What Are The Causes
Although the cause is unknown, it probably results from an abnormality in the fluids of the inner ear. The theory is that too much inner ear fluid accumulates either due to excess production or inadequate absorption. In some individuals, especially those with involvement of both ears, allergies or autoimmune disorders may play a role in producing Ménières disease.
People with Ménières disease have a sick inner ear and are more sensitive to factors, such as fatigue and stress that may influence the frequency of attacks.
Treatments For Meniere’s That Are Slightly Effective
The big problem with this section is separating placebo’s from slightly effective treatments. This intrinsically involves a cost-benefit comparison.
There are an immense number of placebo or nearly placebo treatments for Meniere’s disease. There is nothing wrong with a placebo, if it provides some benefit , and you can afford to do this. However, we don’t think that placebos that are billed to health care insurance providers should be supported. The treatments briefly discussed below are not placebos, but they are high in cost , and low in benefit .
The Meniett device‘s status at this writing seems most likely to be a slightly effective treatment or perhaps just a placebo. This treatment requires a surgical procedure and purchase of a very expensive device . We do not recommend Meniett treatment in our practice. We prefer low-dose gentamicin after medication fails.
Here is what a patient who had a good experience with the Meniett told me.
Etiology And Pathophysiology Of Menieres Disease
The etiology and pathogenesis of the disease remain elusive. An autosomal dominant pattern with features that may indicate anticipation is suggested in familial cases. Endolymphatic hydrops is accepted as the most possible pathophysiologic mechanism of the disease however, not all cases with hydrops become clinically apparent. Indeed, Seo et al. described three cases without vertigo, involving patients with cochleosaccular endolymphatic hydrops, revealed by furosemide-loading vestibular evoked myogenic potential test.
The endolymphatic hydrops is the result of a dysfunction in the mechanism of production and absorption of the endolymph. Although an overproduction of the endolymph has been proposed, it seems more probable that a defect in the absorptive activity of the endolymphatic duct and sac is present. Many studies indicate a possible role of antidiuretic hormone in the pathogenesis of Menieres disease, and especially in the mechanism of induction of the endolymphatic hydrops. Lim et al. assessed ADH levels in 26 patients and although they did not find statistically higher ADH levels in patients with unilateral Menieres disease, they could not exclude this possibility for patients with bilateral Menieres disease.
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What Causes Mnire’s Disease
Although the cause is unknown, Ménières disease symptoms are due to increased volume of fluid in the inner ear. Too much fluid may accumulate either due to excess production or inadequate absorption. In some individuals, especially those with involvement of both ears, allergies or autoimmune disorders may play a role in producing Ménières disease. In some cases, other conditions may cause symptoms similar to those of Ménières disease.
People with Ménières disease have a sick inner ear and are more sensitive to factors such as fatigue and stress that may influence the frequency of attacks.
To find out how to help and what is causing this condition, your physician will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss, or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. When the history has been completed, diagnostic tests to assess your hearing and balance may be performed. They may include:
Hearing testsAn audiometric examination typically shows a sensory type of hearing loss in the affected ear. Speech discrimination is tested as well.
Balance testsAn electronystagmogram test may be performed to measure balance by following eye movement when warm and cool water, or air, are inserted into the ear. Often this shows that the balance function is reduced in the affected ear. Rotational or balance platform testing may also be used to evaluate balance.
Summing It All Up: Menieres Vs Other Maladies
As you can see, there are many maladies that can create Menieres-like symptoms. Experts estimate between one-third and one-half of all dizziness patients experience have also had diagnostic changes and changes to treatment recommendations since their first examination. Thats why you go through all those tests before your doctor settles on a diagnosis. If you have Menieres, then you can take the next steps for planning your care and life modifications for the best quality of life.
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Menieres Disease The Uninvited Guest
Commonly called glaucoma of the inner ear, Menieres disease is related to the inner ear in which the vestibular system is housed. The labyrinth contains three semicircular canals, a complex system of chambers and passageways in the temporal bone. Signals sent from these canals, travel along the nerve pathways to the brain. Inside the canals is a thin-walled membranous sac filled with a fluid called endolymph. Surrounding the sac is another fluid called perilymph. These two fluids constantly bathe the vestibular and hearing organs which enable the person to keep his or her balance, and maintain normal hearing.
