Meniere's Disease (syndrome) - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Meniere's disease (syndrome)

Meniere's disease is a non-inflammatory pathology that affects the inner ear. The disease is expressed in attacks of dizziness, in periodically arising noises in the ear, as well as in hearing loss.

The disease is the eponym of the French physician P. Meniere, who in 1861 first described the clinical picture characteristic of this pathology. According to statistics, most often the disease is diagnosed in people aged 25 to 50 years, in pediatrics it occurs, but quite rarely. The number of cases is equal to 1: 1000. People of the Caucasian race, in particular, intellectual workers living in large settlements, are more susceptible to Meniere's disease.

In the vast majority of cases, unilateral ear damage is observed. Both organs of hearing are involved in the pathological process in no more than 15% of cases. However, as the disease progresses, it passes to the second ear in 17-75% of cases over a period of 5 to 30 years.

Meniere's disease affected such famous people as: A. Shepard (1 American astronaut), D. Swift (satirist, poet, priest), V. Shalamov (Russian writer), R. Adams (American musician).

Content:

• Meniere's disease symptoms
• Causes of Meniere's disease
• Diagnosis of Meniere's disease
• Treatment of Meniere's disease
• Disability with Meniere's disease

Meniere's disease symptoms

Symptoms of Meniere's disease appear in the form of seizures, during which the patient experiences:

• Dizziness. Often this condition is accompanied by a feeling of nausea and vomiting, which occurs repeatedly. Sometimes the dizziness is so strong that a person has the impression that all the space and objects around him revolve around him. There may be a feeling of falling of the body, or its displacement, although the person is in a motionless state. The attack can last from several minutes to several hours. The patient's condition is aggravated when trying to turn his head, so he intuitively tries to sit down or lie down, covering his eyes. (read also: Dizziness - types and causes)
• Loss or severe hearing impairment. At the same time, a person does not hear sounds with a low frequency at all. This clinical sign makes it possible to differentiate Meniere's disease from hearing loss, in which high-frequency sounds are not heard by the patient. At the same time, a person develops a special sensitivity to loud sound vibrations, and during an increased noise accompaniment, pain in the ear may occur.
• Tinnitus. Ringing occurs regardless of whether there is a source of noise in the person's environment. The ringing is whistling, muffled, some patients compare it with the ringing of a bell. Before the onset of the attack, the ringing tends to intensify, and during the attack itself, it can change.

• Feeling of pressure, stuffiness in the ear. The feeling of discomfort and distention occurs due to the accumulation of fluid in the inner ear cavity. This feeling is especially strong before the onset of the attack.
• Diarrhea, abdominal pain.
• Headaches.
• Shortness of breath, tachycardia, pale skin of the face, increased sweating.
• During an attack, nystagmus is observed - rapid oscillatory movements of the eyeballs. Strengthening of nystagmus is noted while the patient is lying on the damaged ear.
• Sudden fall. This is a rather formidable symptom that occurs due to a lack of coordination. This disorder is associated with deformation of the structures of the inner ear, which causes the activation of vestibular reflexes. In this case, the patient shakes from side to side, sometimes he falls, or changes his posture, in an attempt to maintain balance. The main danger is that there are no precursors of the upcoming activation of vestibular reflexes. Therefore, a person can be seriously injured during a fall.
• After the end of the attack, the person retains hearing loss, there may be noise in the ear, a feeling of heaviness in the head. There is also an unstable gait and coordination disorders. The patient feels weak. As the disease progresses, all these symptoms tend to intensify, and become more prolonged over time.
• Hearing impairment is progressive. If at the very beginning of Meniere's disease a person has difficulty distinguishing low-frequency sounds, then later he does not hear well the entire sound range. Hearing loss eventually turns into absolute deafness. When a person goes deaf, the dizziness stops.

The onset of the disease is characterized by the fact that periods of exacerbations are replaced by periods of remission, during which hearing is fully restored, no disability occurs. Transient hearing loss, as a rule, persists during the first 2-3 years of the disease. As the disease progresses, even during the period of remission, hearing is not completely restored, vestibular disorders persist, and performance decreases.

