PubMed was searched on July 1, 2026 for records published from June 1, 2006 through June 1, 2026. A single reproducible strategy combined the MeSH term and title/abstract synonyms for Ménière’s disease with general mechanistic terms and named domains covering endolymphatic hydrops, genetics, inflammation and immunity, ion and water transport, blood-labyrinth barrier dysfunction, and oxidative stress. The complete search was:

(“Meniere Disease” [Mesh] OR meniere*[Title/Abstract] OR ménière*[Title/Abstract]) AND (mechanis*[Title/Abstract] OR pathogenes*[Title/Abstract] OR molecular [Title/Abstract] OR “Endolymphatic Hydrops” [Mesh:noexp] OR “endolymphatic hydrops” [Title/Abstract] OR “Genetic Predisposition to Disease” [Mesh:noexp] OR genetic*[Title/Abstract] OR gene*[Title/Abstract] OR variant*[Title/Abstract] OR familial [Title/Abstract] OR “Inflammation” [Mesh:noexp] OR inflamm*[Title/Abstract] OR immun*[Title/Abstract] OR cytokine*[Title/Abstract] OR allerg*[Title/Abstract] OR “Ion Transport”[Mesh:noexp] OR “ion transport”[Title/Abstract] OR ion channel*[Title/Abstract] OR aquaporin*[Title/Abstract] OR vasopressin [Title/Abstract] OR “blood-labyrinth barrier” [Title/Abstract] OR “blood labyrinth barrier” [Title/Abstract] OR “Oxidative Stress” [Mesh:noexp] OR “oxidative stress” [Title/Abstract]) AND 2006/06/01:2026/06/01[dp]

The search retrieved 1895 unique PubMed records.

Mechanistic research was operationally defined as research that investigated, synthesized, or generated disease-relevant evidence about factors potentially involved in the initiation, modulation, progression, or biological heterogeneity of Ménière’s disease. Eligible evidence therefore included etiologic or pathophysiologic hypotheses; environmental or physiological factors associated with attack onset or disease progression, including atmospheric pressure; disease-related genetic variants or gene-expression findings; molecular, cellular, immune, vascular or barrier, ion or water transport, oxidative-stress, and hydrops-related findings; and imaging or biomarker observations when the authors explicitly linked them to disease biology. Human studies were eligible when they included a defined Ménière’s disease cohort or a separately evaluable Ménière group and reported disease-relevant findings. Animal, cell, and tissue studies were eligible when the experimental model explicitly investigated Ménière’s disease, experimentally induced endolymphatic hydrops, or a pathological process directly linked to Ménière’s disease. Reviews were retained when Ménière’s disease was a principal topic. Purely epidemiological, diagnostic, imaging, or treatment reports were excluded only when they provided no etiologic or pathophysiologic interpretation. Studies focused on sudden sensorineural hearing loss, non-Ménière vertigo, tinnitus, or other inner-ear disorders were excluded when they lacked a separately evaluable Ménière cohort, a Ménière-related model, or an explicit mechanistic synthesis applicable to Ménière’s disease. Incidental mentions, examples, and differential diagnoses were insufficient for inclusion.

Two reviewers independently screened titles and abstracts and consulted the full text when eligibility remained unclear. Disagreements were resolved by discussion and consensus, with senior-author adjudication when required. After screening, 1586 records were excluded and the investigator-defined set of 309 publications was used for the main bibliometric analysis; author and affiliation variants were standardized only after eligibility had been finalized. The identification, single-search retrieval, manual screening, and final inclusion process is summarized in Figure S1.

