Meniere's Disease

The Meniere’s disease was named after the well known French Oto rhino laryngologist (ear, nose, throat specialist), Dr. Prosper Meniere who first described it in the year 1861 A.D as a disorder of the inner ear. His discovery was not well appreciated during those times when such disorders were thought to be incurable. He not only contributed greatly to the field of medicine but also he was known to be a prolific writer, archeologist, and a botanist.

About Meniere’s disease

Meniere’s disease is a disorder of the inner ear that affects mostly people in the age groups between 40 years to 50 years of age. However, it is found to occur also in children. This disorder affects only one ear. With effective Menieres disease treatment the symptoms of the disorder can be cured completely.

The ear consists of three parts which are the external ear, middle ear, and the internal ear. A cluster of passages and cavities known as the labyrinth form the inner ear. The inside part of this labyrinth consists of a membrane filled with fluid known as endolymph, and the membrane is lined with sensory hairs that are sensitive to the movement of this fluid. The endolymph has to maintain certain volume, chemical composition and pressure for the proper functioning of the inner ear. When the properties of the endolymph are altered by certain factors, the Meniere’s disease is caused.

The trigger factors that cause Meniere’s disease are viral infection, allergies, improper fluid drainage due to blockage or abnormality in the structure of ear; abnormal immune response, trauma to head, genetic factors, emotional stress, fatigue, over work, changes in pressure, and salty foods.

Symptoms do not occur all the time in people with Meniere’s disease.

  • When Meniere's disease symptoms occur it is called as an ‘attack’ that lasts from 20 minutes to 2 hours or more.
  • The affected person has episodes of vertigo which is the feeling of spinning around, and then losing balance when you stop spinning.
  • There is nausea and vomiting in severe cases of vertigo.
  • There is certain loss of hearing in the initial stages of the disease which leads to permanent loss of hearing in later stages.
  • A low pitched tinnitus is experienced which is nothing but the buzzing, hissing, whistling or roaring sound in the ear.
  • The affected person can have a feeling of pressure and fullness in the ear.
  • During an ‘attack’ the person may sweat profusely, and experience nausea and vomiting.

The doctor will conduct a physical examination and will ask the patient questions regarding the duration and severity of the sensory problem; history of allergies; past medical history; history of any ear problems in the family.

A hearing test (audiometry) is conducted to check if the patient is able to hear sounds of different pitches, and distinguish between two similar sounding words.

To check the function of the inner ear, there are tests that are conducted like Electronystagamography (ENG) (checks balance function by studying eye movement), Vestibular evoked myogenic potential testing (VEMP)(measures the function of sensors in inner ear), Posturography (reveals which part is causing balance problems) and Rotary chair testing (measures inner ear function).

To rule out other medical conditions that may be causing the symptoms tests like MRI scan (magnetic resonance imaging), computerized tomography(CT scan), and auditory brainstem response audiometry (helps detecting tumor) are done.

  • The doctor prescribes motion sickness medication for vertigo that include diazepam (valium), promethazine and meclizine (antivert) which reduces nausea, vomiting and spinning sensation.
  • To reduce fluid retention in the body that may help regulating the fluid volume in the ear, diuretic like a combination of hydrochlorothiazide and triamterene is used.
  • Steroids like dexamethasone also help in reducing vertigo attacks.
  • When medications do not work, surgery is done. Endolymphatic sac decompression is a surgical procedure in which a small bone present over the endolymphatic sac (regulates fluid in inner ear) is removed to decrease vertigo.
  • In a procedure known as Vestibular nerve section, the vestibular nerve that controls the balance and movement sensors is surgically cut to alleviate vertigo.
  • When there is total hearing loss in the affected ear, then a procedure known as Labyrinthectomy is done in which a part or the entire affected inner ear is surgically removed.
  • Rehabilitation therapy is useful in people who are having balance problems during vertigo attack. The therapy includes activities and exercises that will help to regain balance. The hearing problem can be dealt with by using a hearing aid which can be suggested by the audiologist (specialist who deals with hearing related problems).
  • A device known as Meniett device is used to improve fluid exchange by applying positive pressure on the middle ear.
  • When there is an attack of vertigo, the person should lie flat on the floor and keep his or her eyes fixed to any static object to prevent the feeling of dizziness.
  • There is a chance of vomiting if the person has eaten or has had a drink before the attack.
  • After the symptoms subside the person should slowly get up.
  • The doctor must be called if the vomitings do not subside even after 24 hours.
  • Unusual headache
  • Double vision
  • Difficulty in walking
  • Numbness or tingling sensation
  • Chest pain
  • Difficulty in speech
  • Loss of consciousness
  • Slow heart rate

By making certain healthy life style changes one can prevent Meniere’s disease.

  • Eating and drinking liquids should be evenly distributed throughout the day.
  • Meal timing should be maintained and it is better to have 5 to 6 small meals throughout the day then having three large meals.
  • Salty foods increase water retention in the body so one must limit salt intake in foods. Similarly, an ingredient known as Monosodium glutamate (MSG) is present in prepackaged food that increases the water retention in the body.
  • Other factors that one needs to avoid include smoking, caffeine, stress, and allergens.