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Menieres Disease

Menieres Disease

Alternate Names

  • Meniere's syndrome
  • The ear bones

Definition

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.

What is going on in the body?

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.

Risks

What are the causes and risks of the disease?

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 allergies
  • an autoimmune disorder , or condition in which the person's body creates antibodies against its own tissues
  • excessive intake of alcoholor caffeine
  • excessive sodiumor sugar inthe diet
  • genetic narrowing of parts of the inner ear
  • head injury
  • high cholesterol
  • hypothyroidism, or low levels of thyroid hormone
  • smoking
  • syphilis, a sexually transmitted disease, or STD
  • viral 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

What can be done to prevent the disease?

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 triggers
  • avoiding smokingand secondhand smoke
  • effectively treating syphilis
  • following safer sex guidelines to avoid syphilis
  • limiting caffeine and sodiumin the diet
  • using a combination of diet, exercise, and medicines to lower high cholesterol
  • using synthetic thyroid hormone medicines to treat hypothyroidism

Diagnosed

How is the disease diagnosed?

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.

Long Term Effects

What are the long-term effects of the disease?

Recurrent episodes of Meniere's disease can lead to gradual loss of hearing and balance.

Other Risks

What are the risks to others?

Meniere's disease is not contagious and poses no risk to others.

Treatments

What are the treatments for the disease?

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 ear
  • diuretics, such as triamterene with hydrochlorothiazide, to help the kidneys excrete excess fluid from the body
  • medicines 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.

Side Effects

What are the side effects of the treatments?

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.

After Treatment

What happens after treatment for the disease?

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.

Monitor

How is the disease monitored?

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.

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