Ménière's Disease

Meniere's disease, also called Idiopathic Endolymphatic Hydrops, is a disorder of the inner ear. Although the cause is unknown, it results from an abnormality in the fluids of the inner ear. Ménière's disease is a common cause of dizziness originating from the inner ear. In most cases, only one ear is involved, but both ears may be affected in about 15% of patients. Ménière's disease typically starts between the ages of 20 and 50 years. Men and women are equally affected.

Causes

The exact cause of ménière's disease is unknown, but it is believed to be the result of an abnormality in the fluids of the inner ear. The movement of the fluid is restricted and causes uncoordinated stimulation of the nerve fibres' controlling balance.

Symptoms

Symptoms of ménière's disease include:

• episodic vertigo (attacks of a spinning sensation)
• hearing loss
• tinnitus (a roaring, buzzing, or ringing sound in the ear)
• a sensation of fullness in the affected ear.

Vertigo is often accompanied by nausea and vomiting. Attacks may last for 20 minutes to two hours or longer, while fatigue and an off-balance sensation may last for hours to days. During attacks, patients may be unable to perform their usual activities, needing to lie down until the vertigo resolves. Hearing loss is often irregular, occurring mainly at the time of the vertigo attacks.

Loud sounds may seem distorted and cause discomfort. Usually, the hearing loss involves mainly the lower pitches, but over time this often affects the tone of all pitches. After an extended period of the disease, hearing loss often becomes permanent. Tinnitus and fullness of the ear may come and go with changes in hearing (occurring during or just before attacks), or it may be constant.

Diagnosis

Your doctor will take a history of the frequency, duration, severity and character of your attacks; the duration of hearing loss or whether it has been changing; and whether you have had tinnitus or fullness in either or both ears. When the history has been completed, diagnostic tests will check your hearing and balance functions. These tests may include:

• For hearing

An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in the affected ear. Speech discrimination (the patient's ability to distinguish between words like 'sit' and 'fit') is often diminished in the affected ear.

• For balance

Balance will be tested by the doctor using a variety of head movements and tilts. In about 50% of patients, the balance function is reduced in the affected ear. Rotational testing or balance platform may also be performed to evaluate the balance system.

Treatment

Although there is no cure for ménière's disease, the vertigo attacks can be controlled in nearly all cases.

Treatment may include:

• a low salt diet and avoiding alcohol, tobacco and caffeine
• diuretic (water pill)
• anti-vertigo medications, e.g., cyclizine or stugeron
• surgery.

Your otolaryngologist (physician treating diseases of the head and neck) will help you choose the treatment that is best for you, as there are things to consider with each. For example, while anti-vertigo and anti-nausea medications will reduce dizziness, they may cause drowsiness.

Other treatments also carry both positive implications as well as drawbacks. Intratympanic injections involve injecting medication through the eardrum into the middle ear space where the ear bones are located. This treatment is done in the otolaryngologist's office and includes either making a temporary opening in the eardrum or placing a tube in the eardrum. The medication may be administered once or several times.

Medication injected may include gentamicin or corticosteroids. Gentamicin alleviates dizziness but could also, in some individuals, cause increased hearing loss in the treated ear. Corticosteroids do not cause worsening of hearing loss, but are less effective in alleviating the major dizzy spells.

When is surgery recommended?

If vertigo attacks are not controlled by conservative measures and are disabling, you are advised to discuss other alternatives, such as surgery, with you doctor.

What should I do during an attack?

Lie flat and still, and focus on an unmoving object. Often people fall asleep while lying down and feel better when they awaken.

How can I reduce the frequency of ménière's disease episodes?

Avoid stress and excess salt ingestion, caffeine, smoking and alcohol. Get regular sleep and eat properly. Remain physically active but avoid excessive fatigue. Consult your otolaryngologist about other treatment options which may be available.

References
American Academy of Otolaryngology. Website: http://www.entnet.org