Meniere's Disease Health Article

Definition

Meniere's disease is a condition characterized by recurring vertigo (dizziness), hearing loss, and tinnitus (a roaring, buzzing or ringing sound in the ears).

Description

Meniere's disease was named for the French physician Prosper Meniere who first described the illness in 1861. It is an abnormality within the inner ear. A fluid called endolymph moves in the membranous labyrinth or semicircular canals within the bony labyrinth inside the inner ear. When the head or body moves, the endolymph moves, causing nerve receptors in the membranous labyrinth to send signals to the brain about the body's motion. A change in the volume of the endolymph fluid, or swelling or rupture of the membranous labyrinth is thought to result in Meniere's disease symptoms.

Causes and symptoms

The cause of Meniere's disease is unknown; however, scientists are studying several possible causes including noise pollution, viral infections, or other biological factors. The symptoms are associated with a change in fluid volume within the labyrinth of the inner ear.

Symptoms include severe dizziness or vertigo, tinnitus, hearing loss, and the sensation of pain or pressure in the affected ear. Symptoms appear suddenly, last up to several hours, and can occur as often as daily to as infrequently as once a year. A typical attack includes vertigo, tinnitus and hearing loss; however, some individuals with Meniere's disease may experience a single symptom, like an occasional bout of slight dizziness or periodic, intense ringing in the ear. Attacks of severe vertigo can force the sufferer to have to sit or lie down, and may be accompanied by headache, nausea, vomiting, or diarrhea. Hearing tends to recover between attacks, but becomes progressively worse over time.

Meniere's disease usually starts between the ages of 20 and 50 years and affects men and women in equal numbers. In most patients, only one ear is affected, but in about 15% of patients, both ears are involved.

Diagnosis

An estimated 3 to 5 million people in the United States have Meniere's disease, and almost 100,000 new cases are diagnosed each year. Diagnosis is based on medical history, physical examination, hearing and balance tests, and medical imaging with magnetic resonance imaging (MRI).

Several types of tests may be used to diagnose the disease and to evaluate the extent of hearing loss. In patients with Meniere's disease, audiometric tests (hearing tests) usually indicate a sensory type of hearing loss in the affected ear. Speech discrimination or the ability to distinguish between words that sound alike is often diminished. In about 50% of patients, the balance function is reduced in the affected ear. An electronystagnograph (ENG) may be used to evaluate balance. Since the eyes and ears work together through the nervous system to coordinate balance, measurement of eye movements can be used to test the balance system. For this test, the patient is seated in a darkened room and recording electrodes, similar to those used with a heart monitor, are placed near the eyes. Warm and cool water or air are gently introduced into the each ear canal and eye movements are recorded.

Another test that may be used is an electrocochleograph (EcoG), which can measure increased inner ear fluid pressure.

Treatment

There is no cure for Meniere's disease, but medication, surgery, and dietary and behavioral changes, can help control or improve the symptoms.

Medications

Symptoms of Meniere's disease may be treated with a variety of oral or injectable medications. Antihistamines, like diphenhydramine, meclizine, and cyclizine can be prescribed to sedate the vestibular system. A barbiturate medication like pentobarbital may be used to completely sedate the patient and relieve the vertigo. Anticholinergic drugs, like atropine or scopolamine, can help minimize nausea and vomiting. Diazepam has been found to be particularly effective for relief of vertigo and nausea in Meniere's disease.

There have been some reports of successful control of vertigo after antibiotics (gentamicin or streptomycin) or a steroid medication (dexamethasone) are injected directly into the inner ear. This procedure is done in the doctor's office and is less expensive and less invasive than a surgical procedure.