{"id":4224,"date":"2025-07-28T06:06:58","date_gmt":"2025-07-28T06:06:58","guid":{"rendered":"https:\/\/www.raffaellopagani-ccsvi.it\/?p=4224"},"modified":"2025-07-28T20:53:51","modified_gmt":"2025-07-28T20:53:51","slug":"menieres-disease-and-ccsvi","status":"publish","type":"post","link":"https:\/\/www.raffaellopagani-ccsvi.it\/en\/menieres-disease-and-ccsvi\/","title":{"rendered":"CCSVI and M\u00e9ni\u00e8re\u2019s Disease: A Possible Vascular Origin"},"content":{"rendered":"\t\t
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As a vascular specialist, I often see patients who\u2019ve been diagnosed with M\u00e9ni\u00e8re\u2019s disease<\/strong>. They come to my office after a long journey filled with medical appointments, audiological tests, medications, and sometimes desperate attempts to make sense of their symptoms. Intense vertigo, persistent tinnitus, that annoying sense of fullness in the ear that comes and goes… Anyone who suffers from it knows just how debilitating these symptoms can be\u2014even when test results \u201cdon\u2019t show anything significant.\u201d <\/p>

And yet, when you really listen to these stories, a detail often emerges\u2014one that tends to be overlooked by those who focus solely on the ear: the symptoms aren\u2019t constant<\/strong>. They fluctuate with posture, worsen after standing for long periods, and often improve when lying down or with gentle cervical traction. In some cases, the episodes are triggered by physical exertion or periods of significant muscle tension in the cervical region. <\/p>

These aren\u2019t clues to be ignored.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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A labyrinth disorder... or a neck reflex?\n<\/h2> \r\n\r\n <\/div>\r\n\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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M\u00e9ni\u00e8re\u2019s disease<\/strong> is traditionally described as a disorder of the inner ear, caused by an abnormal buildup of endolymph. This fluid, which normally plays a role in balance and hearing perception, can, under altered conditions, exert excessive pressure on the cochlear and vestibular structures\u2014leading to vertigo, hearing loss, and tinnitus. <\/p>

However, while the endolymphatic theory is widely recognized, it doesn\u2019t account for many of the cases I encounter<\/strong>. Some patients show no documented damage to the cochlea. Others report significant improvement after postural therapy or muscle release treatments. Many say their symptoms can be triggered\u2014or relieved\u2014simply by changing position. In such cases, M\u00e9ni\u00e8re\u2019s disease feels more like a \u201cplaceholder label\u201d than a definitive diagnosis. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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The venous system and the role of CCSVI\n<\/h2> \r\n\r\n <\/div>\r\n\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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It was precisely in these atypical patients that I began exploring a possibility that\u2019s often overlooked: the presence of an extracranial venous drainage dysfunction<\/strong>, particularly involving the internal jugular veins<\/strong>. This condition has a well-defined name\u2014CCSVI<\/strong>, or Chronic Cerebrospinal Venous Insufficiency<\/em>. <\/p>

This condition was first described in the early 2000s by Professor Paolo Zamboni and other researchers. In CCSVI, the blood that should flow freely from the brain toward the heart encounters obstacles along its path. These may include external compressions<\/strong>\u2014such as overactive muscles, elongated bony processes, or adjacent arteries\u2014or intrinsic abnormalities within the vein itself, like malformed valves<\/strong>, septa, or membranes. The result is intracranial venous congestion<\/strong>, which can alter cerebrospinal fluid dynamics and lead to increased pressure affecting the inner ear as well. <\/p>

In short, a vascular component could disrupt endolymphatic circulation<\/strong>, producing symptoms that are clinically indistinguishable from those typically attributed to M\u00e9ni\u00e8re\u2019s disease.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Studies and clinical observations: not just theory\n<\/h2> \r\n\r\n <\/div>\r\n\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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The hypothesis of a vascular component in M\u00e9ni\u00e8re\u2019s disease is not based solely on clinical observation\u2014it\u2019s also supported by scientific literature.<\/p>

