Food-induced stimulation of the antisecretory factor to improve symptoms in Meniere’s disease: our results

  • Alfonso Scarpa
  • Massimo RalliEmail author
  • Pasquale Viola
  • Claudia Cassandro
  • Matteo Alicandri-Ciufelli
  • Maurizio Iengo
  • Giuseppe Chiarella
  • Marco de Vincentiis
  • Michele Cavaliere
  • Ettore Cassandro



Specially processed cereals (SPC) that increase endogenous antisecretory factor (AF) synthesis have been proposed to improve symptoms of Meniere’s disease (MD) with controversial results. The aim of this study was to evaluate the effects of SPC in patients with definite unilateral MD and compare the results to a treatment protocol with intravenous glycerol and dexamethasone.


Thirteen patients with unilateral MD were treated with SPC and 13 patients were treated with intravenous glycerol and dexamethasone for 12 months. Audio-vestibular evaluation was performed before (T0) and at the end of the treatments (T12). The number of vertigo spells were evaluated before and after therapy and the Efficacy Index (EI) was calculated. Questionnaires for hearing loss (HHIA), tinnitus (THI) and quality of life (TFL) were administered.


EI decreased in the SPC group in the second semester compared to the first although not significantly (p = 0.6323). There was a significant reduction for THI score in the SPC group at T12 (p = 0.0325). No significant differences were found between the two groups at T0 (p = 0.4723), while a significant difference was found at T12 (p = 0.0041). Quality of life showed an improvement in daily activities in the SPC group compared to infusion therapy group.


Our study shows a reduced number of vertigo attacks and a positive effect on the discomfort generated by tinnitus and quality of life in patients with unilateral MD treated with SPC and when compared to patients treated with intravenous glycerol and dexamethasone. No effects on hearing thresholds were noted in both groups.


Meniere’s disease Specially processed cereals Endogenous antisecretory factor Vertigo Hearing loss 



