What is Meniere’s Disease?
Meniere’s disease is a condition involving the inner ear, which significantly affects the sense of hearing and equilibrium or balance. The presence of Meniere’s disease is varied according to people. It may have differences in intensity from being mild to severe. It may cause lifelong disability for some.
Meniere’s disease causes the characteristic condition such as hearing loss, tinnitus and vertigo. Patients may experience hearing loss that come and go and some may develop permanent hearing loss. Meniere’s disease predominantly affects women than men. It usually starts during adulthood. There is also increased prevalence with age.
Image Source: buzzle.com
Meniere’s Disease Causes
Meniere’s disease is an idiopathic condition, meaning that there is no definite causation of the condition. However, there has been a link to endolymphatic hydrops in the inner ear characterized by excess fluid. The condition arises from bursts in the endolymphatic channels that allow the fluid to flow into the inner ear and other areas, which causes damage.
The endolymphatic fluid is contained in the membranous labyrinth. The area may become dilated when there is increased pressure in the area and may also dilate as a result of obstruction in the flow of the fluid. Increase in the pressure in the endolymphatic membrane may also be due to swelling of other tissues such as the vestibular system, the inner ear structure responsible for the sense of balance. Some patients may also have a narrow endolymphatic duct since birth. In addition, increased secretion of endolymphatic fluid by the stria vascularis may also lead to increased pressure in the inner ear.
Meniere’s Disease Risk Factors
The presence of increased pressure in the membranous labyrinth that may cause the rupture of the endolymphatic channels may be associated with the following risks:
- Head trauma
- Middle ear infection
- Upper respiratory tract infection
- Cigarette smoking
- Using aspirin
- Increased salt in the diet
- Ear Infection with Herpes virus
Meniere’s Disease Symptoms & Signs
The symptoms of Meniere’s disease include:
Vertigo is one of the four classical symptoms of Meniere’es disease. It is characterized as rotational, severe, unpredictable, and incapacitating and may last up to minutes or hours. The vertigo attacks are usually less than 24 hours, but some patients may have prolonged vertigo of more than a day. Vertigo happens because of problems in the vestibular system, causing conditions affecting the balance. Because of dizziness, vertigo may also be accompanied by sweating, nausea and vomiting. Drop attacks may also happen as a result of vertigo. This is the sudden attack of severe vertigo that causes the person to fall.
Bilateral or unilateral tinnitus
Tinnitus is the presence of ringing in the ears as a result of affectation of the membranous labyrinth.
Hearing loss may be bilateral or unilateral characterized as progressive and fluctuating. Some patients may have problems in the distortion of sounds and some may experience unusual sensitivity to noise.
Pressure or fullness in the ears
Sensations of pressure may also occur in one or both ears because of increased pressure in the endolymphatic membrane.
Migraine may also be experienced by most of the patients with Meniere’s disease
Meniere’s disease Diagnosis (Tests)
The diagnosis of Meniere’s disease starts with a detailed medical history to study the symptoms. Diagnostic tests are usually performed to ascertain the diagnosis. These include:
These examinations involve the visualization or study of the ear structures to determine any problems or conditions in the ear.
These are series of tests done to determine the hearing capacity of the patient.
MRI of the head specifically the ear area is essential in ruling out other conditions such as superior canal dehiscence or vestibular schwannoma. These diseases often have similar symptoms with Meniere’s disease.
The diagnosis of Meneire’s disease is often done by ruling out other conditions. The absence of any possible cause for Meniere’s disease ascertains the diagnosis because it is considered idiopathic.
Criteria for the diagnosis of Meniere’s disease have also been set. These include:
- Progressive and fluctuating sensorineural hearing loss
- Vertigo lasting no more than 24 hours with nystagmus
- There is remission and exacerbation of attacks.
Positive Romberg’s Test shows a patient who has difficulties maintaining balance.
Meniere’s Disease Treatment
Treatment for Meniere’s disease involves those that correct the disorder as well as control the symptoms. These include:
- Salt restriction – Increased salt in the diet leads to increase in pressure in the inner ear because of water retention. Because of this, salt intake should not be more than 2 grams per day.
- Avoidance of alcohol, tobacco and caffeine – These substances were also found to aggravate the symptoms of Meniere’s disease. Avoiding these substances are very essential for patients.
- Anti-emetics – Anti-emetics are usually given to reduce nausea and vomiting associated with vertigo attacks. These drugs may include meclozine, trimethobenzamide, dimenhydrinate, betahistine, ginger root and diazepam. Betahistine is an important medication for Meniere’s disease because it is the only drug that helps prevent symptoms because of vasodilation of the blood vessels in the inner ear.
- Diuretics may also be given to patients to reduce fluid in the inner ear that leads to increased pressure in the labyrinth.
- Antiviral medications – Antiviral drugs such as acyclovir may be given to patients with herpes infection in the eras to reduce the symptoms of the disease. However, antiviral drugs may not be able to correct the permanent damage the virus has caused in the inner ear.
- Steroid injections – Dexamethasone may also be injected in the middle ear in order to reduce inflammation and improve ear circulation.
- Physiotherapy – Physiotherapy may also employ to gain more balance through balance exercises.
- Surgery – Surgery is the last treatment for patients who do not respond to conventional management. Surgery may employ one or more of the following:
- Endolymphatic sac decompression – This procedure involves the decompression of the endolymphatic sac to reduce pressure and provide temporary relief from symptoms.
- Labyrinthectomy – This involves the permanent removal of the membranous labyrinth. However, this may lead to permanent hearing loss to the affected ear because of the removal of the tissue. Chemical labyrinthectomy with the use of gentamicin injections may also be performed in order to preserve the hearing.
- Vestibular neurectomy – This procedure involves the resection of the vestibular nerve to relieve symptoms.
Silverstein Microwick to drain excess fluids in endolymphatic fluid at membranous labyrinth
Image source: audiologyonline.com