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What Is Meniere’s Disease?

Medically reviewed by Maushmi Sheth
Medically reviewed by Maushmi Sheth

Meniere’s disease is associated with an increase in the amount of fluid (endolymph) in the inner ear. The complex of symptoms was described for the first time in 1861 by the French physician Prosper Ménière and was later called Ménière’s disease.

Inner ear anatomy. The inner ear is located inside the canals and cavities of the temporal bone called the bony labyrinth. Inside the bone labyrinth, there is a membranous labyrinth repeating its contours and dimensions.

The space between the membranous and bony labyrinth is filled with perilymph fluid, similar in composition to cerebrospinal fluid. The space inside the membranous labyrinth is filled with endolymph, and its walls completely isolate it.

There are three different structure and function parts of the inner ear vestibule, cochlea, and semicircular canals. The snail is the organ of sound perception. It is in it that the sensitive hair cells are located, which give rise to the auditory nerve. The vestibule and semicircular canals are the organs of balance.

What is the reason for the appearance of symptoms of Meniere’s disease? The appearance of symptoms is associated with an increase in the amount of endolymph. The endolymph, increasing in volume, stretches the walls of the membranous labyrinth. This condition is called endolymphatic hydrops or dropsy of the labyrinth. Since the membranous labyrinth has many sensitive receptor zones in all three sections, their irritation leads to the appearance of symptoms of the disease.

Meniere’s disease is currently not fully understood, so there are several theories where excess endolymph comes from:

  • the penetration of fluid from the blood plasma through the vascular wall of the capillaries
  • penetration of liquid from the perilymph through the wall of the membranous labyrinth
  • violation of the mechanism of production and absorption (absorption) of endolymph
  • accumulation of ions and substances with high molecular weight in the endolymph, which leads to an increase in osmotic pressure
  • insufficient volume of perilymph.

The reasons for the development of Meniere’s disease

The pathophysiology of Meniere’s disease is not well understood, and at present, no theory would fully explain its origin. But clinically, factors can be identified that contribute to the development of the disease or provoke its attacks. These factors include:

  • viral infections
  • autoimmune processes
  • psycho-emotional stress
  • allergic reactions
  • trauma
  • endocrine diseases.

Meniere’s disease is characterized by the appearance of seizures with the following symptoms:

  • dizziness
  • noise in ears
  • hearing loss.

In the absence of one of the symptoms, careful differential diagnosis is needed since dizziness, tinnitus, and hearing loss occur in many other diseases. In most cases, tinnitus and hearing loss is unilateral; that is, the pathological process occurs only in one ear.

The dizziness is quite intense and manifests itself in the rotation of the body or surrounding objects; this type of dizziness is called systemic. Nausea and vomiting are common at the time of an attack. Non-systemic dizziness (staggering when walking, darkening in the eyes, flickering before the eyes) is not common for the typical picture of Meniere’s disease and can only be in its final stage.

Also, there may be a feeling of fullness, fullness, congestion in the affected ear at the time of an attack.

There can be many attacks from once a few months to daily, which determines the severity of the disease.

Clinically distinguish the stages of the disease:

  • Stage 1 (initial). Dizziness attacks occur suddenly or after stress. There may be precursors before an attack, such as congestion in a sore ear. Noise appears in the ear during an attack, hearing decreases; after the attack, hearing is restored to normal ​​within a few days. Outside of the seizures, they feel good; there is no tinnitus.
  • Stage 2 (pronounced clinical manifestations). Dizziness attacks become more frequent and worse, accompanied by nausea and vomiting. Tinnitus is also present outside of seizures. Hearing is also steadily declining. There may be constant pressing headaches, a feeling of stuffiness, and distention in the sore ear.
  • Stage 3 (final). At this stage, the examination does not reveal the typical signs of dropsy of the labyrinth. There is an irreversible death of the receptor cells of both the auditory and the vestibular parts of the inner ear. Therefore, the dizziness attacks weaken- they become rarer and less pronounced. There is an unsystematic nature of unsteadiness of gait, swaying when walking. Hearing on the sore ear is significantly and persistently reduced.

Diagnostics Meniere’s disease

Diagnostics Meniere_s disease

Routine examination of the outer ear and tympanic membrane does not reveal any changes. To establish a diagnosis of Meniere’s disease, a comprehensive examination of the inner ear is necessary. Tests with tuning forks, a study of hearing thresholds by taking an audiogram, vestibular tests, an X-ray examination of the temporal bones, CT and MRI of the head, ultrasound dopplerography of the head’s main vessels, and neck are carried out. Consultations of a neurologist, otoneurologist, otosurgeon, ophthalmologist, therapist, endocrinologist are required.

At the initial stage of the disease outside the attack, all indicators can be within normal limits, and the clinical symptoms resemble those in other diseases. It is necessary to identify and confirm the dropsy of the labyrinth to establish an accurate diagnosis. Currently, there are two reliable methods for diagnosing the hydrops of the labyrinth: electrocochleography and dehydration tests.

  • Dehydration test technique. Initially, a hearing test is performed with an audiogram. Then the patient drinks a solution of glycerol with lemon juice. The amount of glycerol is calculated based on the patient’s body weight. Then again, remove the audiogram after 1, 2, 3, 24, and 48 hours after taking the solution. The test is considered positive if, after 2-3 hours, hearing improves by 5 dB over the entire frequency range or by 10 dB at three studied frequencies and speech intelligibility improves by at least 12% of the original. The test is considered negative if, after 2-3 hours, hearing decreases and speech intelligibility deteriorates. Other options are considered questionable.
  • Electrocochleography technique. Electrocochleography is a recording of the electrical activity of the cochlea and the auditory nerve after a sound stimulus. A sound such as clicks is fed into the ear understudy at a predetermined interval. The device’s sensor amplifies the amplitude of the electrical signal arising in the cochlea’s hair cells, resulting in a graph resembling an ECG. The dropsy of the labyrinth has certain symptoms in this graph.

What other diseases can resemble Meniere’s disease? Tinnitus, dizziness, and hearing loss are not exclusive symptoms of Meniere’s disease; therefore, it is precisely a comprehensive examination of the patient using the above methods that are necessary to exclude other pathologies with similar manifestations: acute cerebrovascular accident, vertebrobasilar insufficiency, benign paroxysmal positional dizziness, brain tumors, skull trauma, labyrinth fistula, inflammation of the vestibular nerve, multiple sclerosis, purulent complications of acute or chronic otitis media, psychogenic dizziness.

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Lone Star Neurology
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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been prepared.read more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well together.read more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your business.read more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any cookies.read more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going there.read more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my treatment.read more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to finish.read more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 stars.read more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his staff.read more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best treatment.read more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my doctor.read more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding solutions.read more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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