A Family Doctor's Tale - MENIERE'S DISEASE

DOC I HAVE MENIERE'S DISEASE

Although there may be no complete cure for Meniere's disease even with surgery, the disease can usually be controlled with injections of stemetil and oral medications .

The typical symptoms are vertigo, tinnitus (buzzing sounds in the ear) and temporary loss of hearing.

Recurrence of episodes of Meniere's disease are common.

Meniere's Disease is a disease of the inner ear which is characterized by the triad of episodic vertigo(giddiness), tinnitus(buzzing sound in ear) and progressive hearing loss.

It is more common in adults between 30-60 years of age and in men more than women.

It usually occurs in one ear.

The exact cause of Meniere's Disease is unknown.

It is believed to be due to distension of the membranous labyrinth with increased pressure and fluid in the endolymph of the inner ear.

As a result the balance in one ear is affected leading to dizziness.

The possible triggers of this condition may be:

1.middle ear infection,


2.head injury


3.upper respiratory tract infection


4.the effect of aspirin,


5.smoking


6.alcohol


7.caffeine


8.salt

Some investigators believed that there is a link with the herpes zoster virus which is activated when the immune system is low, resulting in inflammation of the eight nerve(hearing).

Symptoms:
The classical triad of symptoms are:

1.recurrent bouts of vertigo of varying degrees which may last from hours to days.
Recurrences may be as often as 1 week to several years.

2.Slow progressive loss of hearing in one ear or rarely in both ears starting at low pitch sounds first.

3.Unilateral tinnitus (buzzing sound in one ear), sometimes in both ears

Besides these symptoms, there is also :

4.feeling of pressure(fullness) in one or both ears.

5.Nausea and vomiting sometimes occur with the vertigo

6.hypersensitivity to sound

7.nystagmus(uncontrollable jerky eye movements)

8.poor cognitive performance

9.audiometry shows impairment of hearing

10.MRI scan of the head - to exclude a tumor of the eighth cranial nerve (vestibulocochlear nerve)

Initial treatment:

1.Acute attacks are treated symptomatically with injections of stemetil, maxolon, dimenhydrinate

Other treatments:
1. Oral stemetil, maxolon, dimenhydrinate

2. mild diuretic

3.vitamin B6

4.antihistamines,

5.anticholinergics,

6.corticosteroids orally or injection of steroid medication behind the eardrum

7.Bed rest

8.stress reduction.

9.low-sodium diet.

10.avoid caffeine, alcohol and cigarettes

Surgery :
is only required if the above treatment does not control the vertigo

1.Decompression of the endolymphatic sac may help to relieve symptoms.

2.Permanent surgical destruction of the balance part of one ear may be done where the disease is severe and affects one ear.
This usually causes permanent deafness.

a.chemical labyrinthectomy: a drug (such as gentamicin) that can cause destruction of the balance portion of the inner ear is injected into the middle ear.

b.vestibular neurectomy where section of the nerve to the balance portion of the inner ear is done surgically

c.surgical removal of the inner ear (labyrinthectomy).

Usually balance returns to normal after sugery but hearing may be permanently damaged in one ear.

3.In the belief that Meniere's disease is caused by herpes virus, acyclovir an antiviral drug is given and has been found to relieve symptoms.

Prognosis

Symptoms may remain the same, worsen or disappear spontaneously.

1.Vertigo symptoms may be worse and more frequent but sometimes disappear spontaneously.

2.Hearing symptoms usually become worse and patients may become deaf in the affected ear.

3.Tinnitus usually is more pronounced with time.