Menière's disease: etiology and natural history.
Fifty-three carefully selected patients with Menière's disease were studied. Unlike Pulec, who describes a specific etiology in Menière's disease in 48% of the cases, we found no specific etiology in this study, except in one case (syphilis). The sequence of the development of the symptoms showed marked individual differences. In 16 patients, cochlear and vestibular symptoms started at the same time. In 26 patients the vestibular symptoms started after the cochlear symptoms and in 11 patients the reverse occurred. The meaning of these findings for the mechanism of the Menière attack is discussed.