Meniere Disease

Ear Doctors Denver.jpgWhat Is Meniere Disease? 

Ménière 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. Ménière 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 up to 50 percent of patients. Ménière Disease typically starts between the ages of 20 and 50 years. Men and women are affected in equal numbers. 

What Are The Symptoms? 

The symptoms of Ménière 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. Tinnitus and fullness of the ear in Ménière Disease may come and go with changes in hearing, occur during or just before attacks, or be constant. There may also 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 seem distorted in the affected ear. From all the Ménière Disease’s symptoms, vertigo is usually the most troublesome. It is commonly produced by disorders of the inner ear, but may also occur in central nervous system disorders. Vertigo may last for 20 minutes to two hours or longer. During attacks, patients are usually unable to perform activities normal to their work or home life. The off-balance sensation may last for days. The symptoms of Ménière Disease may be only a minor nuisance, or can become disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning.

How Is A Diagnosis Made? 

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, neurologic or emotional disorders. Tests may be ordered to look for these problems in certain cases. Testing for environmental allergies is also frequently recommended, as these conditions can alter fluid balance in the inner ear. When the history has been completed, diagnostic tests will check your hearing and balance functions. 
They may include:  
For Hearing 
* An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in the affected ear. Speech discrimination (the patient’s ability to distinguish between words like “sit” and “fit”) is often diminished in the affected ear. 

For Balance 
An ENG (electronystagmograph) may be performed to evaluate balance function. In a darkened room, recording electrodes are placed near the eyes. Warm and cool water or air are gently introduced into each ear canal. Since the eyes and ears work in a coordination through the nervous system, measurement of eye movements can be used to test the balance system. In about 50 percent of patients, the balance function is reduced in the affected ear.

Other Tests 
* Electrocochleography (ECoG) may indicate increased inner ear fluid pressure in some cases of Ménière Disease. 
* The auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, and magnetic resonance imaging (MRI) may 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 Ménière Disease. 

Recommended Adult Lifestyle Changes To Reduce The Frequency Of Ménière Disease Episodes
* Avoid alcohol, caffeine, excessive fatigue, smoking, and stress  
* Eat properly  
* Get plenty of sleep  
* Remain physically active  

Diagnosing And Treating Ménière Disease 

A low salt diet and a diuretic (water pill) may reduce the frequency of attacks of Ménière 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., meclizine or diazepam, 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 Ménière Disease. Stress avoidance or counseling may be advised. Allergy treatments may also be recommended, based upon specific testing. 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. 

When Is Surgery Recommended? 

If vertigo attacks are not controlled by conservative measures and are disabling, one of the following surgical procedures might be recommended:
* Intratympanic treatment, also known as chemical labyrinthotomy, is an office procedure in which a medicine, such as gentamicin or dexamethasone, is injected into the middle ear. Other medicines may be used. Gentamicin is an antibiotic that causes a partial loss of balance function in the treated ear, controlling vertigo in about three fourths of cases and usually preserving hearing. Apart from a period of disequilibrium that can occur as the patient adjusts to the new level of balance function, this treatment is usually very well tolerated.
It is also significantly simpler and less invasive than other surgical treatments.