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Meniere's Disease: Causes, Symptoms And Treatment

Meniere's disease is a disorder or a condition that affects the inner ear. The condition can cause vertigo, a type of dizziness that can make you feel like you are spinning. The inner ear is the part of your body which maintains proper hearing and balance in the body [1] . The disorder can develop a ringing noise in the ear, and even lead to hearing problems. In most cases, Meniere's disease affects only one ear.

Although the disease can affect people of any age, it is commonly found between the age of 20 to 25 years. People between the age of 40s and 50s are also prone to the condition [2] . Meniere's disease is considered a chronic condition, and no cure has been likely developed. However, the treatments methods for the condition can manage and control the symptoms associated with it. In some cases, Meniere's disease is also known to cause anxiety, depression and stress due to the limitation it poses in the daily activities of an individual [3] .

Reports reveal that 1 in 1,000 people are affected by Meniere's disease. Every year, around 45,000 people around the globe are diagnosed with the condition.

Causes Of Meniere's Disease

The exact reason why an individual develops the condition is unknown. Studies have linked the case with changes in the fluid tubes located in the inner ear. That is when there is an abnormal amount of fluid (endolymph) in the inner ear.

Some of the other proposed causes include [4]

  • A blow to the head
  • Abnormal immune response
  • Improper fluid drainage ( due to a blockage or anatomic abnormality)
  • Genetic predisposition
  • Viral infection
  • Migraines and headaches

Symptoms Of Meniere's Disease

The signs pertaining to the chronic condition varies from one individual to the other. Meniere's disease symptoms can come as attacks or episodes [4] .

  • Loss of hearing in the affected ear
  • Vertigo, with attacks lasting anywhere from a few minutes to 24 hours
  • Nausea, vomiting, and sweating caused by severe vertigo
  • Tinnitus, or the sensation of ringing, in the affected ear
  • Headaches
  • Loss of balance
  • Aural fullness, or the feeling that the ear is full or plugged

Individuals with Meniere's disease may experience more than one symptom at the same time, such as [5] [6]

  • vertigo,
  • hearing loss,
  • tinnitus, or
  • aural fullness.

In most cases, individuals will not experience the above-mentioned symptoms during the attacks or episodes.

Risk Factors Of Meniere's Disease

There are certain elements that can elevate the chances of developing the condition. Some individuals can be more prone to the disease, in comparison to the others. Following are the risk factors that contribute to the onset of Meniere's disease [7] .

  • Abnormal immune system response
  • Family history
  • Allergies (seasonal and food allergies may lead to the disease)
  • Chronic stress
  • Smoking (individuals who smoke regularly smoke or are chain smokers are more likely to contract the disease)
  • Ear, throat, nose and upper respiratory illnesses may contribute to the disease
  • Taking certain prescription medicines
  • Head trauma
  • Alcohol abuse (drinking too much alcohol will put you at a higher risk)

Stages Of Meniere's Disease

The chronic disorder affects people differently, that is, it affects individuals in various stages with the signs and symptoms developing over time [8] .

1. Early stage

During this phase, an individual will undergo sudden episodes of vertigo. The episodes of vertigo can last from 20 minutes to 24 hours. During the early stage, the individual's ear may feel full or blocked. They may also experience hearing loss, which usually goes away as the episode subsides. It is also common to experience the effects of tinnitus during this stage [9] .

2. Middle stage

During this phase, the symptoms of vertigo will reduce predominantly. But along with that, the hearing loss, as well as the tinnitus, will elevate. Many individuals will also undergo long-term remission that will last for a period of more than three months. In some cases, it can last for a longer period of time[10] .

3. Late stage

The last phase of Meniere's disease is different in comparison to the early and middle stage. During this stage, individuals will not suffer from constant attacks of vertigo, and some will even be relieved from it. But, tinnitus and hearing loss will get progressively worse. And people are increasingly prone to experience a lack of balance on a regular basis.

When To Go To A Doctor

If you have undergone the following, it is necessary that you go to a doctor immediately and get yourself checked for Meniere's disease.

