Meniere’s disease

Meniere’s diseaseMeniere’s disease (also known as Idiopathic Endolymphatic Hydrops) is the disorder of the inner ear that leads to the episodes of vertigo and hearing impairment.

Description


Meniere’s disease is a chronic condition that usually involves one ear. Commonly the onset of the disease takes place at the age 40-60, although person at any age may be affected. The disease is characterized by tinnitus (ringing or roaring sound in the ear), the feeling of the spinning (vertigo), hearing loss and poor balancing.


Causes

The cause of the disease in not known, although changes of the fluids in the inner ear (endolymphatic hydrops) are suggested. This may be the result of genetic and environmental (for example, food allergy) factors.

Endolymphatic hydrops is an excessive production of the endolymph fluid within the tubes of the inner ear. Not every person who has endolymphatic hydrops develop Meneire’s disease Sometimes the imbalance of the fluid in the inner ear occurs irregularly leading to isolated subtypes of the disorder – vestibular (when the vestibular system is affected) or cochlear (the hearing system/cochlea is involved) Meniere’s disease.

Probably the increased quantity of the endolymph causes dysfunction of the sensory cells.


Risk factors


Meniere’s disease is more frequent among the women and severely obese persons. Arthritis, psoriasis, migraine and irritable bowel syndrome are associated with Meniere’s disease.

Symptoms

The main symptom of the disease are the attacks of vertigo – the sensation of spinning around accompanied by dizziness, vomiting, nausea and sweating. These episodes last from a few minutes to several hours. Affected person also experiences tinnitus (the hearing of the ringing, roaring or whistling noises), a sense of fullness in the ear, and hearing loss. The progression of the disease causes stress, anxiety, and depression.

Stages of the disease


The symptoms of the disease, their duration and intensiveness varies from person to person and changes during the course of the disease.

  • Stage one (early)

In this stage occur sudden and unpredictable attacks of vertigo. During an episode, a person may experience nausea, dizziness, vomiting, hearing loss and at the same time tinnitus. These episodes may last from 20 minutes to 24 hours.sometimes the feeling of fullness in the ear may precede an attack of vertigo.

  • Stage two (intermediate)

Attacks of the vertigo are less severe than previously, but tinnitus and hearing loss worsens. Before or after an episode the person may experience giddiness. Remission periods may last several months.

  • Stage three (late)

Episodes of vertigo occur even more and more frequently until they vanish spontaneously. Hearing impairment (including hearing discomfort and sensitivity to loud sounds) and tinnitus continue to worsen. At the same time affected persons have poor equilibrium, the distortion of the balance is especially intense in the darkness.

In some cases the attacks of Meniere’s disease occur in clusters. However, in other cases even years may pass between the episodes of vertigo.

Meniere’s disease may also be classified due to the hearing impairment (according to Kumagami et al).

  • In stage one hearing is disturbed only during the attacks of vertigo. Otherwise the hearing is normal.
  • In stage two hearing does not return to normal after the vertigo is gone.
  • In stage tree the levels of hearing remain below 60dB HL.

Hearing loss in Meniere’s disease is characterized by the distorted sensitivity to quite sounds of low frequency.

The progression of the disease leads to the involvement of the second ear. About 50% of ill persons present both ears to be affected after 30 years long history of the disorder.

[Related: Conductive hearing loss]


Diagnosis


To suspect the disease at least 2 episodes of vertigo that lasts at least for 20 minutes should be reported.

To exclude other possible causes of such symptoms blood tests, CT or MRI examination is performed.

Treatment

There is no treatment to provide total recovery for the affected person, although a lot of options are possible to control the symptoms.

Acute attacks of vertigo may be managed with the intake of:

  • Meclizine (Antivert) in dose from 12.5 twice a day to 50 mg three times a day;
  • Lorazepam (Ativan) 0.5 mg twice a day sublingually (under the tongue);
  • Phenergan 12.5 mg every 12 hours for vomiting;
  • Compazine 5 mg every 12 hours for vomiting;
  • Dexamethasone  4 mg for 4 days;

It is recommended to lay down on a firm surface during an attack. The person should remain motionless with eyes focused on the stable object until the vertigo vanishes.

To prevent the attack the administration of following medications may be necessary:

  • Diuretics -Dyazide (Triamterine);
  • Vestibular Suppressants:  Klonapin 0.5 mg twice a day; Lorazepam 0.5 mg twice a day; Diazepam  2 mg twice a day or as needed;
  • Calcium Channel Blockers: Verapamil, Cinnarizine, Nimodipine;
  • Steroids are used rarely (Dexamethasone, Prednisone);

Sometimes the Meniett device is used. It creates small pulses of pressure and sends them into the ear and helps reduce the amount of fluid in the inner ear.

In rare cases the destruction of the inner ear by the means of ototoxic medications (Gentamicin) or surgery is needed.

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