PubMed supplied titles, abstracts, indexing terms, publication dates, authors, and affiliations. Bibliographic records were analyzed with the bibliometrix package in R [20], with CiteSpace supporting bibliographic-format conversion and citation-network processing [26]. Publication-level global citation counts and cited-reference lists were retrieved from OpenAlex in July 2026 and matched by PMID or DOI [27]. Local citation counts, direct-citation links, historiography, and document co-citations were calculated within the 309-record corpus from the matched reference lists; records without a reliable reference match were retained for descriptive productivity analyses but omitted from network calculations requiring unavailable reference data. Author productivity used full publication counting after name disambiguation. Country and institution productivity used full counting of author-affiliation occurrences; accordingly, cumulative country or institution totals could exceed 309 and were labeled as occurrences rather than publications. Descriptive and science-mapping analyses included annual output, source productivity, country and institutional contributions, author productivity, collaboration networks, citation impact, historiography, document co-citation, and keyword co-occurrence and temporal evolution. Predefined nonspecific Ménière-related terms were removed before the keyword analysis, and the six most frequent retained keywords were visualized.

For the focused immune-inflammatory analysis, a secondary PubMed search combined Ménière’s disease with terms related to inflammation, immunity, autoimmunity, cytokines, inflammasomes, immunogenetics, the blood-labyrinth barrier, and the endolymphatic sac. This search retrieved 338 records; after mechanistic screening using the same disease-specific principles, 91 studies were retained. Their annual output, influential publications, mechanistic themes, and direct citation backbone were evaluated. Relative Citation Ratio values were retrieved from the NIH iCite database in July 2026 and matched by PMID as a field- and time-normalized indicator of article influence; records without an available RCR were retained in the other analyses but omitted from RCR-based ranking [28].

The PubMed search retrieved 1895 records, of which 309 met the manually applied eligibility criteria and were included in the main bibliometric analysis. Annual publication output showed an overall upward trajectory from 2006 to 2026 despite pronounced year-to-year fluctuations, reaching 28 publications in 2025; the 21 records assigned to 2026 reflected partial-year coverage at the retrieval date (Figure 1(A)). Mean annual citations varied across publication years, peaking at 6.65 for articles published in 2016, and declined among the newest records because of the shorter citation window (Figure 1(B)). Bradford’s law identified 11 core journals, compared with 38 journals in Zone 2 and 103 in Zone 3, showing that a small subset of sources accounted for a substantial proportion of the 309-document corpus (Figure 1(C)).

The country collaboration network retained three major interconnected clusters, with Spain and Australia acting as prominent hubs in the blue cluster, China and the United States occupying central positions in the orange cluster, and a predominantly European green cluster (Figure 1(D)). Geographic mapping showed that China, Spain, and the United States accounted for the largest country-attributed contributions (Figure 1(E)). Under full counting of author-affiliation occurrences, cumulative totals reached 577 for China, 317 for Spain, 183 for the United States, and 105 each for Italy and Japan (Figure 1(F)). Citation impact was uneven across countries: Luxembourg ranked first in total citations (203), followed by China (122) and the United States (112) (Figure 1(G)).

An exploratory logistic model estimated a maximum annual output of approximately 54 publications around 2053 (Figure 1(H)). Because model fit was moderate (R² = 0.553) and the projection extended far beyond the observed period, it should be interpreted only as a descriptive scenario rather than a precise forecast.

Cumulative author-affiliation occurrences increased markedly in the later study years (Figure 2(A)). After affiliation disambiguation, Shandong University had the highest count (105), followed by Universidad de Granada (63), Central South University (47), and the University of Sydney (43); Huazhong University of Science and Technology and Harvard Medical School were tied at 27 occurrences (Figure 2(B)). These results indicate strong contributions from Chinese, Spanish, and Australian research centers.

Figure 1.Temporal evolution, source concentration, geographic distribution, and international collaboration in mechanistic research on Ménière’s disease, 2006 - 2026. (A) Annual publication output. (B) Mean annual citation rate; the recent decline should be interpreted in the context of citation lag. (C) Bradford source zones. (D) Country collaboration network; node size represents weighted collaboration strength, edge width represents collaboration frequency, and color represents cluster membership. (E) Geographic distribution of country-attributed author-affiliation occurrences. (F) Cumulative author-affiliation occurrences for the five leading countries under full counting. (G) Total citations assigned to the most highly cited countries. (H) Exploratory logistic growth model; points indicate observed output, the solid curve the fitted trajectory, the dashed curve the projection, and the vertical line the estimated peak year (approximately 54 publications around 2053; R² = 0.553).