  • Two episodes of vertigo, each lasting 20 minutes or longer but not longer than 12 hours
  • Tinnitus or a feeling of fullness in your ear
  • Hearing loss verified by a hearing test

Diagnosis Of Meniere's Disease

In the event of the symptoms, your doctor will carry out a number of tests to examine your hearing and balance. It will also help the doctor in ruling out any other diseases.

1. Hearing tests

An audiometry test will be used by the doctor to determine if you are experiencing any hearing loss. The hearing test will be carried out through listening to noises of a variety of pitches and volumes through a headphone. The technician will ask you about the voices you can hear and not, which will help the technician in determining whether you are experiencing hearing loss or not [11] .

The test will also examine how well you can distinguish between similar-sounding words. You will be asked to repeat the words you heard through the headphone by the doctor. It is done so as to examine and understand if both your ears or one ear is affected.

2. Balance tests

Between the vertigo attacks or episodes of vertigo, most people will regain their sense of balance. However, you may still have some problems with balance which can be assessed through the following tests [12] [13] .

Rotary-chair testing: This test measures inner ear function based on your eye movement. You are made to sit in a computer-controlled rotating chair, which will stimulate your inner ear.

Vestibular evoked myogenic potentials (VEMP) testing: This test is not only for diagnosing, but also for monitoring Meniere's disease. It shows the specific changes in the affected ears of individuals with Meniere's disease.

Posturography: This computerized test reveals which part of the balance system (such as your vision, inner ear function, or sensations from the skin, muscles, tendons and joints) you mostly rely on and which parts may cause problems. Posturography involves you standing a safety harness, in bare feet on a platform and keep your balance under various conditions.

Video head impulse test (vHIT): This new type of test makes use of video to measure eye reactions to abrupt movement. While you are focusing on a specific point, your head is turned quickly and unpredictably. And, if your eyes move off the target when your head is turned, that means you have an abnormal reflex.

Electrocochleography (ECOG): Under this test, the inner ear response to sounds will be examined. It might help to determine the possibility of an abnormal build-up of fluid in the inner ear. But however, it isn't specific for Meniere's disease[14] .

Videonystagmography (VNG): Under this test, the balance function will be examined by assessing the eye movement. Balance-related sensors in the inner ear are linked to muscles that control the movement of the eye.

Treatment For Meniere's Disease

As there is no specific cure for the condition, the treatment methods can only reduce the severity of the symptoms (vertigo episodes)[15] .

1. Medications for vertigo

Your doctor may prescribe you with motion sickness and anti-nausea medications. The motion sickness medications will help in reducing the spinning sensation. And the other medication will help control nausea and vomiting during a vertigo attack[16] .

2. Positive pressure therapy

This is used in the cases of severe vertigo, that is hard to treat. The therapy involves the application of pressure to the middle ear so as to reduce the fluid buildup.

3. Rehabilitation

This can be practised if you have a problem with the balance between vertigo episodes. Vestibular rehabilitation therapy is the best method to improve balance.

4. Middle ear injections

Applying or injecting medicines into the middle ear, which will be absorbed into the inner ear can help improve the symptoms of vertigo. Steroids and gentamicin are the two medications used for this purpose [17] .

5. Hearing aid

This is helpful in regaining the hearing in the ear affected by the chronic condition. An audiologist will help you in choosing the best suitable hearing aid.

6. Surgery

Apart from all the aforementioned treatments, surgery is applied in the event of severe cases. The procedures involved are vestibular nerve section, labyrinthectomy and endolymphatic sac procedure [18] [19] .

Lifestyle Changes

Along with all these medications and surgeries, you can adapt to some changes in your daily life so as to manage and control the symptoms [20] .

