Understanding Meniere’s Disease: Symptoms, Diagnosis, and Treatment Options

MENIERE’S DISEASE

  • Meniere’s disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. Meniere’s disease usually affects only one ear.
  • Meniere’s disease can develop at any age, but it is more likely to happen to adults between 40 and 60 years of age. Some people have a family history of Meniere’s disease, which means people may inherit the condition.

The four main symptoms are:

  • Vertigo.
  • Hearing loss.
  • Tinnitus.
  • Feeling pressure or a sense of fullness. This is usually in just one ear.

Other symptoms include:

  • Headaches.
  • Abdominal pain.
  • Nausea.

What triggers Meniere’s disease symptoms?

  • Symptoms happen when endolymph, a fluid in your inner ear, builds up and disrupts the delicate process your body uses to manage balance and hearing. 
  • Endolymph is like a translator. It interprets outside airwaves and sends signals that your brain and inner ear use to allow you to hear and maintain your balance. When there’s too much endolymph in your inner ear, those signals become scrambled so your brain can’t manage your sense of balance and hearing.

DIAGNOSIS :

Hearing assessment

A hearing test is called audiometry. Audiometry looks at how well you hear sounds at different pitches and volumes. It can also test how well you can tell between words that sound the same. People with Meniere’s disease often have trouble hearing low frequencies or combined high and low frequencies. They may have typical hearing in the midrange frequencies.

Balance assessment

Between vertigo attacks, balance returns to normal for most people with Meniere’s disease. But you might have some ongoing balance problems.

Tests that study how well the inner ear is working include:

  • Electronystagmogram or videonystagmography (ENG or VNG) – These tests measure balance by studying eye movement. One part of the test looks at eye movement while your eyes follow a target. One part studies eye movement while your head is put in different positions. A third test, called the caloric test, follows eye movement by using temperature changes to trigger a reaction from the inner ear. Your health care provider may use warm and cold air or water in the ear for the caloric test.
  • Rotary-chair testing – Like a VNG, this test measures how well your inner ear works based on eye movement. You sit in a computer-controlled chair that spins from side to side, which triggers activity in your inner ear.
  • Vestibular evoked myogenic potentials (VEMP) testing – This test uses sound to make parts of the inner ear active. It records how well muscles react to that sound. It may show common changes in the affected ears of people with Meniere’s disease.
  • Computerized dynamic posturography (CDP) – This test shows which part of the balance system you rely on the most and which parts may cause problems. The parts of the balance system include vision, inner ear function, or feelings from the skin, muscles, tendons and joints. While wearing a safety harness, you stand barefoot on a platform. Then you keep your balance under different conditions.
  • Video head impulse test (VHIT) – This test looks at how well the eyes and inner ears work together. VHIT uses video to measure eye reactions to sudden movement. While you focus on a point, your head is turned quickly and unpredictably. If your eyes move off the target when your head is turned, you have a reflex issue.
  • Electrocochleography (ECOG) – This test looks at how the inner ear reacts to sounds. It can help see if you have inner ear fluid buildup. But this test isn’t given only for Meniere’s disease.

How is Meniere’s disease treated?

Meniere’s disease does not have a cure yet, but your doctor might recommend some of the treatments below to help you cope with the condition.

  • Medications:  The most disabling symptom of an attack of Meniere’s disease is dizziness. Prescription drugs such as meclizine, cinnarizine, betahistine can help relieve dizziness and shorten the attack.
  • Salt restriction and diuretics:  
  • Limiting dietary salt and taking diuretics (water pills) help some people control dizziness by reducing the amount of fluid the body retains, which may help lower fluid volume and pressure in the inner ear.
  • Other dietary and behavioral changes. Some people claim that caffeine, chocolate, and alcohol make their symptoms worse and either avoid or limit them in their diet. Not smoking also may help lessen the symptoms.
  • Cognitive therapy :  Cognitive therapy is a type of talk therapy that helps people focus on how they interpret and react to life experiences. Some people find that cognitive therapy helps them cope better with the unexpected nature of attacks and reduces their anxiety about future attacks.
  • Injections:  Injecting the antibiotic gentamicin into the middle ear helps control vertigo but significantly raises the risk of hearing loss because gentamicin can damage the microscopic hair cells in the inner ear that help us hear. Some doctors inject a corticosteroid instead, which often helps reduce dizziness and has no risk of hearing loss.
  • Surgery:  Surgery may be recommended when all other treatments have failed to relieve dizziness. Some surgical procedures are performed on the endolymphatic sac to decompress it. Another possible surgery is to cut the vestibular nerve, although this occurs less frequently.

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