Conditions
Meniere's disease is a disorder of the balance organs inside the ear, characterized by episodes of vertigo (sensation of movement, usually rotary).
Definition
Meniere's disease is a disorder of the balance organs inside the ear, characterized by
- episodes of vertigo (sensation of movement, usually rotary)
- tinnitus
- progressive hearing loss in one or both ears
- a sensation of fullness in the ear/s
- nausea, vomiting and sweating may occur
- abnormal eye movements in some patients
It is caused by an increase in the volume and pressure of the endolymph fluid within the semicircular canals ( also called the Vestibular apparatus) of the inner ear.
Causes
Meniere's typically begins, gradually, during middle age, affecting men slightly more often than women. 45% of cases are bilateral.
The exact cause of the increased fluid in the balance organs is not known, but theories and some known risk factors include
- middle ear infection
- trauma
- recent viral illness
- allergies, smoking and alcohol use
- some prescription drugs, e.g. aspirin
- genetic predisposition (familial)
- migraine
- some other conditions may mimic Meniere's, for example acoustic neuroma, cerebral aneurysms, TIA, multiple sclerosis
Diagnosis
The diagnosis of Meniere's is mainly clinical, though some conditions may give similar symptoms. A detailed neurological examination and hearing tests must therefore be done to confirm the clinical diagnosis. Head MRI scans may show cerebral tumours or aneurysms.
Treatment
There s no definitive treatment for Meniere's disease, but most patients show improvement with good medical management aimed at reducing the amount of endolymph fluid:
- restricting salt intake
- diuretics
- some anti-histamines
Associated symptoms such as nausea and vertigo may respond to anti-emetics and sedatives.
Hearing aids and masking devices can help the deafness and tinnitus.
Sudden movements and bright flickering lights may worsen symptoms and should be avoided.
Surgery for severe or non-responsive cases may involve
- increasing the drainage of fluid from the balance organ, or may be more invasive
- severing Vestibular nerves or
- injecting substances to destroy the nerve endings, or even
- removing the inner ear apparatus completely.
These procedures may give good relief of vertigo and seldom increase hearing loss, but require craniotomy under general anaesthetic
Outcome
The progression of the disease is unpredictable. Some patients have symptoms for a few years and then heal with only minimal hearing loss.
Dr. AG Hall