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Meniere's disease, also called idiopathic endolymphatic hydrops,
is a disorder of the inner ear. Although the cause is unknown,
it probably results from an abnormality in the fluids of the
inner ear. Meniere's disease is one of the most common causes
of dizziness originating in the inner ear. 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. Men and women are affected in equal numbers.
The symptoms of the Meniere's disease
are episodic rotational vertigo (attacks of a spinning sensation),
hearing loss, tinnitus, (a roaring, buzzing, or ringing sound
in the ear), and a sensation of fullness in the affected ear.
Vertigo is usually the most troublesome symptom of Meniere's
disease. It is defined as a sensation of movement when no movement
is occurring. Vertigo is commonly produced by disorders of
the inner ear, but may also occur in central nervous system disorders.
The vertigo of Meniere's disease occurs in attacks of a spinning
sensation and is accompanied by disequilibrium (an off- balance
sensation), nausea, and sometimes vomiting. The vertigo lasts
for 20 minutes to two hours or longer. During attacks, patients
are usually unable to perform activities normal to their work
or home life. Sleepiness may follow for several hours, and
the off-balance sensation may last for days.
There may be an intermittent hearing loss early in the disease,
especially in the low pitches, but a fixed hearing loss involving
tones of all pitches commonly develops in time. Loud sounds may
be uncomfortable and appear distorted in the affected ear.
The tinnitus and fullness of the ear in Meniere's disease may
come and go with changes in hearing, occur during or just before
attacks, or be constant.
The symptoms of Meniere's disease may be only a minor nuisance,
or can become disabling, especially if the attacks of vertigo
are severe, frequent, and occur without warning.
The physician will take a history of the frequency, duration,
severity, and character of your attacks, the duration of hearing
loss or whether it has been changing, and whether you have
had tinnitus or fullness in either or both ears. You may be
asked whether there is history of syphilis, mumps, or other
serious infections in the past, inflammations of the eye, an
autoimmune disorder or allergy, or ear surgery in the past.
You may be asked questions about your general health, such
as whether you have diabetes, high blood pressure, high blood
cholesterol, thyroid, and neurologic or emotional disorders.
Tests may be ordered to look for these problems in certain
cases. The physical examination of the ears and other structures
of the head and neck are usually normal, except during an attack.
An audiometric examination (hearing test) typically indicates
a sensory type of hearing loss in affected ear. Speech discrimination
(the patient's ability to distinguish between words like "sit" and "fit")
is often diminished in the affected ear. An ENG (electronystagmograph)
may be performed to evaluate balance function. This is done in
a darkened room. Recording electrodes are placed near the eyes.
Wires from the electrodes are attached to a machine similar to
a heart monitor. Warm and cool water or air is gently introduced
into each ear canal. Since the eyes and ears work in a coordinated
manner through the nervous system, measurement of eye movements
can be used to test the balance system. In about 50% of patients,
the balance function is reduced in the affected ear. Other balance
tests, such as rotational testing or balance platform, may also
be performed to evaluate the balance system.
Other tests may be done. Electrocochleography (ECoG) may indicate
increased inner ear fluid pressure in some cases of Meniere's
disease. The auditory brain stem response (ABR), a computerized
test of the hearing nerves and brain pathways, computed tomography
(CT) or, magnetic resonance imaging (MRI) might be needed to
rule out a tumor occurring on the hearing and balance nerve.
Such tumors are rare, but they can cause symptoms similar to
Meniere's disease.
A low salt diet and a diuretic (water pill) may reduce the frequency
of attacks of Meniere's disease in some patients. In order to
receive the full benefit of the diuretic, it is important that
you restrict your intake of salt and take the medication regularly
as directed. Anti-vertigo medications, e.g., Antivert® (meclizine
generic), or Valium® (diazepam generic), may provide temporary
relief. Anti-nausea medication is sometimes prescribed. Anti-vertigo
and anti-nausea medications may cause drowsiness.
Avoid caffeine, smoking, and alcohol. Get regular sleep and
eat properly. Remain physically active, but avoid excessive fatigue.
Stress may aggravate the vertigo and tinnitus of Meniere's disease.
Stress avoidance or counseling may be advised.
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.
If vertigo attacks are not controlled by conservative measures
and are disabling, one of the following surgical procedures
might be recommended:
- The endolymphatic shunt or decompression procedure is an
ear operation that usually preserves hearing. Attacks of vertigo
are controlled in one-half to two-thirds of cases, but control
is not permanent in all cases. Recovery time after this procedure
is short compared to the other procedures.
- Selective vestibular
neurectomy is a procedure in which the balance nerve is cut
as it leaves the inner ear and goes to the brain. Vertigo
attacks are permanently cured in a high percentage of cases,
and hearing is preserved in most cases.
- Labryrinthectomy and
eighth nerve section are procedures in which the balance
and hearing mechanism in the inner ear are destroyed on one
side. This is considered when the patient with Meniere's disease
has poor hearing in the affected ear. Labryrinthectomy and
eighth nerve section result in the highest rates for control
of vertigo attacks.
Other operations or treatments may be advised
in some cases. If surgical treatment seems to be needed, the
risks and benefits should be thoroughly discussed with your
surgeon. Although there is no cure for Meniere's disease, the
attacks of vertigo can be controlled in nearly all cases.
© 2004 AAO-HNS/AAO-HNSF
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