For unknown reasons in Menieres disease, the endolymph is over-abundant. Like glaucoma of the eye, the pressure increases until the sac bursts. The mixing of endolymph and perilymph sends an unbalanced message down the vestibular nerve , causing the patient to experience severe spinning, vertigo, nausea, hearing loss, tinnitus , and a feeling of fullness in the ear. As the disease progresses, hearing loss increases and the patients confidence plummets as these attacks are frustratingly unpredictable. The disease affects one ear in 85% of patients and both ears in 15%. In 50% of cases, the attacks will subside after two years in 70% of cases, they will disappear in eight years. Hearing loss may become progressively worse.
Treatment Of Acute Spells
- Sedative medication .
- Anti-nausea and anti-vomiting medication .
- Avoidance of caffeine, tobacco and alcohol.
- Low-sodium diet 1500-2000 mg/day.
- Lipoflavins and vitamins available over the counter .
- Diuretic medications once or twice daily.
- Fluid intake
- Vestibular or labyrinthine exercises.
- Allergy treatment.
- Treatment with local overpressure with the Meniett Low Pressure Pulse Generator Medtronics Xomed. Non-destructive, non-invasive, safe, portable, simple.
While no one believes that stress causes Meniere’s Disease, most people with the disease recognize a relationship between stressful events and the recurrence of their symptoms. Many patients believe that stress is a factor in how well they can prevent recurrent attacks and cope with the disruption caused by Menieres Disease. Not knowing when the next attack of vertigo may occur is a significant stress all by itself. For these reasons, patients with Menieres Disease are advised to manage their stress as much as possible. Professional counseling may be helpful in this regard.
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Diagnosis Of Menieres Disease
A diagnosis of Menieres disease includes vertigo, hearing loss, tinnitus and a feeling of pressure. Many of the symptoms of Menieres disease can also be caused by other conditions, so diagnosis of the condition often involves first ruling out other medical possibilities.There is no specific test for Menieres disease, but doctors use a range of tests in combination to help diagnose the disorder. These include:
- Hearing tests to test if hearing loss is specific to your inner ear. Low frequency loss is an indicator of Menieres.
- Electronystagmography measures involuntary eye movement while your balance is put under stress.
- Magnetic resonance imaging can be used to rule out disorders of the central nervous system that may be confused with Menieres disease, such as acoustic neuroma, Arnold-Chiari malformation and multiple sclerosis .
How Common Is Meniere’s Disease
Studies have shown that Meniere’s disease affects about 200 out of 100,000 people . This is roughly the same prevalence as multiple sclerosis . The majority of people with Meniere’s disease are over 40 years of age, with equal distribution between males and females. Interestingly, the Framingham study found that 2/100 people believe they have Meniere’s disease in the US, suggesting that misdiagnosis is far more common than the correct diagnosis.
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What Are The Symptoms Of Mnires Disease
Ménières disease often develops quickly, without any warning signs. Once someone has developed Ménières disease there is a fairly common progression of symptoms: usually individuals will first experience a sensation of ear pressure, and tinnitus with some fluctuating hearing loss and severe episodes of vertigo following this. Attacks of Ménières can vary in severity and can occur more than once a day, or just a few times in a year. The main symptoms include:
- A feeling of dizziness or vertigo, as if the world is spinning around you. This can be so extreme that you may not be able to stand up. The dizziness can last from a few minutes to a few hours and can cause you to feel severe nausea, vomiting, and sweating.
- A feeling of pressure or fullness in the ear. This is usually in just one ear.
- A decline in your ability to hear. This may result in a muffled effect. The inability to hear low frequencies is usually lost first, though higher pitches may be lost eventually as well. Hearing loss can recover between attacks, but it will permanently worsen over time.
- Ringing in the ear.
You should see your doctor if you have any of these symptoms.
Support Groups And Charities
There are several support groups and charities that can provide you with useful information and advice about living with Ménière’s disease. They can also put you in touch with other people with the condition.
- operating heavy machinery
You may also need to make sure that someone is with you most of the time, in case you need help during an attack.
These restrictions may leave you feeling stressed, anxious, or depressed. Speak to your GP if you’re finding it difficult to come to terms with the effect that Ménière’s disease is having on your life. They can offer advice and support.
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What To Do During An Attack Of Mnire’s Disease
Ménière’s disease can cause you to lose balance.
At the first sign of an attack you should:
- take your vertigo medicine if you have some
- sit or lie down
- close your eyes, or keep them fixed on a still object in front of you
- do not turn your head quickly
- if you need to move, do so slowly and carefully
Once the attack is over, try to move around to help your eyesight and other senses compensate for the problems in your inner ear.
Duration And Frequency Of Attacks
Attacks can last from 20 minutes to 24 hours. They can occur with the frequency of many attacks each week or they can be separated by weeks, months, and even years. The unpredictable nature of this disease makes managing it challenging. It also complicates the ability of scientists and physicians to study it.
