Meniere's Disease

Meniere's Syndrome, Endolymphatic Hydrops

What is Meniere's disease?

Meniere's disease is a chronic, episodic disease characterized by a sensation of spinning or moving (vertigo) with fluctuating hearing loss, a ringing in the ears (tinnitus), and pressure in the affected ear.

Meniere's disease usually affects one ear, with 25 to 50 percent of the cases eventually developing bilateral disease. The first attack occurs between the ages of 20 and 50. Its cause is unknown. The sudden, unprovoked attacks of vertigo with vomiting and loss of balance can last from minutes to days. Episodes of the disease are recurrent over months or years. Tinnitus and hearing loss accompany an attack , but the worst symptom is the vertigo.

As the disease progresses, the tinnitus may become as constant and debilitating as the vertigo. Permanent hearing loss may eventually develop in the affected ear. Vertigo often ceases after this occurs.

How is it diagnosed?

Symptoms of Meniere's Disease

  • In the initial stages of Meniere's disease, the individual is usually most distressed by the vertigo. It can range in severity from episodic impaired balance to an intense illusion of spinning. It may last from 30 minutes to several hours, and is accompanied by severe nausea and vomiting.
  • The tinnitus is often described as roaring or buzzing in the ears. Typically, the symptoms subside completely after the attack. However, the individual may experience a sense of unsteadiness. The attacks may occur at any time and may waken the individual from sleep.
  • In later stages of the disease, the tinnitus may become constant and this symptom frequently becomes the chief complaint.

Physical exam: The physical exam is generally normal.

Tests: Audiometry tests can identify the sensorineural hearing loss seen in primary disorders of the ear like Meniere's disease. When these tests are combined with the other symptoms of episodic vertigo, tinnitus, and fullness, the diagnosis is almost certain.

How is Meniere's disease treated?

Medication is prescribed to combat the vertigo and its accompanying nausea and vomiting. Other treatments may include the use of diuretics and a low-salt diet to decrease fluids in the body. The consumption of caffeine, nicotine, and alcohol is to be avoided. Sedatives may be prescribed to relieve the severe anxiety that a serious attack can cause. In less than ten percent of individuals with Meniere's disease, medical treatment fails to control the frequency and severity of attacks, and surgery is recommended. The operation may involve a procedure to relieve the pressure within the inner ear and its distended membranes. Sometimes, the auditory nerve is cut. When hearing loss is severe or complete in the affected ear and vertigo is disabling, a procedure is performed in which the entire inner ear is destroyed (destructive labyrinthectomy). This operation is generally reserved for the elderly. For individuals with disease affecting both ears, certain antibiotics can be administered and carefully controlled so that the balance portion of the inner ear is disrupted while hearing is preserved.

Medications

Diamox (Acetazolamide), Xanax (Alprazolam), Decadron (Dexamethasone), Valium (Diazepam)

What might complicate it?

Complications include permanent hearing loss and chronic tinnitus.

Predicted outcome

For most individuals, the disorder is primarily an inconvenience as the attacks are sporadic, occurring months or years apart. For a few, however, Meniere's disease can cause complete deafness, and the vertigo and accompanying nausea can be frequent and debilitating. Most individuals live normal life expectancies.

Alternatives

Acoustic neuroma, cerebellar pontine angle tumor, ischemic vertigo, and acute labyrinthitis are other possible diagnoses

Appropriate specialists

Otolaryngologist, audiologist, and neurologist.

Last updated 8 August 2011


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