Meniere’s disease is when an excessive amount of fluid builds up in the inner ear cavity. Since this department is responsible for spatial orientation and maintaining the balance of the human body, dysfunction of the inner ear leads to the development of characteristic symptoms.
Symptoms of Meniere’s disease. The most striking manifestation of the disease is systemic dizziness. This symptom often forces the patient to seek diagnosis and subsequent treatment of Meniere’s disease. During an attack of dizziness, a person experiences a sensation as if all the space around them is set in motion; the surrounding objects are displaced and rotated. Unlike normal dizziness, systemic dizziness causes the feeling that the body is “falling through,” tilting heavily. The sensations are so powerful that the patient cannot stand on their feet and reflexively grabs the furniture of people standing next to them and, in principle, cannot maintain an upright position of the body or even sit. The duration of an attack can last from several minutes to several days, but the average duration of an episode of vertigo is 2-7 hours.
In addition to this symptom, Meniere’s disease also manifests itself in other, less obvious, but requiring the attention of specialists, signs:
- Decreased hearing and hearing impairment. In this case, the patient periodically notes congestion in the affected ear and a decrease in the perception of low frequencies. As the disease progresses, the decrease in hearing acuity progresses with each new attack. Without treatment for Meniere’s disease, the condition leads to complete and irreversible deafness.
- Nausea and vomiting. During vertigo attacks, these symptoms are very common and occur for the same reason as motion sickness. Subjective sensations of rotation of the space itself and one’s body cause episodes of indomitable vomiting in the patient.
- During attacks of systemic dizziness, there is pallor of the skin, a violation of the heart rate, excessive sweating, the inability of the patient to focus their gaze (patients have a rotational movement of the eyeballs).
At the beginning of the development of the disease, the exacerbation of the disease alternates with periods of remission, during which the patient is more or less able to restore working capacity. Treatment of Meniere’s disease at this stage is most effective, as it prevents further dysfunctions of the inner ear.
Diagnosis and causes of Meniere’s disease
Meniere’s disease is usually classified according to the symptoms that predominate at the onset of the disease:
- Cochlear form. The cochlear form is characterized by the onset of the disease, in which the patient has mainly auditory disorders (noise and ringing in the ears, decreased hearing acuity). It is observed in about half of all cases of the disease.
- Vestibular form. It is diagnosed in about 20% of all cases of Meniere’s disease. The disease begins with more or less pronounced vestibular disorders and episodes of systemic dizziness.
- Classic (or mixed) form. In this form of the disease, cochlear and vestibular symptoms occur and develop at the same time. The severity of hearing impairment and the severity of seizures may vary, but two types of symptoms are present.
Causes of Meniere’s disease. To date, the exact causes of Meniere’s disease remain unclear. There are several hypotheses and assumptions that, to a certain extent, explain the probable causes of the development of this disease:
- complications of viral infections, as a result of which autoimmune processes develop (mechanisms of the immune system directed against the cells and tissues of one’s own body)
- hereditary predisposition (several researchers note cases of this disease in previous generations in the family history of patients with Meniere’s disease)
- vascular diseases in which the outflow of blood from the tissues of the inner ear is impaired, which leads to the accumulation of excess fluid in its cavity
- metabolic disorders, in particular, water-volitional metabolism
- traumatic injury to the inner ear
- endocrine diseases in which estrogen deficiency is expressed
- inflammatory and infectious diseases of the inner ear with interrupted or incorrect treatment, as a result of which negative changes develop in the tissues of the labyrinth
The causes, symptoms, and treatment of Meniere’s disease are quite closely related concepts. Treatment of the disease must consider the peculiarities of the clinical picture, history, and objective diagnostic results, making it possible to assess the severity of the condition.
Symptoms of Meniere’s disease are sufficiently characteristic so that even during the initial examination, the doctor could understand what kind of disease caused the patient’s complaints.
The following diagnostic methods are used to confirm the diagnosis and assess the severity of the lesions:
- audiometry is a method that detects hearing loss in the low-frequency range, which is characteristic of the initial stage of the disease
- acoustic impedance measurement, which allows assessing the degree of mobility of the auditory ossicles
- promontory test is performed to assess the condition of the auditory nerve
- otoscopy (microotoscopy) is aimed at identifying possible pathologies of the external auditory canal and changes in the tympanic membrane
- vestibulometry and other methods of assessing the work of the vestibular apparatus
- MRI of the brain to exclude neoplastic diseases, including neuroma of the auditory nerve.
Depending on the characteristics of the clinical picture, the otolaryngologist can supplement the examination complex with several other diagnostic methods. They may be required to detail already identified circumstances and exclude other diseases with similar manifestations.
Treatment of Meniere’s disease also requires controlled diagnostic studies that help evaluate the effectiveness of therapy and adjust the prescription or select other methods if their insufficient effectiveness is revealed.
Treatment of Meniere’s disease
Treatment of Meniere’s disease has two directions: relieving attacks of systemic vertigo and preventing further changes in the inner ear.
Depending on the characteristics of the course of the disease, the presence of concomitant pathologies in the patient, the degree of dysfunction of the inner ear, and other factors, various methods of treatment can be used.
Medication. Based on the results of the diagnosis, the patient is assigned the following groups of drugs:
- sedatives, etc.
The combination of drugs and specific names are selected by the doctor and are taken according to the scheme indicated by them. In most cases, treatment of the symptoms of Meniere’s disease and its complications in the inner ear is done on an outpatient basis. For severe vestibular disorders accompanied by nausea and vomiting, the prescribed drugs are administered by injection.
Surgery. If the effectiveness of drug treatment is insufficient or completely absent, surgical intervention is recommended.
Depending on the identified changes in the inner ear and other factors, surgery may have the following goals:
- It can reduce fluid pressure on the inner ear cells. For this, decompression operations are used to normalize the outflow of fluid from the ear cavity. For different indications, different methods can be used (drainage of the endolymphatic sac, perforation of the stapes base, and others).
- Destructive surgeries allow controlled destruction of the inner ear and its innervation pathways, responsible for the onset of symptoms of Meniere’s disease. This type of intervention is indicated for severe attacks of systemic vertigo, which cannot be controlled with medication, and when changes in the inner ear cavity have reached the point where draining operations are impractical.
- Surgery on the autonomic nervous system involves separating the channel through which there is a “translation” of erroneous signals from the inner ear to the brain; this allows you to solve the systemic dizziness problem in the most radical way.