Meniere’s disease
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Overview
- Meniere’s disease is a medical condition of the inner ear that affects your hearing and balance. This disorder is mainly characterised by sudden bouts of severe dizziness (vertigo), a ringing sound in your ears (tinnitus), a feeling of fullness or pressure in your ears and difficulty in hearing. Some people experience nausea and vomiting along with dizziness and are unable to continue their daily routine.
- Meniere’s disease affects 12 in 1000 people globally. Most people get affected by Meniere’s disease in only one ear. But in about 15-40% of the cases, it can affect both ears. It often starts in one ear and progresses to both ears
What is Meniere’s Disease ?
Overview
- Meniere’s disease is a medical condition of the inner ear that affects your hearing and balance. This disorder is mainly characterised by sudden bouts of severe dizziness (vertigo), a ringing sound in your ears (tinnitus), a feeling of fullness or pressure in your ears and difficulty in hearing. Some people experience nausea and vomiting along with dizziness and are unable to continue their daily routine.
- Meniere’s disease affects 12 in 1000 people globally. Most people get affected by Meniere’s disease in only one ear. But in about 15-40% of the cases, it can affect both ears. It often starts in one ear and progresses to both ears.
Meniere’s Disease cause12
Causes
- The exact cause of Meniere’s disease is unknown. This condition has been associated with a combination of genetic and environmental factors. Meniere’s disease is associated with abnormalities of the inner ear. The inner ear consists of a fluid and anything that affects this fluid can result in Meniere’s disease.
- Factors that disturb the fluid resulting in Meniere’s disease are:
- Viral infections
- Abnormal immune system response
- Genetic factors
- Poor fluid drainage due to a blockage or anatomic abnormality
- Allergies
- Autoimmune diseases
What is Meniere’s Disease ?
Overview
- Meniere’s disease is a medical condition of the inner ear that affects your hearing and balance. This disorder is mainly characterised by sudden bouts of severe dizziness (vertigo), a ringing sound in your ears (tinnitus), a feeling of fullness or pressure in your ears and difficulty in hearing. Some people experience nausea and vomiting along with dizziness and are unable to continue their daily routine.
- Meniere’s disease affects 12 in 1000 people globally. Most people get affected by Meniere’s disease in only one ear. But in about 15-40% of the cases, it can affect both ears. It often starts in one ear and progresses to both ears.
Meniere’s Disease Symptoms
Signs & symptoms
- Recurring attacks of vertigo
- You feel either you are spinning or the world around you is spinning. It starts and stops on its own. Vertigo lasts for about 20 minutes to several hours. It does not go beyond 24 hours. The spinning sensation comes on without any warning and can occasionally cause nausea.
- Ringing in the ears (tinnitus)
- You may experience a ringing, roaring, buzzing, hissing or whistling sound in your ear. This is known as tinnitus.
- . Hearing loss
- Some people experience fluctuations in hearing. The hearing loss may fluctuate and eventually become permanent.
- Feeling of fullness
- You will often feel pressure and a sensation of fullness in your affected ear. This is known as aural fullness.
Meniere’s Disease Symptoms
Signs & symptoms
- Recurring attacks of vertigo
- You feel either you are spinning or the world around you is spinning. It starts and stops on its own. Vertigo lasts for about 20 minutes to several hours. It does not go beyond 24 hours. The spinning sensation comes on without any warning and can occasionally cause nausea.
- Ringing in the ears (tinnitus)
- You may experience a ringing, roaring, buzzing, hissing or whistling sound in your ear. This is known as tinnitus.
- Hearing loss
- Some people experience fluctuations in hearing. The hearing loss may fluctuate and eventually become permanent.
- Feeling of fullness
- You will often feel pressure and a sensation of fullness in your affected ear. This is known as aural fullness.