Most patients with Meniere's disease are able to anticipate an impending attack, as it is preceded by a certain aura. It is expressed in impaired coordination of movements, increasing ringing appears in the ears. In addition, there is a feeling of pressure and filling in the ear. In some cases, there is a temporary improvement in hearing before the attack itself.

Depending on what the symptoms of Meniere's disease are, you can determine the degree of progression of the pathology:

• For the first stage, the leading symptom is considered to be dizziness with vomiting and nausea, while blanching of the skin occurs, hyperhidrosis is observed. Hearing persists between attacks.
• The second stage of the disease is characterized by the development of hearing loss, dizziness has a maximum severity, with a subsequent tendency to weakening.

• The third stage is characterized by hearing loss and the development of bilateral deafness. In this case, dizziness disappears altogether, but coordination disorders persist and intensify when the patient is in the dark.

These three stages characterize the classic course of Meniere's disease, that is, the onset of the pathological process is manifested by a combination of vestibular and auditory disorders. This form of the disease affects 30% of all patients. In addition, there is also a cochlear (begins only with hearing disorders) and vestibular (begins with vestibular disorders) forms of the disease. They account for 50% and 20% of cases, respectively.

Causes of Meniere's disease

The causes of Meniere's disease have not yet been accurately established, although the clinical signs of the disease have been described more than 150 years ago. Naturally, scientists have several hypotheses regarding the factors influencing the etiology of this pathology.

The main theories of the development of the disease:

• Anatomical theory. Scientists believe that the disease can develop as a result of the anatomical pathology of the temporal bone structure.
• Genetic theory indicates that the disease develops due to its inheritance. According to the latest scientific studies, it was found that the pathology is transmitted in an autosomal dominant mode of inheritance.
• Viral theory. According to her, the disease occurs as a result of the influence of a viral infection, for example, as a result of exposure to cytomegalovirus or herpes simplex virus.
• The allergy theory indicates that there is a link between allergies and Meniere's disease. It has been found that, in contrast to the general population, allergic reactions in people with Meniere's disease are much more common.
• The vascular theory links the disease to migraine. Meniere himself pointed out this fact.
• The immunological theory indicates that immune complexes are found in the endolymphatic sac in people with Meniere's disease.
• The metabolic theory associates the disease with potassium retention in the endolymphatic space. For this reason, intoxication of the hair cells occurs, which provokes dizziness and the formation of hearing loss.

Most scientists are of the opinion that Meniere's disease is a polyetiological pathology, that is, several factors simultaneously influence its development.

Provocative reasons can be:

• Postponed viral diseases of the middle ear;
• Head and ear injuries;
• Congenital malformations of the hearing organs;
• Errors in nutrition with impaired water-salt metabolism;
• Lack of estrogen in the body;
• Occupational hazards.

The following external influences are capable of provoking the onset of the next attack:

• Physical overwork;
• Stressful situations;
• Binge eating;
• Inhalation of tobacco smoke;
• Reception of alcoholic beverages;
• Increased body temperature;
• Medical procedures performed in the ear;
• Pronounced noisy environment.

Diagnosis of Meniere's disease

Diagnosis of Meniere's disease does not present any particular difficulties and is built on the basis of clinical signs and according to instrumental examinations, among which audiometry is the leading one.

The American Academy of Surgery and Otolaryngology has identified the following diagnostic criteria for confirming the presence of Meniere's disease:

• More than two attacks of dizziness lasting 20 minutes or longer;
• Hearing loss according to audiometry;
• Tinnitus, complaints of a stuffy feeling in the ear;
• The absence of other reasons leading to this symptomatology.

During audiometry, a mixed nature of hearing impairment is found. At the initial stage of the development of the disease, hearing is reduced in the low frequency range, and as the pathology progresses, hearing disappears at all frequencies.