Figure 2. Leading affiliations, productive authors, and collaboration structure in mechanistic research on Ménière’s disease, 2006 - 2026. (A) Cumulative author-affiliation occurrence counts of five highlighted affiliations. (B) Affiliations ranked by author-affiliation occurrence count after name consolidation. (C) Annual production of the leading authors; bubble size indicates publication count and color indicates citations per year. (D) Authors ranked by publication count after author-name disambiguation. (E) Co-authorship network; node size indicates PageRank, edge width collaboration strength, and color collaboration cluster.

Author productivity was similarly concentrated (Figure 2(C)). José Antonio López-Escámez was the most productive author, with48 publications, followed by Álvaro Gallego-Martínez (18); Lidia Frejo contributed 16 publications, while Andrés Soto-Varela and Ismael Aran each contributed 15 publications (Figure 2(D)). López-Escámez maintained the longest publication trajectory, whereas several Chinese investigators became increasingly active in recent years.

The co-authorship network contained several interconnected research communities (Figure 2(E)). A major Spanish-led cluster centered on López-Escámez and included Aran, Soto-Varela, Frejo, Requena, and Pérez-Carpena, whereas a distinct Chinese cluster included Wang, Zhang, Song, and Li. López-Escámez established an otology and neurotology research group in 2002 and helped develop the international Ménière’s Disease Consortium; his work integrates clinical phenotyping, genomics, immunogenetics, and inflammatory endotyping. His position in the network therefore reflects both sustained productivity and a central role in multicenter collaboration.

Among the Chinese contributors, Yongdong Song and Haibo Wang were central members of the Shandong University-Shandong Provincial ENT Hospital network. Their earlier work encompassed vestibular phenotyping and surgical management of intractable Ménière’s disease, while recent studies extended this program toward translational immunology. In 2026, Song was a co-first author and Wang the senior author of a study linking oxidative stress-induced DNA release and macrophage STING activation to endolymphatic hydrops and audio-vestibular dysfunction. They also contributed to research associating sympathetic stress signaling, CD11b-positive myeloid inflammation, and G-CSF with disease progression.

Following the contributor analysis, we examined publication venues and the intellectual structure of the field. Otology & Neurotology published the largest number of included articles (n = 21), followed by Acta Oto-Laryngologica (n = 15) and Scientific Reports (n = 12) (Figure 3(A)). Otology & Neurotology also showed the strongest sustained growth (Figure 3(B)) and the highest local h-index (h = 11), followed by Acta Oto-Laryngologica (h = 10) (Figure 3(C)). The participation of otology, neurology, genetics, and multidisciplinary journals underscores the cross-disciplinary nature of this literature.

Nakashima et al. (2016) was the most globally cited document (313 citations), followed by Gürkov et al. (2016; 233 citations) (Figure 3(D)). The historiographic map connected earlier foundational studies with later genetic, immune-inflammatory, and molecular investigations (Figure 3(E)). The co-citation network separated the knowledge base into interconnected clusters, with López-Escámez et al. (2015) and Merchant et al. (2005) acting as central references (Figure 3(F)).

To clarify the basis of their influence, we reviewed the leading cited documents in greater detail (Table 1). The two most cited records were broad reviews that synthesized widely relevant conceptual frameworks, whereas the leading original studies defined clinical subgroups, supported autoimmune involvement, or demonstrated familial clustering and genetic heterogeneity in Ménière’s disease.

Table 1. Characteristics of the Leading Globally Cited Documents.

Figure 3.Publication sources, highly cited documents, and intellectual structure of mechanistic research on Ménière’s disease, 2006 - 2026. (A) Sources ranked by publication count. (B) Cumulative output of leading sources. (C) Local source impact measured by h-index within the dataset. (D) Documents ranked by global citations. (E) Historiographic network of direct citation relationships. (F) Document co-citation network; node size indicates PageRank centrality, edge width indicates co-citation strength, and color indicates cluster membership.