  • Eat less salt, as this will help in fluid retention in your body.
  • Reduce the quantity of your body and increase the number of times.
  • Drink water regularly.
  • Reduce alcohol intake.
  • Manage stress and anxiety through meditation or therapy.
View Article References
  1. [1] Sajjadi, H., & Paparella, M. M. (2008). Meniere's disease. The Lancet, 372(9636), 406-414.
  2. [2] Nakashima, T., Naganawa, S., Sugiura, M., Teranishi, M., Sone, M., Hayashi, H., ... & Ishida, I. M. (2007). Visualization of endolymphatic hydrops in patients with Meniere's disease. The Laryngoscope, 117(3), 415-420.
  3. [3] Minor, L. B., Schessel, D. A., & Carey, J. P. (2004). Meniere's disease. Current opinion in neurology, 17(1), 9-16.
  4. [4] Paparella, M. M. (1985). The cause (multifactorial inheritance) and pathogenesis (endolymphatic malabsorption) of Meniere's disease and its symptoms (mechanical and chemical). Acta oto-laryngologica, 99(3-4), 445-451.
  5. [5] Paparella, M. M. (1983). Pathogenesis of Meniere's disease and Meniere's syndrome. Acta Oto-Laryngologica, 96(sup406), 10-25.
  6. [6] Paparella, M. M., & Djalilian, H. R. (2002). Etiology, pathophysiology of symptoms, and pathogenesis of Meniere's disease. Otolaryngologic Clinics of North America, 35(3), 529-545.
  7. [7] Wladislavosky‐Waserman, P., Facer, G. W., Mokri, B., & Kurland, L. T. (1984). Meniere's disease: A 30‐Year epidemiologic and clinical study in rochester, mn, 1951‐1980. The Laryngoscope, 94(8), 1098-1102.
  8. [8] Young, Y. H., Huang, T. W., & Cheng, P. W. (2003). Assessing the stage of Meniere's disease using vestibular evoked myogenic potentials. Archives of Otolaryngology–Head & Neck Surgery, 129(8), 815-818.
  9. [9] Klockhoff, I., & Lindblom, U. (1967). Glycerol test in Meniere's disease. Acta oto-laryngologica, 63(sup224), 449-451.
  10. [10] Shea, J. J. (1993). Classification of Menière's disease. The American journal of otology, 14(3), 224-229.
  11. [11] Mori, N., Asai, A., Suizu, Y., Ohta, K., & Matsunaga, T. (1985). Comparison between electrocochleography and glycerol test in the diagnosis of Meniere's disease. Scandinavian audiology, 14(4), 209-213.
  12. [12] Thomas, K., & Harrison, M. S. (1971). Long-term follow up of 610 cases of Meniere's disease.
  13. [13] Gates, G. A. (2006). Meniere's disease review 2005. Journal of the American Academy of Audiology, 17(1), 16-26.
  14. [14] Conlon, B. J. (2000). Electrocochleography in the diagnosis of Meniere's disease. Acta oto-laryngologica, 120(4), 480-483.
  15. [15] Sharon, J. D., Trevino, C., Schubert, M. C., & Carey, J. P. (2015). Treatment of Meniere’s disease. Current treatment options in neurology, 17(4), 14.
  16. [16] Grewal, K., Austin, P. C., Kapral, M. K., Lu, H., & Atzema, C. L. (2018). The impact of opioid medications on subsequent fractures in discharged emergency department patients with peripheral vertigo. Canadian journal of emergency medicine, 20(1), 28-35.
  17. [17] Beyea, J. A., Instrum, R. S., Agrawal, S. K., & Parnes, L. S. (2017). Intratympanic dexamethasone in the treatment of Meniere's disease: a comparison of two techniques. Otology & Neurotology, 38(6), e173-e178.
  18. [18] Baloh, R. W. (2017). Meniere’s disease.
  19. [19] Ghavami, Y., Mahboubi, H., Yau, A. Y., Maducdoc, M., & Djalilian, H. R. (2016). Migraine features in patients with Meniere's disease. The Laryngoscope, 126(1), 163-168.
  20. [20] Ghavami, Y., Haidar, Y. M., Moshtaghi, O., Lin, H. W., & Djalilian, H. R. (2018). Evaluating Quality of Life in Patients With Meniere’s Disease Treated as Migraine. Annals of Otology, Rhinology & Laryngology, 127(12), 877-887.

Story first published: Tuesday, February 19, 2019, 17:27 [IST]
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