A study conducted at the Policlinico of Palermo<\/strong> (Piraino, Faletra et al., 2018) investigated the effects of an intensive cervical physiotherapy program focused on relieving neck muscle tension in patients diagnosed with M\u00e9ni\u00e8re\u2019s disease. The results were striking: the diameter of the internal jugular veins improved<\/strong>, venous flow normalized, and M\u00e9ni\u00e8re\u2019s symptoms progressively diminished<\/strong>. At the one-year follow-up, many patients maintained the benefits they had achieved. <\/p>

Another study, published in Current Neurovascular Research<\/em> da Menegatti et al. (2017)<\/strong><\/span><\/a>, compared patients with inner ear disorders to healthy controls. High-resolution analysis of the jugular valves<\/strong> revealed that many patients had fixed, absent, or immobile valves, resulting in altered venous flow<\/strong>. This anomaly can disrupt pressure within the cochleovestibular canals<\/strong>, potentially contributing to symptoms such as vertigo and tinnitus. <\/p>

The study by studio di Filipo et al. (2015)<\/strong><\/span><\/a>, published in European Archives of Oto-Rhino-Laryngology<\/em>, further supports this hypothesis. Among a sample of 32 patients with M\u00e9ni\u00e8re\u2019s disease, 65.6% showed signs of intracranial venous reflux<\/strong>, and 66.7% had jugular vein stenosis<\/strong>\u2014significantly higher rates than those observed in the control population. These findings suggest that CCSVI may play a real pathogenic role in a subset of cases. <\/p>

A 2016 publication in Acta Oto\u2011Laryngologica<\/em><\/strong><\/span><\/a> proposed that many otologic conditions traditionally labeled as idiopathic may, in fact, be associated with chronic extracranial venous congestion<\/strong>\u2014particularly in individuals with connective tissue predispositions or postural dysfunctions.<\/p>

Finally, a study published in the<\/strong><\/span><\/a>Journal of Vascular and Interventional Radiology<\/strong><\/span> (JVIR)<\/em> documented the clinical course of patients with both M\u00e9ni\u00e8re\u2019s disease and confirmed CCSVI who were treated with venous angioplasty<\/strong>. After 24 months<\/strong>, many reported sustained improvement in vestibular symptoms<\/strong>, including vertigo and tinnitus. While these findings do not suggest a definitive cure, they offer promising evidence for a targeted therapeutic approach in carefully selected cases. <\/p>

Taken together, this body of evidence suggests that CCSVI is not merely a coincidental finding<\/strong>\u2014it may represent an underrecognized pathogenic mechanism in many atypical or treatment-resistant cases of M\u00e9ni\u00e8re\u2019s disease.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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The body speaks, if we know how to listen\n<\/h2> \r\n\r\n <\/div>\r\n\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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There are signals the body sends that are worth listening to. If symptoms worsen when standing and improve when lying down; if they are accompanied by positional headaches, cognitive difficulties, or a sense of pressure in the head or ear that doesn\u2019t match audiological findings\u2026 then it\u2019s time to look beyond the ear<\/strong>. <\/p>

I\u2019m not suggesting that every patient with tinnitus or vertigo has CCSVI. That would be a mistake. But it would be just as mistaken to rule out<\/strong> the possibility altogether when everything else fails to provide an explanation. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Diagnosis and treatment: an integrated approach\n\n<\/h2> \r\n\r\n <\/div>\r\n\r\n \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Assessing cerebral venous outflow is no simple task. It requires specific tests such as dynamic Doppler ultrasound<\/strong>, MR venography<\/strong>, or catheter-based venography<\/strong>\u2014all of which must be performed by experienced professionals. Doppler ultrasound, in particular, is valuable for observing how venous caliber changes with body position or under physical strain. <\/p>

When a genuine dysfunction is identified, treatment isn\u2019t always surgical. On the contrary, many patients benefit from: <\/p>