemodynamic imbalance and/or autonomic dysregulation. (C) 2008 Elsevier Ltd. All rights reserved.