Diagnosis of Meniere’s Disease
Diagnosis
Diagnosis of Meniere’s disease is made by observing the presence of the following:
- Two attacks of vertigo that each last for 20 minutes or more but lesser than 12 hours
- Tinnitus
- Hearing loss confirmed by a hearing test
- Ruling out other known causes of the above symptoms
- 1. Patient history
- Your physician will ask you about the following to ascertain the diagnosis of Meniere’s disease:
- Severity of symptoms
- Frequency and intensity of the symptoms
- Overall health
- Medications that are taken by you
- Any past history of ear problems
- History of allergies or infectious diseases
- Family history of inner ear issues
- Clinical examination
Your physician will examine you for the symptoms experienced by you in the following way:
a. Audiometric exam
The physician will examine your ability to tell the difference between similar-sounding words to ascertain the hearing loss in your affected ear. The process is known as ‘speech discrimination’ and your doctor will say words like ‘fit’ and ‘sit’ to confirm the diagnosis.
b. Rotatory chair testing
You will be made to sit on a chair that keeps turning and is controlled by a computer. The doctor will observe how your eye movement affects your inner ear.
c. Balance assessment
People with Meniere’s disease experience difficulty in balancing themselves while walking. The poor sense of balance gets resolved when the vertigo episode subsides.
3. Investigations
The following tests are advised by your physician to diagnose Meniere’s disease:
a. Electronystagmogram
Evaluation of your balance by placing you in a dark room. Warm and cool air is blown through your ear canal and your eye movements are measured.
b. Electrocochleography
Measurement of the fluid pressure in your inner ear to check if there is any abnormal built up of fluid in the inner ear
c. Vestibular-evoked myogenic potential (VEMP)
Measurement of your reaction to sudden, loud noises.This test helps not only in diagnosis of Meniere's disease but also monitoring of meniere's disease.
d. Posturography
The test measures your balance and how well you are able to manage it. You are made to stand barefoot on a platform that moves in several directions. A harness is strapped around your body to allow your doctor to see your response to the movement of the platform.
e. Video head impulse test (VHIT)
To measure your eye’s response to sudden movement and their ability to focus while seeing video images.This test is done to check the reflex action of your body to measure eye reactions to abrupt movement.
f. Auditory brainstem response test (ABR)
In this test, you will be made to wear headphones and a computer will measure the brain waves occurring during your response to different sounds.
g. Other tests
Your doctor may also recommend an MRI scan or a CT scan to rule out other conditions like brain tumours or multiple sclerosis that may cause your symptoms.
Diagnosis of Meniere’s Disease
Diagnosis
Diagnosis of Meniere’s disease is made by observing the presence of the following:
- Two attacks of vertigo that each last for 20 minutes or more but lesser than 12 hours
- Tinnitus
- Hearing loss confirmed by a hearing test
- Ruling out other known causes of the above symptoms
- 1. Patient history
- Your physician will ask you about the following to ascertain the diagnosis of Meniere’s disease:
- Severity of symptoms
- Frequency and intensity of the symptoms
- Overall health
- Medications that are taken by you
- Any past history of ear problems
- History of allergies or infectious diseases
- Family history of inner ear issues
Clinical examination
Your physician will examine you for the symptoms experienced by you in the following way:
Audiometric exam
The physician will examine your ability to tell the difference between similar-sounding words to ascertain the hearing loss in your affected ear. The process is known as ‘speech discrimination’ and your doctor will say words like ‘fit’ and ‘sit’ to confirm the diagnosis.
Rotatory chair testing
You will be made to sit on a chair that keeps turning and is controlled by a computer. The doctor will observe how your eye movement affects your inner ear.
Balance assessment
People with Meniere’s disease experience difficulty in balancing themselves while walking. The poor sense of balance gets resolved when the vertigo episode subsides.
3. Investigations
The following tests are advised by your physician to diagnose Meniere’s disease:
a. Electronystagmogram
Evaluation of your balance by placing you in a dark room. Warm and cool air is blown through your ear canal and your eye movements are measured.
b. Electrocochleography
Measurement of the fluid pressure in your inner ear to check if there is any abnormal built up of fluid in the inner ear
c. Vestibular-evoked myogenic potential (VEMP)
Measurement of your reaction to sudden, loud noises.This test helps not only in diagnosis of Meniere's disease but also monitoring of meniere's disease.
d. Posturography
The test measures your balance and how well you are able to manage it. You are made to stand barefoot on a platform that moves in several directions. A harness is strapped around your body to allow your doctor to see your response to the movement of the platform.
e. Video head impulse test (VHIT)
To measure your eye’s response to sudden movement and their ability to focus while seeing video images.This test is done to check the reflex action of your body to measure eye reactions to abrupt movement.
f. Auditory brainstem response test (ABR)
In this test, you will be made to wear headphones and a computer will measure the brain waves occurring during your response to different sounds.
g. Other tests
Your doctor may also recommend an MRI scan or a CT scan to rule out other conditions like brain tumours or multiple sclerosis that may cause your symptoms.
