Meniere's Disease Causes, Symptoms, Breakthrough Treatment (original) (raw)
What is Meniere's disease?
Symptoms of Meniere disease, an inner ear disorder that causes hearing loss, include ringing, ear fullness, hearing loss, and poor equilibrium.
Meniere's disease is a disorder of the flow of fluids in the inner ear. It is a chronic condition that manifests as hearing loss, vertigo, and ringing in the ears. Various surgical options are available for refractory Meniere's disease that does not respond to medications or if the symptoms of the disease are severe.
What causes Meniere's disease?
Although the cause of Meniere's disease is unknown, it probably results from an abnormality in the way fluid of the inner ear is regulated.
- In most cases, only one ear is involved, but both ears may be affected in about 15% of patients.
- Meniere's disease typically starts between the ages of 20 and 50 years of age (although it has been reported in nearly all age groups).
- Men and women are equally affected.
- The symptoms may be only a minor nuisance or can become disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning.
- Meniere's disease is also called idiopathic endolymphatic hydrops.
What are the symptoms of Meniere's disease?
The symptoms of Meniere's disease typically include at least several of the following:
- Episodic rotational vertigo: Attacks of a spinning sensation accompanied by disequilibrium (an off-balanced sensation), nausea, and sometimes vomiting. This is usually the most troublesome symptom. Vertigo usually last 20 minutes to four hours or longer. During attacks, patients are very disabled, and sleepiness may follow. An off-balanced sensation may last for several days.
- Tinnitus: A roaring, buzzing, machine-like, or ringing sound in the ear. It may be episodic with an attack of vertigo or it may be constant. Usually, the tinnitus gets worse or will appear just before the onset of the vertigo.
- Hearing loss: It may be intermittent early in the onset of the disease, but over time it may become a fixed hearing loss. It may involve all frequencies, but most commonly occurs in the lower frequencies. Loud sounds may be uncomfortable and appear distorted in the affected ear.
- Ear fullness: Usually this full feeling occurs just before the onset of an attack of vertigo.
How is Meniere's disease diagnosed?
The diagnosis of Meniere's disease is primarily made from the history and physical examination. Tinnitus or ear fullness (aural fullness) needs to be present to make the diagnosis.
An audiogram is helpful to show hearing loss, and to rule out other abnormalities. It is often helpful if it can be done safely, to have an audiogram during or immediately following an attack of vertigo. This may show the characteristic low-frequency hearing loss. As the disease progresses hearing loss usually worsens.
Other tests such as the auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computer tomography (CT scan), or magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing or balance nerve. These tumors are rare, but they can cause symptoms similar to Meniere's disease. A full neurological evaluation is performed to exclude other causes of vertigo.
SLIDESHOW Ear Infection Symptoms, Causes, and Treatment See Slideshow
How can Meniere's disease be treated?
Treatment for Meniere's disease could include the following:
- Medications: A diuretic (water pill) such as triamterene (Dyazide, Maxzide) combined with a low salt diet, is the primary treatment of Meniere's disease. Anti-vertigo medications such as meclizine (Antivert, Bonine, Meni-D, Antrizine) mask the symptoms, providing relief, or diazepam (Valium) may provide temporary relief during more severe attacks of vertigo. Anti-nausea medications [for example, promethazine (Phenergan)] sometimes also are prescribed. In some cases, steroids and certain antibiotic medications (gentamicin) injected into the middle ear may provide some relief from vertigo symptoms. Both anti-vertigo and anti-nausea medications may cause drowsiness. Because nausea can be so severe at times, medications may be prescribed in the form of a suppository
- Air pulse generator: In some patients, periodic delivery of small air pulses transmitted through a tube placed in the eardrum has had some variable success.
- Surgery: If vertigo attacks are not controlled medically and are disabling, for a minority of patients, one of the following surgical procedures may be recommended depending on the individual patient's situation:
- Endolymphatic shunt (A surgical procedure in which a shunt (tube) is placed in the endolymphatic sac that drains excess fluid from the ear)
- Selective vestibular neurectomy
- Labyrinthectomy (surgical removal of the labyrinth of the ear) and eighth nerve section
What surgical procedures can treat Meniere’s disease?
Doctors will evaluate you to know if you are in good health and able to withstand surgery and anesthesia. They will obtain a thorough history and perform a careful physical examination before the procedure. The following conditions are considered as contraindications for the surgery:
- Active otitis media or mastoiditis: Doctors will first resolve these infections, and then, they will go ahead with the surgery.
- Bilateral Meniere's disease is often a contraindication for labyrinthectomy due to the risk of permanent imbalance.
- Poor general health.
The various surgical procedures for Meniere's disease include:
- Endolymphatic sac surgery
- The endolymphatic sac plays a role in regulating fluid levels in the inner ear. During the procedure, doctors remove a small amount of bone from around the endolymphatic sac. This helps reduce the pressure of the fluid in the sac.
- Labyrinthectomy
- Doctors will perform the surgery in either of the two ways:
* Osseous labyrinthectomy (drilling out the bone and removing all labyrinth)
* Destroying some of the soft tissue in the inner ear - The procedure destroys the part of the ear that helps with balancing as well as the part that helps you hear. It is performed only if your hearing power is severely compromised in the ear affected by Meniere's disease.
- Doctors will perform the surgery in either of the two ways:
- Vestibular nerve section/vestibular neurectomy
- The procedure involves cutting off nerve fibers (vestibular nerve) that help you to balance. The procedure does not affect your hearing ability.
Health News
What is the prognosis for Meniere's disease?
Although there is no real cure for Meniere's disease, the attacks of vertigo can be controlled in nearly all cases. If you have vertigo without warning, you should not drive, because failure to control the vehicle may be hazardous to yourself and others. Safety may require you to forego ladders, scaffolds, and swimming.
The success rate of the surgery for Meniere's disease depends on the type of surgery performed. Endolymphatic sac surgery controls vertigo in 6 to 9 times out of every 10 patients. It can improve the hearing over time but carries a low risk of hearing loss as well.
- Labyrinthectomy and vestibular nerve sectioning have success rates of about 95-98%. However, they have a greater risk of hearing loss.
- Trans tympanic injection of medications is a relatively new surgical approach, and its efficacy is still not established. Success rates near 90% have been reported.
What are the complications of surgery for Meniere’s disease?
Surgery for Meniere's disease can cause potentially serious complications, though rare. They depend on the type of surgery or approach used. Your doctor will explain the specific risks involved in your surgery. The possible complications include:
- Hearing loss
- Tinnitus
- Dizziness
- Facial paralysis
- Hematoma (pooling of blood)
- Bleeding
- Cerebrospinal fluid (CSF) leakage
- Taste disturbance
- Mouth dryness
- Otitis media
- Otorrhea
- Meningitis
- Headache
Remember, it is normal to experience severe vertigo and imbalance for the first few days after the surgery. Doctors will prescribe medications to alleviate nausea and vomiting during this time.
Medically Reviewed on 1/18/2024
References
Moskowitz, Howard S., M.D., Ph.D. "Meniere disease." UptoDate.com. Updated Mar. 22, 2016
Li JC. Surgical Treatment of Meniere Disease. Medscape. https://emedicine.medscape.com/article/856658-overview#
Bogaz EA, Cavallini da Silva AF, Ribeiro DK, et al. Meniere’s Disease Treatment. In: Bahmad F Jr. ed. Up to Date on Meniere's Disease. IntechOpen; 2017. https://www.intechopen.com/books/up-to-date-on-meniere-s-disease/meniere-s-disease-treatment