Meniere’s disease

Meniere’s disease is a disease of the inner ear that causes episodes of vertigo, noises in the ear (tinnitus), a feeling of fullness or pressure in the ear and fluctuating hearing loss. It is named after a french physician who first described it in 1861.

A typical attack is preceded by fullness in one or both ears, hearing fluctuation or tinnitus (ringing sounds in the ears). The attack involves severe vertigo (spinning sensation), nausea, vomiting, sweating in severe cases. An attack usually lasts from minutes to a few hours. The episodes may occur as several attacks in a short time or in other cases, months or even years may pass between episodes. Between the acute attacks, most people are free of symptoms or experience only mild imbalance and tinnitus. In 75 percent of cases, the disease is confined to one ear, in the rest, both ears may be involved. In most cases a progressive hearing loss occurs in the affected ear. Though acute attacks are incapacitating, the disease itself is not fatal.

Mechanism of symptoms of Meniere’s disease

The inner ear serves the body’s functions of hearing and balance. It is a system of hollow coiled tubes containing fluid (endolymph) and suspended in fluid (perilymph). The hearing and balance are in continuityanatomically and ohysiologically. In a normal ear, the endolymph is maintained at a constant volume. An acute attack of Meniere’s disease is believed to result from from fluctuating pressure of the endolymph fluid within the inner ear. The underlying cause of Meniere’s disease is unknown

Diagnosis of Meniere’s disease

The diagnosis is based on history, findings at clinical examination and results of hearing tests like Audiometry and Impedance Bridge studies and vestibular (balance) tests like Electronystagmography (E.N.G.), the gold standard by which the function of the balance organ is measured.. Rarely an M.R.I. brain scan may be required to exclude a rare tumour of the nerve of balance. (Ac neuroma) which presents with symptoms of Meniere’s disease. See vertigo testing Click

Management of an acute attack

During an acute attack, one must lie down on a firm surface. Do not move till the severity of vertigo subsides, then get up slowly. The eyes must be kept open and fixed on a stationary object. Do not drink water. It may cause vomiting.. If the vomiting and vertigo persist, send for the family physician . If relief is still not obtained, an E.N.T. specialist has to be consulted.

How does one cope up with the symptoms?

Avoid maneuvers involving neck twisting, Be extra careful during crossing roads, avoid sitting on two wheelers, avoid dangerous heights, etc. From now on, you will have to rely more on the two other modalities for maintenance of balance – namely – vision and proprioception (sensations from the peripheral sensory inputs of skin, muscle and joint sense. It is advisable to tell colleagues at work what to do if an acute attack occurs.

What can be done to reduce the symptoms?

Between attacks, different medications and different types of Vestibular rehabilitation exercises may be prescribed to help to encourage coordination between ears, eyes, cervical spine and stance and gait.

Salt restriction during the acute attack helps prevent water logging within the internal ear and helps early recovery. A permanent tinnitus (ringing in the ears) or a progressive hearing loss may be the consequence of a long term Meniere’s disease. In severe cases not responding to medication, surgery may be advised to block the transmission of information from the affected ear to the brain. The surgical methods available can be discussed with doctor when the need arises.

For Vestibular rehabilitation exercises Click