Meniere's Disease

Meniere's disease is named after Dr. Prosper Meniere who, in 1861, described the condition for the very first time. It is a chronic inner ear disorder that typically affects only one ear.

The ear consists of three basic parts: the outer, the middle and the inner ear. The outer ear, which is the visible part, channels sound towards the eardrum which serves to separate the outer ear from the middle ear. The middle ear mainly consists of the ossicles which are three small bones that are connected to the eardrum. As they vibrate, they amplify sound. For its part, the inner ear, which is filled with fluid, is made up of the cochlea, responsible for hearing and the semicircular canals, responsible for maintaining balance.

Meniere's disease is characterized by a surplus of endolymph, one of the fluids found in the inner ear. This causes pressure in the ear to increase to the point where it can actually rupture the ear canals and causes the brain to receive contradictory signals as though the person were lying down and standing up at the same time. As a result, persons with this condition may experience sudden attacks of vertigo and dizziness. The first symptoms of the disease generally appear in those aged 20 to 50 years old and the condition affects men and women equally.

Causes

The cause of Meniere's disease is not yet known. There are, however, certain risk factors:

• Food allergies
• Excessive salt intake
• Chronic exposure to very loud noises or sounds
• Significant amounts of stress and fatigue

Symptoms

The symptoms of Meniere's disease often present as "attacks" that are more or less spaced out and that last anywhere from 20 minutes to 24 hours. Persons with Meniere's disease occasionally suffer from after-effects (particularly with regards to hearing loss) which usually diminish or disappear over time. Meniere's disease can cause:

• Tinnitus (relentless buzzing or ringing)
• Headache
• Malaise
• Nausea or vomiting
• Nystagmus (uncontrollable eye movements)
• Partial or total hearing loss (progressive and becomes increasingly permanent over time)
• Sensation of fullness or pressure in the affected ear
• Sweating
• Vertigo

Diagnosis

Meniere's disease is diagnosed by a general physician. After having reviewed the patient's medical history, symptoms and frequency of symptoms, the physician will conduct a physical examination. He may also request additional tests or recommend that the patient consult with a specialist. Specialists trained in treating Meniere's disease include otorhinolaryngologists (ear-nose and throat specialists) and neurologists.

According to the guidelines established by The American Academy of Otolaryngology (AAO-HNS), the three major symptoms for Meniere's disease are:

1. Two spontaneous attacks of vertigo lasting 20 minutes or more
2. Tinnitus or sensation of fullness in the ear
3. Hearing loss documented by a hearing test

Treatment and Prevention

Since there is no cure, treatment for Meniere's disease focuses on alleviating the symptoms. The number of attacks can be reduced by eating and drinking regularly, limiting one's salt and sugar intake, avoiding monosodium glutamate (MSG) and caffeine, stopping smoking and reducing stress. Rehabilitation exercises aimed at relearning how to maintain one's balance can sometimes prove helpful.

Diuretics and vasodilators are used to reduce the number of attacks. They are often combined with anti-vertigo (ex. Bonamine™, Serc™) or anti-nausea (ex. Gravol™) medications. Anxiety, which can aggravate the problem, does occasionally occur as a result of an attack and can also be treated.

Another type of treatment involves injecting a toxic antibiotic intended for the inner ear through the eardrum. These injections are given under local anesthesia and prevent the affected ear from sending messages to the brain. The other ear then becomes solely responsible for balance. Attacks of vertigo are then significantly reduced and are not as severe.

Lastly, surgery is an option for more serious cases or where traditional treatments have failed. This treatment option can provide a permanent solution to the problem but may come at a heavy price since the risk of losing one's hearing and becoming deaf is a possibility that cannot be ignored or taken lightly.