Meniere’s Disease

General Illness Information

Medical Term: Meniere’s Disease

Common Name: None Specified

Description: Meniere’s disease is a disorder of the inner ear

Probably results from an abnormality in the inner ear fluid regulation. Usually it involves one ear, but both ears may be affected in 15% of patients. Typical onset age is between 20 and 50 years of age. Both sexes are equally affected.  Intermittent attacks of vertigo, tinnitus (ringing in the ears), hearing loss and ear fullness occur.

Causes: Unknown

Postulated possible causes:

• allergic factors;
• metabolic disorders;
• vascular abnormalities;
• infections e.g. viral, syphilis;
• trauma.

Prevention:

• Avoid exposure to loud noises;
• Treat infections e.g. syphilis.

Signs & Symptoms

Symptoms may be only a minor nuisance, or can be disabling.

May present with:

• Sudden attacks of vertigo with or without warning– spinning sensation accompanied by and off balance sensation and associated nausea and occasionally vomiting.
• Tinnitus a roaring, buzzing, machine-like or ringing sound in the ear.
• It may be episodic with an attack of vertigo or may be constant. Usually tinnitus is worse or will become worse just before the onset of vertigo
• Hearing Loss– is intermittent at the onset of illness, but often persists during remission and over time becomes a fixed hearing loss ,most commonly at lower frequencies. Loud sounds may be uncomfortable and appear distorted.
• Ear fullness.
• this usually occurs just before the onset of an attack of vertigo.
• Attacks may last from 15 minutes to several hours with long periods of remission– weeks to months to years.

Risk Factors

• Head injury;
• Syphilis.

Diagnosis & Treatment

Diagnosis of Meniere’’s disease is usually made on history and physical examination. Some of the laboratory tests may help in confirming the diagnosis of Meniere’’s disease and in ruling out other causes of vertigo.

Audiogram (hearing test) may show hearing loss in the lower frequencies. However early in the onset of the illness hearing may be normal .It is only later on in the illness that permanent hearing loss occurs.Blood tests can be done to rule out thyroid disorder, syphilis or lipid disorder .Other tests may be performed to rule out tumors on the auditory or the balance nerves. These tumors are rare but may cause symptoms similar to those of Meniere’s disease. These tests are : ABR- Auditory brain stem response- a computerized test of the hearing nerves and brain pathways. MRI- magnetic resonance imaging.

General Measures:

• Low salt diet
• Avoid caffeine, alcohol and smoking. Other measures: Regular sleep and continue to be physically active in between the attacks. Avoid stress and excessive fatigue.

Surgical remedies are reserved for those who remain substantially disabled despite a prolonged varied trial of medical therapy and exercises. Depending on the patient’’s situation one of the following three procedures may be recommended:

1. Endolymphatic shunt.
2. Selective vestibular neurectomy.
3. Labyrinthectomy and eight nerve section.

Medications:

• Diuretics (water pills) such as thiazide and a low salt diet may prevent relapses
• For the treatment of an attack ,the most common drug classes employed are the antihistamines, anticholinergics, and sedative-hypnotic drugs. Less severe vertigo may often be alleviated with antihistamines such as meclzine (antivert), 25mg, or cyclizine or dimenhydrinate, 25-50mg,orally every 6 hours.
• In acute severe attacks, patient may have to be hospitalized and given diazepam, 2.5-5mg intravenously to abate an attack Relief from nausea and vomiting usually requires an anti-emetic, delivered intramuscularly or by rectal suppository(e.g.prochlorperazine,10mg intra-muscularly, or 25mg rectally , every 6 hours). Bed rest may reduce the severity of acute vertigo.

Activity:

• Patients who get vertigo without any warning should not drive or operate any heavy machinery and also avoid any potentially dangerous activities such as climbing ladders, scaffolds etc.
• Strict bed rest is advised during an attack, and medical supervision is necessary .

Diet:

• Low salt diet;
• Avoid caffeine, alcohol and smoking.

Possible Complications : Nil

Prognosis

Although there is no real cure for Meniere’s disease -attacks of vertigo can be controlled in most cases.

Other

Nothing Specified.

Posted by RxMed