Building on the journal and citation analyses, we evaluated the thematic composition of the filtered keyword dataset. Endolymphatic hydrops was the most frequent term (31 occurrences), followed by exome sequencing and genetics (eight each), magnetic resonance imaging (six), and aldosterone and inflammation (five each) (Figure 4(A)). Its cumulative frequency increased most strongly, particularly in 2025, whereas the remaining topics showed more gradual growth (Figure 4(B)).

Figure 4.Keyword landscape and temporal evolution after removal of predefined nonspecific terms. (A) Frequencies of the six most frequent retained keywords. (B) Cumulative keyword occurrences, 2006 - 2026. (C) Temporal span of each keyword; lines indicate first and last publication years, while bubble position and size indicate median year and frequency. (D) Keyword co-occurrence network; node size indicates frequency and edge width the number of shared documents. (E) Annual keyword heatmap; darker cells indicate higher frequencies.

Genetics first appeared in 2016, followed by aldosterone in 2017, inflammation in 2018, and exome sequencing in 2019; inflammation and magnetic resonance imaging remained active through 2026 (Figure 4(C)). In the co-occurrence network, endolymphatic hydrops was linked mainly to magnetic resonance imaging and aldosterone, while genetics clustered with exome sequencing and, less strongly, inflammation (Figure 4(D)). The annual heatmap confirmed persistent interest in endolymphatic hydrops, increasing activity in genetics and exome sequencing, and more continuous representation of inflammation and magnetic resonance imaging during 2023 - 2026 (Figure 4(E)).

The increasing prominence of inflammation in Figure 4 motivated a focused analysis of immune-inflammatory mechanisms. A PubMed search combining Ménière’s disease with terms related to inflammation, immunity, autoimmunity, cytokines, inflammasomes, immunogenetics, the blood-labyrinth barrier, and the endolymphatic sac retrieved 338 records published from June 1, 2006, to June 1, 2026. After title and abstract screening, 91 studies with direct mechanistic relevance were retained; records limited to incidental inflammatory mentions, non-Ménière conditions, epidemiology, diagnosis, imaging, or non-mechanistic treatment were excluded.

Annual output remained low during the early period but increased after 2020: 52 of the 91 studies were published during 2021 - 2026, with a peak of 11 studies in 2024 (Figure 5(A)). Greco et al. (2012) was the most cited article (95 citations), followed by Frejo et al. (2018) and Calabrese et al. (2010), each with 86 citations (Figure 5(B)). Several recent studies showed high Relative Citation Ratios despite lower cumulative citation counts, indicating strong impact relative to articles of similar age and field.

Theme evolution showed a shift from broad autoimmune hypotheses toward more specific inflammatory mechanisms (Figure 5(C)). Autoimmunity and allergy dominated 2007 - 2012 (13 studies), whereas cytokines and immune endotypes increased to 14 studies in 2023 - 2026. Immunogenetics and multi-omics remained active across successive periods, and studies of the blood-labyrinth barrier and endolymphatic sac increased in the latest interval. Innate signaling and inflammasome research also emerged, although the number of studies remained limited.

The temporal citation network connected early studies of autoimmunity, allergy, and oxidative injury with later work on cytokine-defined endotypes, immunogenetics, multi-omics, innate signaling, inflammasome activation, and barrier dysfunction (Figure 5(D)). Node position indicates publication year and dominant theme, node size represents citation count, and edges denote direct citations within the 91-study dataset. Together, the network supports a transition toward biologically defined subgroups and more specific molecular and barrier-related mechanisms.

Figure 5.Evolution and citation structure of immune-inflammatory research in Ménière’s disease. (A) Annual output of 91 mechanism-focused studies, 2007 - 2026. (B) Eight influential articles ranked by NIH iCite citation count; the Relative Citation Ratio provides field- and time-normalized impact. (C) Evolution of six mechanistic themes. (D) Direct citation backbone of 50 influential or emerging studies; node size indicates citation count, color the dominant theme, and edges direct citation relationships within the dataset.