Meniere’s Disease treatment option
Treatment for Meniere's disease
1. Medications
You will be provided medicines to lessen the severity of the vertigo attack.These medicines can be
1)Motion sickness medications to help reduce the spinning sensation and help control the nausea.
2)Diuretics drugs that help to reduce the fluid retention in the body.
2. Surgery
There are different surgical options available to manage Meniere’s disease. These include:
a. Endolymphatic sac decompression
b. Labyrinthectomy
.c. Vestibular nerve section
This surgery is done for patient with severe Meniere's disease with attacks of vertigo that continue despite aggressive medical management and still have good hearing in the affected ear. If all other therapies are exhausted and the patient’s hearing is still useful in the affected ear, then this surgery is considered.
The surgery involves sectioning off the vestibular nerve. This nerve connects your balance and movement sensors from your inner ear to your brain.This an excellent option in terms of vertigo control, hearing preservation, and postoperative quality of life
3. Positive pressure treatment
Pressure is applied to your middle ear to ease the fluid build-up. This is done with the help of a device known as the Meniett pulse generator. That applies pressure in pulses to your ear canal through the ventilation tube. The pressure is applied three times a day for five minutes each time.
4. Vestibular rehabilitation therapy
It provides customised Exercises and activities are planned to ifrom the findings of the clinical assessment, laboratory testing and imaging studies, and input from patients. There are different factors that can impact the potential for recovery including activity level, pain, other medical conditions, medications, and emotional concerns through this therapeutic way.
How to prepare for the doctor consultation?
- Consult your physician when you experience any of the above symptoms, like severe vertigo, tinnitus, nausea or vomiting.
- Your physician will recount on your medical history, family history and dietary habits.
- You may need to get a series of tests done for the physician to understand your clinical condition.
- Sort your queries with your physician regarding the status of your condition. Understand from your doctor what signs you need to be wary of and when you need to consult in case of an emergency.
Benefits of Treatment for Meniere’s Disease
Diuretics are the most commonly prescribed maintenance medications for Meniere's disease.
- Diuretics work by restricting the overproduction of fluid in the inner ear. Diuretics are long-term medications. They help reduce the number of vertigo attacks, and in some cases, they help stabilize hearing.
-
Endolymphatic sac surgery controls vertigo in 60-90% of patients, it has a low risk of hearing loss, and it can improve the patient's hearing over time.
-
Wheras , vestibular nerve sectioning have success rates of about 95-98%.It is attempt to eliminate recurrent attacks of vertigo
Risk and Delay in treatment for Meniere’s Disease
Risks if not treated in time (complications)
- Unpredictable attacks of severe vertigo
- Possible permanent hearing loss
- Fatigue
- Stress
- Loss of balance due to vertigo resulting in falls and accidents
Disease progression
Meniere’s disease usually develops in two stages. You may not experience symptoms between these two stages for a long time.
1. Early stage
- Sudden unpredictable vertigo
- Mild loss of hearing that gets better once vertigo subsides
- Your ear may feel blocked with a feeling of fullness or pressure
- Tinnitus with ringing or roaring in the ears
- Exhaustion that lasts for a few hours
- Diarrhoea
- Blurry vision
- Jerky eye movements
- Cold sweat
- Nausea
- Vomiting
- Trembling
- Palpitations
2. Late stage
- Less frequent vertigo attacks
- Balance problems
- Vision disturbances
- Hearing issues
- Tinnitus that is steadily getting worse
- You are unable to perform tasks in the dark
- Sudden drop attacks that involve losing posture or sudden falls while being conscious
Updated on : 19 October 2022
Reviewer
Dr. Aman Priya Khanna
MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES
12 Years Experience
Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More
Author
An enthusiastic writer with an eye for details and medical correctness. An avid reviewer and publisher. She emphasises authentic information and creates value for the readers. Earlier, she was involved in making ...View More
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