Meniere's disease is a disorder characterized by recurrent attacks of disabling vertigo. Vertigo is a sensation of movement when none is actually occurring. The person may feel that he or she is spinning or rotating abnormally.
Meniere's disease is a disorder of the inner ear. The inner ear is made up of the cochlea and the labyrinth. The cochlea is a snail-shaped structure involved in hearing. The labyrinth is made up of canals in the inner ear that control balance. Within the cochlea and labyrinth are two fluid-filledcompartments. The separation between the two compartments is necessary for hearing and balance. It allows the nerves to communicate with each other within that space.
Experts believe that damage to the inner ear starts the process of Meniere's disease. The injury causes fluid to build up in the two compartments. The pressure increases and damages the labyrinth. In some cases, the cochlea is also damaged.
As the pressure builds, there is a sensation of the ear being plugged. There is also a decline in low-frequency hearing. The person may have roaring or a ringing sound in the ear. The hearing impairmentfluctuates. This means that the person hears better at some times and worse at others.
The episodes may occur in clusters or there may be years between episodes. In between episodes, some people may have a small degree of imbalance and ringing in the ears. Other people have no symptoms at all between episodes.
Following are other symptoms of Meniere's syndrome: abnormal side-to-side eye movements, known as nystagmusataxia, or an abnormal, unsteady walking gaitdiarrheadizzinessheadachenauseavomiting
In most cases, the cause of Meniere's disease is not known. There is some evidence that inflammation in the ear causes poor drainage of fluid. Possible causes of Meniere's disease are as follows: allergies, particularly food allergiesan autoimmune disorder , or condition in which the person's body creates antibodies against its own tissuesexcessive intake of alcoholor caffeineexcessive sodiumor sugar inthe dietgenetic narrowing of parts of the inner earhead injuryhigh cholesterolhypothyroidism, or low levels of thyroid hormonesmokingsyphilis, a sexually transmitted disease, or STDviral infections of the inner ear
Meniere's disease is most common in people over age 40 and is as common in men as women.
Prevention of Meniere's disease is not always possible. Following sports guidelines for children, adolescents, and adultsmay prevent head injuries that cause inner ear problems. Some measures that may prevent or minimize attacks of vertigo include the following: avoiding allergy triggersavoiding smokingand secondhand smokeeffectively treating syphilisfollowing safer sex guidelines to avoid syphilislimiting caffeine and sodiumin the dietusing a combination of diet, exercise, and medicines to lower high cholesterolusing synthetic thyroid hormone medicines to treat hypothyroidism
Diagnosis of Meniere's disease begins with a medical history and physical examination. A hearing testcan identify hearing impairments. Sometimes acranial MRImay be ordered to rule out other conditions.
Recurrent episodes of Meniere's disease can lead to gradual loss of hearing and balance.
Meniere's disease is not contagious and poses no risk to others.
During an acute attack, individuals are advised to lie flat on a firm surface and focus on a fixed point. The person should avoid eating or drinking, which may bring on an episode of vomiting. After the vertigo gets better, the person will probably need to sleep.
Medicines are tailored for each person, but may include the following: calcium channel blockers, such as verapamil, flunarizine with cinnarizine, and nimodipine, that dilate the small blood vessels of the inner eardiuretics, such as triamterene with hydrochlorothiazide, to help the kidneys excrete excess fluid from the bodymedicines that suppress the activity of the inner ear, such as lorazepam, meclizine, diazepam, and clonazepam
Steroids, such as prednisone, are used occasionally to treat Meniere's disease. Medicines that suppress the immune system, such as methotrexate, are used rarely.
People with infrequent symptoms may not need to be on medicine all the time. It may be best to treat the attacks as they occur. For those with more frequent attacks, diuretics can be useful. Otherwise known as "water pills", diuretics work on the kidneys to excrete excess fluid from the body.
A person with Meniere's disease may also be advised to follow a special diet. A hydrops diet focuses on limiting the intake of sodiumand sugar. This diet also includes restrictions on excess intake of caffeine, alcohol, and monosodium glutamate, which is also called MSG. MSG is found in Chinese foodsand some prepackaged foods.
In some cases, a person may have frequent, untreatable spells of vertigo. The healthcare provider may recommend procedures to destroy hair cells or nerves in the inner ear. These procedures can take the form of surgery or medicines, such as certain antibiotics that are toxic to the ear. Surgery may include removal of the labyrinth or the entire inner ear. This procedure can be helpful, particularly in individuals who have lost their hearing. In those who still have reasonable levels of hearing, the balance nerve can be cut.
Medicines used to treat Meniere's disease commonly cause drowsiness and dry mouth. Surgery carries a risk of bleeding, infection, hearing impairment, and allergic reactionto anesthesia.
Calcium channel blockers have long been used to treat Meniere's disease as well as high blood pressure. However, the findings of two recent studies show that people who take a calcium channel blocker have a much higher incidence of complications than people taking other medicines for high blood pressure. The findings of one study, for example, showed that the risk of heart attackwas 27% greater. Also, the risk of congestive heart failurewas 26% higher. The American Heart Association recommends discussing the risks and benefits of the medicine with a healthcare provider.
An appropriate diet combined with medicines can help reduce the frequency and severity of the attacks. Those whose inner ear structures have been removed generally become permanently deaf. They may also have chronic problems with their balance.
Meniere's disease is monitored by evaluating the frequency of the attacks. The provider will also check for hearing impairment. Any new or worsening symptoms should be reported to the healthcare provider.
