Meniere’s disease is a disorder localized in the inner ear that causes dizziness, fluctuating sensorineural hearing loss, and tinnitus. There is no reliable diagnostic test. Dizziness and nausea are treated symptomatically with anticholinergics or benzodiazepines in acute attacks. The frequency and severity of episodes of illness can be reduced by using diuretics and a low-salt diet as the first choice. In severe or therapy-resistant cases, chemical (with gentamicin injections through a previously inserted ventilation tube) or surgical ablation of the vestibular apparatus can be performed.
In Menière’s disease, fluctuations in the pressure and volume of the endolymph in the labyrinth affect the functions of the inner ear. The etiology of the endolymphatic fluid stagnation has not been clarified. In addition to a family history of Menière’s disease, possible risk factors can also include autoimmune diseases, allergies, skull or ear traumas and – very rarely – syphilis. The frequency peak is found among 20 to 50 year olds.
Symptoms and Ailments
Menière patients have sudden attacks of dizziness , which usually last for 1–6 hours, but in rare cases can last up to 24 hours, and are associated with nausea and vomiting. Accompanying symptoms can be sweating (diaphoresis), diarrhea and unsteadiness of gait.
Constant or intermittent tinnitus (buzzing or roaring) in the affected ear, regardless of position or movement, can result in typical hearing deterioration – for low-frequency sounds. Shortly before and during an episode, many patients feel a feeling of fullness or pressure in the affected ear. The majority of patients have only one ear affected.
In the early stages the symptoms subside again and again, and the symptom-free periods between individual episodes of illness can last> 1 year. However, as the disease progresses, hearing loss gradually persists and worsens, and tinnitus can also become chronic.
- Clinical evaluation
- Audiogram and gadolinium MRI to rule out other causes
The diagnosis of Meniere’s disease is made clinically, the simultaneous combination of fluctuating low-frequency sensorineural hearing loss, episodic vertigo, ipsilaterally fluctuating hearing abundance and tinnitus is characteristic. because similar symptoms can also occur with vestibular migraines, viral labyrinthitis or neuronitis, a cerebellar bridge angle tumor (e.g. acoustic neuroma) or infarction (in the brainstem area). Although Menière’s disease can be bilateral, bilateral symptoms increase the likelihood of an alternative diagnosis (e.g. vestibular migraine). Vestibular migraine (also known as migraine dizziness) is characterized by episodes of dizziness in patients with a history of migraine or with other features of migraine, such as headache, Photophobia and phonophobia or visual aura; there is no hearing loss.
In an acute attack, in addition to nystagmus, the patient has a tendency to fall to the diseased side. The examination may be completely normal between attacks. The Fukuda stair test (walking with closed eyes, formerly known as the Unterberger test), however, in protracted or refractory cases with associated labyrinthine hypofunction, causes the patient to turn to the affected ear, which corresponds to a unilateral labyrinthine lesion.
The Halmagyi head impulse maneuver or head impulse test is another technique used to detect unilateral labyrinthine dysfunction. In this test, the examiner prompts the patient to visually fixate on a target straight ahead (e.g. the examiner’s nose). The examiner then quickly turns the patient’s head 15 to 30 degrees to the side while observing the patient’s eyes. If vestibular function is normal on the side to which the head was turned, the patient’s eyes remain fixed on the target. If the vestibular function is disturbed on the side to which the head was turned, the vestibular ocular reflex fails and the patient’s eyes do not remain fixed on the target,
An audiogram and cranial MRI (with gadolinium contrast enhancement) should be performed for symptoms suggestive of Meniere’s disease, and special attention should be paid to the internal auditory canals to rule out other causes. The audiogram reveals low-tone hearing loss as a typical sensorineural hearing loss in the affected ear that fluctuates between tests. The Rinne test and Weber test (tuning fork test) can indicate sensorineural hearing loss.
- Relieve symptoms with antiemetics, antihistamines, or benzodiazepines
- Diuretics and low-salt diet
- Rarely, vestibular ablation from drugs or surgery
- Contact the specialist doctor i.e neus keel oorarts Oostende
Menière’s disease is self-limiting. Treatment of an acute attack aims to relieve symptoms and is carried out according to a defined method. The least invasive measures are tried first, and ablative procedures are sometimes used when other measures do not work.
With anticholinergic anti-emetics (e.g. prochlorperazine 25 mg rectally or 10 mg po every 6 to 8 hours; promethazine 25 mg rectally or 25 mg po every 6 to 8 hours), vagal-mediated gastrointestinal symptoms can be alleviated; Ondansetron is a second-line antiemetic. Antihistamines (e.g. diphenhydramine, meclizine or cyclizine, 50 mg po every 6 hours) or benzodiazepines (e.g. diazepamevery 6–8 h 5 mg po) are used to sedate the vestibular apparatus. Neither antihistamines nor benzodiazepines are suitable for prophylactic treatment. Some doctors treat acute episodes of illness with oral corticosteroid burst therapy (e.g., with prednisone, 60 mg po for 1 week, then tapered off for 1 week) or with intratympanic dexamethasone injections.
A low-salt diet ( < 1.5 g / day), avoiding alcohol and caffeine and taking diuretics (e.g. 25 mg hydrochlorothiazide once a day po or 250 mg acetazolamide twice a day po) can help Prevent or reduce the occurrence of dizziness and are generally applied first. However, there are no well-designed studies that clearly demonstrate the effectiveness of these measures for Meniere’s disease.
Although more invasive, depressurizing the endolymphatic sac leads to an improvement in dizziness in the majority of patients and carries only a small risk of (hearing loss). Therefore, this procedure is still classified as a treatment that is gentle on the vestibular apparatus.
If treatment attempts that are gentle on the vestibular apparatus fail, an ablative procedure is considered. Intratympanic gentamicin (chemical labyrinthectomy – typically 0.5 ml at a concentration of 40 mg / ml) is injected through the eardrum. Follow-up with serial audiometry is recommended to monitor for hearing loss. If dizziness persists without hearing loss, the injection can be repeated after 4 weeks.
Ablative surgery should be reserved for patients whose frequent and debilitating episodes of illness do not respond to less invasive therapy modalities. After an intracranial operation (neurectomy of the vestibular nerve), dizziness subsides in around 95% of patients and their hearing ability is mostly retained. A surgical labyrinthectomy is only performed if there was already severe hearing loss.
Unfortunately, it is not known how the natural progression of hearing loss can be stopped. Most patients develop moderate to severe sensorineural hearing loss in the affected ear within 10–15 years.
- Menière’s disease usually causes dizziness with nausea and vomiting, unilateral tinnitus, and chronic, progressive hearing loss.
- An audiogram and MRI are done to rule out other disorders.
- Antiemetics and antihistamines can relieve symptoms. Some doctors also use oral or transtympanic corticosteroids.
- More invasive treatments for refractory cases include endolymphatic sac decompression, gentamicin labyrinthectomy, and vestibular nerve neurectomy.
- Diuretics, a low-salt diet, and avoiding alcohol and caffeine can prevent seizures.