SYMPTOMS
Patients with this debilitating syndrome experience recurring episodes of spinning dizziness (vertigo), decreased hearing, fullness in the ear, and tinnitus. These episodes typically last a few minutes to a few hours. They severely impact the patients quality of life.
CLINICALLY
During these episodes (not often witnessed by the attending doctor), the patient is extremely dizzy, nauseous, has jumping of the eyes called nystagmus, has decreased hearing and often Is vomiting. Between the attacks there is little to be found apart from mild decrease in hearing.
PROGRESSION
There is a varying course in this disease and its unpredictable nature leads to extreme stress and anxiety. Often hearing slowly decreases and the patient may feel off-balance between attacks.
EPIDEMIOLOGY
This usually occurs in adults and more often females than males. It can run in family’s i.e. genetic link. There is a link to vestibular migraine.
CAUSE
Unfortunately, we do not know the cause of Menieres Syndrome, but it may be auto-immune, viral, allergic disease, or Eustachian Tube Dysfunction.
PATHEGENISIS
If one looks at the normal anatomy of the inner ear, it is divided into two. The first if the vestibular (balance) and the second is the cochlea (hearing). Both these inner ear structures contain thin tubes with fluid called endolymph. With the disease there is intermittent increase of this fluid with rupture of the sacs resulting in the signs and symptoms of Menieres Syndrome. This rupture heals only to recur later.
INVESTIGATIONS
A hearing test usually shows a low tone sensori-neural hearing loss. Other investigators such as vestibular testing, CT scan or MRI scans may be done. The scans would be used to exclude other causes.
THE MEDICAL MANAGEMENT OF AN ACUTE EPISODE
Vestibular sedatives, e.g. Stugeron together with anti-nausea tables e.g. Zofran are used. Other potential management in the acute episode are cortisone, anti-virals and Imigran.
MEDICAL MANAGEMENT OF THE CHRONIC DISEASE (PREVENTION)
Lifestyle, with a decrease intake of alcohol, caffeine, salt and no smoking, there is an approximate 50% control of symptoms. Other lifestyle changes, such as stress management and exercise and adequate sleep also help.
MEDICATION
Diuretics, e.g. Moduretic
Calcium Blockers e.g. Nimotop.
Betahistine e.g. Serc
Others, such as antihistamines and Topamax.
Other forms of chronic prevention will include vestibular rehabilitation and the need for hearing aids.
SURGICAL MANAGEMENT OF THE CHRONIC DISEASE
Myringotomy and Grommet insertion. This can be done with or without steroid or aminoglycoside installation into the middle ear. The steroid would act as an anti-inflammatory and immune suppressant. The aminoglycoside is partially selective and destroys the dizzy component of the inner ear. Other surgical methods such as inner ear sac decompression and dizzy nerve section can be considered as a last resort.
IN CONCLUSION
Menieres disease is an extremely debilitating, unpredictable condition and little is known abouts its cause. Management if monitored by an ENT surgeon can decrease the effects and slow down the progression and severity of the attacks.
(108) Meniere’s Disease – What Happens in the Inner Ear? – YouTube