What is Meniere’s disease?
Meniere’s disease is a disorder that affects the inner ear. It produces a set of episodic symptoms including, vertigo, hearing problems, fullness of the affected ear and a ringing sound in the ear (tinnitus). This condition is usually affects only one ear. However, in about 15% of patients with Meniere’s disease, both ears may be involved. One episode lasts from about 20 minutes to 4 hours.
Meniere’s disease is a common disorder affecting up to 615000 people in the United States and commonly occurs in people aged between 40 to 60 years. Both men and women have an equal chance of developing this condition. However, the presentation and the disease course may be different from one person to another and therefore the treatment will be decided according to the symptoms.
What are the causes of Meniere’s disease?
The cause of Meniere’s disease is not known. However, many researchers believe that Meniere’s disease is probably due to changes in the volume of fluid in the inner ear. The volume of fluid within the inner ear can increase either due to reduced absorption or excessive production. As mentioned before, Meniere’s disease can sometimes affect both ears and in such cases, the underlying cause can be due to allergies or autoimmune disorders.
In people with Meniere’s disease, they have an affected inner ear and therefore they are more sensitive to stress and fatigue thus affecting the frequency of attacks.
What are the symptoms of Meniere’s disease?
Meniere’s disease results in episodic symptoms, sometimes referred to as “attacks”. This means that they develop the symptoms only during these episodes and are completely normal between episodes.
The symptoms of Meniere’s disease include:
- Vertigo – This is the feeling of spinning sensation. Patients either feel as if they are spinning or the environment is spinning.
- Tinnitus – A ringing, buzzing or a roaring sensation on the affected ear.
- Loss of hearing on the affected ear – This is often intermittent and usually occurs at the same time they experience vertigo. Loud sounds may be distorted and cause discomfort to the patient. However, mostly it is the low pitch sounds that they are unable to hear but over time this affects tones of all pitches.
- Feeling of fullness of the affected ear
- Loss of balance
- Nausea and vomiting
How is Meniere’s disease diagnosed?
On your visit to the doctor, they will first talk to you and take a detailed history from you regarding the symptoms you experience. They will question you on the duration, severity, frequency and the character of the symptoms you experience. Other questions they may ask are:
- Duration of the hearing loss and has there been any change over time.
- Have you experienced tinnitus before or fullness of the ears
- Is only one ear affected or both ears?
Once a detailed history is taken, your doctor will carry out certain diagnostic tests to check your hearing or balance and also to rule out other causes that may cause similar symptoms.
Hearing tests are also known as audiometric examination and is indicated if you experience hearing loss. During the test, you will be given headphones and will be allowed to hear sounds with a variety of pitches and volumes. When these different sounds are played, you will be asked to indicate when you can hear and not hear them, so that the technician can determine if you are experiencing any hearing loss.
You will also be tested if you can recognize words with similar sounds correctly. Again, during this test, you will be given headphones and different words will be played and you will be asked to repeat the words aloud. This test will enable the doctor to say if you one or both ears are affected.
Other hearing tests that can be done are:
This is done to test the electrical activity of the ear because hearing loss can also be caused by a problem in never in the ear.
Auditory brainstem response (ABR)
This test will enable your doctor to accurately determine if the hearing loss is due to a problem in the inner ear or a problem in the nerves.
Balance tests are responsible for testing the function of the ears. The most commonly used balance test for Meniere’s disease is electronystagmography (ENG). The principal this test uses is the fact that both ears and eyes work together in coordination. Here, they will insert hot or cold water into the ear and will record the eye movements. The water causes the balance function to work. Nearly 50% of patients with Meniere’s disease will have reduced balance functions in the affected ear.
A rotational or balance platform test is less commonly used to assess whether the balance problem is arising from the ear or the brain.
How is Meniere’s disease treated?
The treatment depends on the individual symptoms experienced and will be chosen by your otolaryngologist. The following are treatment methods may be used:
- Low salt diet and a diuretic – This usually controls the symptoms adequately.
- Intratympanic injection – This is the injection of medication to the middle ear. This is done by making a temporary opening in the ear drum or placing a tube in the ear drum through which medicine such as Gentamycin or corticosteroids are administered.
- Air pressure pulse generator – This is a mechanical pump that generates air pressure leading to a change in the pressure within the inner ear.
- Anti-vertigo medications
- Surgery – Surgery is an indication in patient who does not respond to the above treatment methods and for those who experience severe, disabling attacks. The surgical options available are:
- Endolymphatic sac shunt – This procedure helps to reduce the fluid production within the inner ear and promotes the drainage of fluid. One-half to two-third of the cases with vertigo showed improvement following this procedure. However, the control is only temporary.
- Selective vestibular neurectomy – In this procedure the nerve that connects the ear to the brain is cut. It reduces vertigo while conserving hearing.
- Labyrinthectomy – This procedure is indicated when there is total hearing loss. Here, the entire inner ear is removed and therefore both hearing and balance function will be lost on the affected ear.