Several types of diagnostics of Mienier's disease are used:

1. Using such a diagnostic method as acoustic impedance measurement, it is possible to assess the mobility of the auditory ossicles and the work of the intra-aural muscles.
2. The promontorial test allows you to determine the presence of abnormalities in the functioning of the auditory nerve.
3. Methods such as otoscopy and microotoscopy make it possible to exclude the presence of inflammation.
4. MRI of the brain is indicated to confirm the absence of an auditory neuroma.
5. Deviations in the functioning of the vestibular apparatus are detected using indirect otolithometry, vestibulometry, stabilography.
6. In addition, it is possible to consult a patient with a neurologist, who directs the patient to ECHO-EG, EEG, REG, duplex scanning of cerebral vessels.
7. Glycerol test allows you to assess the state of endolymphatic pressure, an increase in which is the basis of the disease. To carry out the test, the patient will need to drink a mixture of fruit juice and glycerin calculated based on his body weight. After 2 hours, audiometry is performed and the patient's hearing is assessed. If at 3 frequencies it decreases by 10 dB, then the test is considered positive.

It is important during diagnostics to differentiate Meniere's disease with other pathologies of the organ of hearing, such as: otosclerosis, eustachitis, otitis media, tumors, vestibular neuronitis, etc.

Treatment of Meniere's disease

Treatment of Meniere's disease is aimed at stopping its progression and at achieving control over the symptoms of pathology. Completely modern medicine cannot save a person from Meniere's disease.

If we take into account the provocative factors that stimulate the development of seizures, then controlling their frequency can be quite simple. To do this, you need to maintain a healthy lifestyle, follow a diet, give up overeating, from taking alcoholic beverages and from smoking.

To control the attack, it is possible to prescribe the following funds:

• Antihistamines (Trimethobenzamide, Meclozin);
• Remedies for nausea;
• Generally acting vasodilators (Nikoshpan, No-shpa);
• Antipsychotics (Triftazin, Aminazin);
• Betahistine, as a drug that dilates the vessels of the inner ear.

Most often, an attack can be stopped without hospitalization of the patient. However, if the patient has repeated bouts of vomiting, they will need intravenous antiemetics.

In order to reduce the volume of retained fluid, diuretics are recommended. This helps to normalize the pressure that builds up in the inner ear. The most common combination is hydrochlorothiazide and triamterene.

Diuretics are recommended for long-term use, therefore, in parallel, the patient should follow a diet with a high mineral content. The fact is that the drugs of this group, together with excess fluid, wash out useful substances from the body.

Meniere's syndrome is treated by injecting directly into the middle ear. This conservative method has an effect close to the effect of surgery.

The following means are subject to introduction:

• Antibiotic Gentamicin, which can reduce the number of attacks and reduce their intensity. However, the risk of such treatment is associated with the possibility of complete hearing loss.
• Hormones Prednisolone, Dexamethasone also allow you to control the patient's condition. However, hormones are not as effective as injections with Gentamicin. But the risk of hearing loss is also reduced, which is their undoubted advantage.

When the effect of the therapy is absent, it is possible to perform surgical treatment. However, even surgery cannot guarantee hearing preservation.

Operations can be of the following types:

• Destructive interventions are the removal of the labyrinth, crossing the branch of the 8th nerve, laser destruction of the labyrinth, etc.
• Drainage interventions are aimed at enhancing the outflow of endolithm from the ear cavity. For this, drainage of the labyrinth, perforation of the stapes base, drainage of the endolymphatic sac can be performed.
• Operations on the autonomic nervous system are reduced to resection of the tympanic string, to the intersection of the tympanic plexus, or to cervical sympathectomy.

As for the prognosis for the development of the disease, Meniere's disease does not lead to deaths, although it is incurable at the moment. Timely medical treatment can slow the progression of hearing loss. If hearing continues to deteriorate, it is advisable to wear a hearing aid or to have an implant.

Disability with Meniere's disease

Disability in Meniere's disease is most often not appropriated.

It can only be obtained by those patients who have other incurable chronic diseases against the background of Meniere's disease, as well as under the following conditions:

• Severe and irreversible hearing loss;
• The presence of a severe concomitant disease;
• Lack of effectiveness of the treatment carried out against the background of frequent long-term attacks, which were documented;
• The presence of vestibuloatactic syndrome is moderate (group 3), pronounced (group 2) or sharply expressed (group 1) degree.

In any case, the decision to assign a particular disability group to a patient will be decided by a special medical commission. Most often, disability is received by people of retirement age, in whom the disease debuted in youth or childhood.

The author of the article: Lazarev Oleg Vladimirovich | ENT

Education: In 2009, he received a diploma in the specialty "General Medicine" at the Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in Otorhinolaryngology (2010)