The authors declare that they have no sources of funding.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of the University of Naples ‘‘Federico II” (2017) and the University of Salerno (2018) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Goebel JA (2016) 2015 Equilibrium Committee Amendment to the 1995 AAO-HNS guidelines for the Definition of Meniere’s Disease. Otolaryngol Head Neck Surg 154(3):403–404. CrossRefPubMedGoogle Scholar
  2. 2.
    Naganawa S, Nakashima T (2014) Visualization of endolymphatic hydrops with MR imaging in patients with Meniere's disease and related pathologies: current status of its methods and clinical significance. Jpn J Radiol 32(4):191–204. CrossRefPubMedGoogle Scholar
  3. 3.
    Salt AN, Plontke SK (2010) Endolymphatic hydrops: pathophysiology and experimental models. Otolaryngol Clin North Am 43(5):971–983. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Paparella MM (1991) Methods of diagnosis and treatment of Meniere's disease. Acta Otolaryngol Suppl 485:108–119CrossRefGoogle Scholar
  5. 5.
    Ralli M, Greco A, Altissimi G, Turchetta R, Longo L, D'Aguanno V, Tombolini M, Cianfrone G, Vincentiis M (2017) Vestibular schwannoma and ipsilateral endolymphatic hydrops: an unusual association. Int Tinnitus J 21(2):128–132. CrossRefPubMedGoogle Scholar
  6. 6.
    Russo FY, Ralli M, De Seta D, Mancini P, Lambiase A, Artico M, de Vincentiis M, Greco A (2018) Autoimmune vertigo: an update on vestibular disorders associated with autoimmune mechanisms. Immunol Res 66(6):675–685. CrossRefPubMedGoogle Scholar
  7. 7.
    Ralli M, D'Aguanno V, Di Stadio A, De Virgilio A, Croce A, Longo L, Greco A, de Vincentiis M (2018) Audiovestibular symptoms in systemic autoimmune diseases. J Immunol Res 2018:5798103. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hussain K, Murdin L, Schilder AG (2018) Restriction of salt, caffeine and alcohol intake for the treatment of Meniere's disease or syndrome. Cochrane Database Syst Rev 12:CD012173. 10.1002/14651858.CD012173.pub2Google Scholar
  9. 9.
    Crowson MG, Patki A, Tucci DL (2016) A systematic review of diuretics in the medical management of Meniere's disease. Otolaryngol Head Neck Surg 154(5):824–834. CrossRefPubMedGoogle Scholar
  10. 10.
    Phillips JS, Westerberg B (2011) Intratympanic steroids for Meniere's disease or syndrome. Cochrane Database Syst Rev 7:CD008514. 10.1002/14651858.CD008514.pub2Google Scholar
  11. 11.
    Pullens B, van Benthem PP (2011) Intratympanic gentamicin for Meniere's disease or syndrome. Cochrane Database Syst Rev 3:CD008234. 10.1002/14651858.CD008234.pub2Google Scholar
  12. 12.
    Ingvardsen CJ, Klokker M (2016) Antisecretory therapy with no improvement in functional level in Meniere's disease. Acta Otolaryngol 136(3):232–235. CrossRefPubMedGoogle Scholar
  13. 13.
    Leong SC, Narayan S, Lesser TH (2013) Antisecretory factor-inducing therapy improves patient-reported functional levels in Meniere's disease. Ann Otol Rhinol Laryngol 122(10):619–624CrossRefGoogle Scholar
  14. 14.
    Hanner P, Rask-Andersen H, Lange S, Jennische E (2010) Antisecretory factor-inducing therapy improves the clinical outcome in patients with Meniere's disease. Acta Otolaryngol 130(2):223–227. CrossRefPubMedGoogle Scholar
  15. 15.
    Hanner P, Jennische E, Lange S, Lonnroth I, Wahlstrom B (2004) Increased antisecretory factor reduces vertigo in patients with Meniere's disease: a pilot study. Hear Res 190(1–2):31–36. CrossRefPubMedGoogle Scholar
  16. 16.
    Johansson E, Lange S, Lonnroth I (1997) Identification of an active site in the antisecretory factor protein. Biochim Biophys Acta 1362(2–3):177–182. CrossRefPubMedGoogle Scholar
  17. 17.
    Johansson E, Lonnroth I, Lange S, Jonson I, Jennische E, Lonnroth C (1995) Molecular cloning and expression of a pituitary gland protein modulating intestinal fluid secretion. J Biol Chem 270(35):20615–20620. CrossRefPubMedGoogle Scholar
  18. 18.
    Bjorck S, Bosaeus I, Ek E, Jennische E, Lonnroth I, Johansson E, Lange S (2000) Food induced stimulation of the antisecretory factor can improve symptoms in human inflammatory bowel disease: a study of a concept. Gut 46(6):824–829. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lange S, Lonnroth I, Skadhauge E (1987) Effects of the antisecretory factor in pigs. Pflugers Arch 409(3):328–332. CrossRefPubMedGoogle Scholar
  20. 20.
    Laurenius A, Wangberg B, Lange S, Jennische E, Lundgren BK, Bosaeus I (2003) Antisecretory factor counteracts secretory diarrhoea of endocrine origin. Clin Nutr 22(6):549–552CrossRefGoogle Scholar
  21. 21.
    Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease (1995) American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 113(3):181–185. 10.1016/S0194-5998(95)70102-8Google Scholar
  22. 22.
    Newman CW, Weinstein BE, Jacobson GP, Hug GA (1990) The Hearing Handicap Inventory for adults: psychometric adequacy and audiometric correlates. Ear Hear 11(6):430–433CrossRefGoogle Scholar
  23. 23.
    Passi S, Ralli G, Capparelli E, Mammone A, Scacciatelli D, Cianfrone G (2008) The THI questionnaire: psychometric data for reliability and validity of the Italian version. Int Tinnitus J 14(1):26–33PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Alfonso Scarpa
    • 1
  • Massimo Ralli
    • 2
    Email author
  • Pasquale Viola
    • 3
  • Claudia Cassandro
    • 4
  • Matteo Alicandri-Ciufelli
    • 5
  • Maurizio Iengo
    • 6
  • Giuseppe Chiarella
    • 3
  • Marco de Vincentiis
    • 2
  • Michele Cavaliere
    • 6
  • Ettore Cassandro
    • 1
  1. 1.Department of Medicine and SurgeryUniversity of SalernoSalernoItaly
  2. 2.Department of Sense OrgansSapienza University of RomeRomeItaly
  3. 3.Unit of Audiology, Department of Experimental and Clinical Medicine, Regional Centre for Cochlear Implants and ENT DiseasesMagna Graecia UniversityCatanzaroItaly
  4. 4.Surgical Sciences DepartmentUniversity of TurinTurinItaly
  5. 5.Otolaryngology DepartmentUniversity Hospital of ModenaModenaItaly
  6. 6.Department of Neuroscience, Reproductive and Odontostomatologic Science, Ear, Nose and Throat SectionUniversity of Naples ‘‘Federico II’’NapoliItaly

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