Menière’s disease patient Mr Stephen Spring and his former doctor, ENT surgeon Professor Bill Gibson, have developed a patient/practitioner education animation about Meniere’s disease.
The animation, which shows and describes the vertigo attack mechanism, is available free online for education purposes.
Spring presented it at the Prosper Menière’s Society meeting PMS 2025, the 20th International Symposium and Workshops on Inner Ear Medicine in Austria from March 22-29, 2025. The society is named after Dr Prosper Menière, the French doctor who first named the condition.
His presentation also showed the mechanism of action of vertigo and expanded on it with subsets and molecular mechanisms from Professor Lindsay Wing’s pioneering work in Royal Hobart Hospital in the late 1970s.
Spring is an expert patient advocate on Menière’s, also called endolymphatic hydropic inner ear disease, and Prof Gibson, who is now semi-retired, is a world leader in cochlear implantation and Menière’s disease and was the University of Sydney’s first professor of otology.
Spring was once Prof Gibson’s Menière’s patient and vice-president of the now defunct Menière’s Disease Research Fund at the University of Sydney when Prof Gibson was its medical advocate.
“I have presented this animation work at several international conferences and it has been viewed online thousands of times,” Spring said.
“Full credit goes to the animators and the modellers. With Prof Gibson’s help, all were able to strike a balance between an informative medical animation to impart technical knowledge and anatomically correct information yet it is not so sophisticated that patients have difficulty understanding what it all means.”
Spring said people with hearing loss or those wanting to slow the narration could use video controls to slow down the animation and generate closed captions.
Can be distressing
“Patients are often extremely anxious when their vestibular system seems to go out of control which, along with tinnitus, ear fullness and hearing loss, can be extremely distressing,” Spring said.
He collaborated on the animation because he “didn’t want Prof Gibson’s work to be lost in the same way as other science pioneers have been, many who are 25 years ahead of their time”.
Spring said that before 2008 it was commonly thought vertigo attacks in Menière’s disease occurred when the two inner ear fluids mixed, via an inner ear membrane rupture, until the rupture healed and vertigo resolved.
“If that was true, the mixing would kill hearing but it did not kill hearing,” he said.
He said Prof Gibson did not believe this theory as the true mechanism.
“In an elegant series of human and animal experiments with audiologist Dr Celine McNeil and then new Phd student, Mr Daniel Brown, they showed ruptures were unlikely as endolymph and perilymph would have mixed, and hearing would crash or deafen the patient, which was not what happened,” Spring said.
“Now Gibson has retired, I decided this seminal work should not go unnoticed because it begs the real question – why does endolymphatic hydrops develop in one person and not another considering about 90% of Menière’s disease is sporadic?”
Valve opens and stimulates vestibular system
Spring said Prof Gibson’s mechanism of action theory upended the existing theory. The old model was that ruptures caused the attacks; the new mechanism is that a tiny valve (the Valve of Bast) opens and stimulates the vestibular system as seen in the animation.
Professor Lindsey Wing, former head of ENT anatomy at the University of Sydney and a pioneering ENT immunologist, ran face to face lectures in local support groups that Spring attended and he later became his patient.
“Prof Wing was dealing with his patients with obviously distinct Menière’s subsets in the early 2000s, before recent publications. This was despite his own material being published in Australian medical journals but not released on-line,” Spring said.
Menière’s events
Spring attended February’s Association for Research in Otolaryngology ARO 2025 Menière’s symposium which he said “gave an impression that little has happened in the field since 1972 including a slide with nothing except question marks”.
“This evidences a communication breakdown as much is known but it is yet to reach the clinic, a topic I gave evidence to for the government inquiry into Australian hearing health in 2017,” Spring said.
He also attended the Vertigo Academy International Meeting in Budapest from April 3 to 6 2025 and presented at PMS 2025.
“The PMS 2025 meeting is a medical gathering that is unique because a variety of views are encouraged and science is discussed and debated, rather than taught,” Spring said.
Dr Ilmari Pyykkö, professor and head of the Hearing and Balance Research Unit at Tampere University School of Medicine in Finland, received the gold medal award. He has more than 1,500 published papers on inner ear research with an emphasis on Meniere’s.
Implantable sensors
Curtin University Associate Professor Daniel Brown, a hearing and balance physiologist with particular focus on Ménière’s disease, developed new methods of objectively diagnosing Ménière’s disease, new animal models of Ménière’s, and new approaches to quantifying functional and morphological changes in the inner ear.
“Daniel Brown presented his ideas for implantable sensors, applications and repurposed drugs. There were other people, including some leading thinkers in the field especially immunology which is set for innovation as new ideas take hold,” Spring said.
Spring said the meeting highlighted different approaches of clinicians, difficulties of diagnosis and identifying people under umbrella definitions, reflecting the multi -actorial nature of hydropic inner ear disease.
Topics included surgery, immunology, processes that damage the endolymphatic sac, immunogenetic underpinnings, and how migraine and Menière’s can co-exist with different approaches needed to get results. “Michael Toxiedo’s talk was a tour de force on the migraine-Menière’s interrelation,” Spring said.
He said a presentation by Dr Andreas Eckhard, co-director of the Otopathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, and Harvard Medical School assistant professor of otolaryngology – head and neck surgery, was a significant step.
“He identified degenerative types of endolymphatic sacs with some observable changes (but still functional) versus wholly hypoplastic and fibrotic types, which had lost function,” Spring said.
“An algorithm for MRI detection will hopefully be taken up by imaging specialists. This is significant because a possible outcome might be a way to standardise and initially detect hydropic damage and monitor treatments by detecting degrees of basement membranes degeneration, or not.
“This is currently done in animal work but has been harder in humans until recently. This work might go towards explaining the condition and treatment successes and failures.”