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What Is Menieres Disease
It also can cause ringing in your ear , hearing loss that comes and goes, and a feeling of fullness or pressure in your ear. Usually, only one ear is affected. The hearing loss eventually can be permanent.
The disorder takes its name from a French doctor, Prosper Meniere, who suggested in the 1860s that the symptoms came from the inner ear and not the brain, as most people believed.
How Is Mnires Disease Treated
Ménières disease does not have a cure yet, but your doctor might recommend some of the treatments below to help you cope with the condition.
Pressure pulse treatment.
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Hearing And Balance Assessment In The Diagnosis Of Meniere’s Disease
A hearing test detects hearing loss and determines the extent of hearing loss. This test is also very helpful when it comes to identifying whether the hearing problem is in the inner ear or affect the auditory nerve.
As for a balance assessment, patients undergo several tests. The most commonly performed is electronystagmography . ENG is of major importance for evaluation of balance. This is achieved by assessing eye movement. Namely, balance-related sensors in the inner ear are connected to eye muscles. During the test, specially designed electrodes are placed near the eyes and on the forehead. What follows is stimulation of the inner ear by cool water, warm or cool air, all of which are introduced into the ear canal. By measuring involuntary eye movements, doctors check patient’s response and may successfully confirm whether there are any problems with the inner ear.
Rotatory-chair testing is similar to ENG because it evaluated eye movements. But this time the person is placed in a special rotating chair and by moving the chair, one’s inner ear gets stimulated.
Finally, there are two more test performed, vestibular evoked myogenic potentials and posturography.
In order to rule out other potential causes of symptoms, doctors additionally perform MRI, CT scan and auditory brainstem response audiometry.
Why Do People Get Menieres Disease
The National Institute on Deafness and other Communication Disorders estimates that around 615,000 individuals in the U.S. are diagnosed with Menieres disease, with over 45,500 newly-diagnosed cases each year.
There are no definite answers as to why people develop Menieres disease and research into the causes is still ongoing. Possibilities include it being a result of constrictions in blood vessels like those that cause migraine headaches, a result of viral infections, allergies, genetics , and autoimmune reactions.
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Symptoms Of Meniere Disease
Symptoms of Meniere disease include sudden , unprovoked attacks of severe, disabling vertigo, nausea, and vomiting. Vertigo Dizziness and Vertigo Dizziness is an inexact term people often use to describe various related sensations, including Faintness Light-headedness Dysequilibrium (feeling off balance or… read more is a false sensation that people, their surroundings, or both are moving or spinning. Most people describe this unpleasant feeling as “dizziness,” although people often also use the word “dizzy” for other sensations, such as being light-headed.
These symptoms usually last for 1 to 6 hours but can last up to 24 hours. Before and during an attack, a person often feels a fullness or pressure in the affected ear. Hearing in the affected ear tends to fluctuate but progressively worsens over the years. Tinnitus Ear Ringing or Buzzing Ringing in the ears is noise originating in the ear rather than in the environment. It is a symptom and not a specific disease. Tinnitus is very common10 to 15% of people experience… read more , which some people describe as “ringing in the ear,” may be constant or intermittent and may be worse before, during, or after an attack of vertigo. Both hearing loss and tinnitus usually affect only one ear, and the hearing loss is typically greatest in the lower sound frequencies.
Treatment For Mnire’s Disease
There’s no cure for Ménière’s disease, but medicine can help control vertigo, nausea and vomiting.
The 2 medicines usually recommended by GPs are:
- prochlorperazine, which helps relieve severe nausea and vomiting
- antihistamines, which help relieve mild nausea, vomiting and vertigo
The aim is to get the medicine into your body as soon as possible, at the first sign of symptoms.
You may also need treatment for:
- loss of balance
Distress is common in people with Ménière’s disease, as it’s a difficult and unpredictable condition.
A GP can offer advice and support if you’re finding it difficult to cope with the effect Ménière’s disease is having on your life.
You may be offered:
There are also support groups and organisations, such as the Ménière’s Society, that can provide help and advice.
What To Do During An Attack
During an attack, take your medication as soon as possible and grab the nearest available support. Get into a position in which you feel most stable or comfortable, and keep as still as possible. If you need to move, do so slowly and carefully. Close your eyes or keep them fixed on objects in front of you, and don’t turn your head quickly.
Once your symptoms start to improve, it’s best to gradually try to move around, as this encourages your brain to use your vision and other senses to compensate for the problems in your inner ear.