Meniere's Disease

Ménière's disease is an abnormality of the inner ear causing a host of symptoms, including vertigo or severe dizziness, tinnitus or a roaring sound in the ears, fluctuating hearing loss, and the sensation of pressure or pain in the affected ear. The disorder usually affects only one ear and is a common cause of hearing loss. Named after French physician Prosper Ménière who first described the syndrome in 1861.

What causes Ménière's disease?

The symptoms of Ménière's disease are associated with a change in fluid volume within a portion of the inner ear known as the labyrinth. The labyrinth has two parts: the bony labyrinth and the membranous labyrinth. The membranous labyrinth, which is encased by bone, is necessary for hearing and balance and is filled with a fluid called endolymph. When your head moves, endolymph moves, causing nerve receptors in the membranous labyrinth to send signals to the brain about the body's motion. An increase in endolymph, however, can cause the membranous labyrinth to balloon or dilate, a condition known as endolymphatic hydrops.

The exact cause of Meniere’s disease is unknown. Scientists are investigating several possible causes of the disease, including genetics, anatomy, viral infections and environmental factors.

What are the symptoms of Ménière's disease?

The symptoms of Ménière's disease occur suddenly and can arise daily or as infrequently as once a year. The symptoms include dizziness, hearing loss, tinnitus and ear pressure. People experience these symptoms at varying frequencies, durations, and intensities. Some may feel mild symptoms only a few times a year while others can be debilitated and deafened by frequent attacks. In the early stages, a person's hearing tends to recover between attacks but over time usually becomes worse.

Vertigo, often the most debilitating symptom of Ménière's disease, typically involves a whirling dizziness that forces the sufferer to lie down. Vertigo attacks can lead to severe nausea, vomiting, and be accompanied by diarrhea and sweating and often come with little or no warning. Some patients have less mild vertigo that makes them feel only off balance or slightly dizzy and are not debilitating.

How is Ménière's disease diagnosed?

Based on a recent study, NIDCD estimates that there are currently approximately 615,000 individuals with diagnosed Ménière's disease in the United States and 45,500 newly diagnosed cases each year. Meniere’s disease is a clinical diagnosis that sometimes requires time and observation to diagnose. Proper diagnosis of Ménière's disease begins with a medical history interview and a physical examination by a physician experienced in the diagnosis of Meniere’s disease and careful audiometric testing. Accurate measurement and characterization of hearing loss are of critical importance in the diagnosis of Ménière's disease. These are frequently repeated over time and after attacks to conclude the diagnosis. Other electrophysiolocal tests of the hearing, blood work balance tests, and medical imaging with magnetic resonance imaging (MRI) are sometimes used. Electrocochleography, recording the electrical activity of the inner ear in response to sound, sometimes helps confirm the diagnosis or evaluate if the other ear is at risk for developing Meniere’s disease, as it can be bilateral in 15-30% of cases. A VNG (video electronystagmogram) can help evaluate the status of the inner ear. Other balance tests are sometimes ordered.

How is Ménière's disease treated?

There is no cure for Ménière's disease. However, the symptoms of the disease are often controlled successfully by reducing the body’s retention of fluids through dietary changes (such as a low-salt or salt-free diet and no caffeine or alcohol) or medication. Eliminating tobacco use and reducing stress levels are more ways some people can lessen the severity of their symptoms. Diuretics are the most frequently prescribed drugs for Meniere’s. Betahistine, allergy medications, steroids and vasodilators are frequently used.

Different surgical procedures have been advocated for patients with persistent, debilitating vertigo from Ménière's disease. An endolymphatic sac decompression and shunt insertion can help improve Meniere’s disease in up to 75% of cases. The Meniette device is sometimes prescribed for people with Meniere’s disease who are not good candidates for an endolymphatic sac surgery, or who are medically not suitable for surgery. The administration of the ototoxic antibiotic, gentamycin directly into the middle ear space has gained popularity worldwide for the control of the vertigo of Ménière's disease. Injections of steroids through the tympanic membrane can also sometimes be helpful. Labyrinthectomy (removal of the inner ear sense organ) can effectively control vertigo, but sacrifices hearing and is reserved for patients with nonfunctional hearing in the affected ear. Vestibular neurectomy, selectively severing a nerve from the affected inner ear organ, usually controls the vertigo while preserving hearing, but carries surgical risks.

Meniere's Disease Surgery

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