Meniere's Disease

Definition

Meniere's disease is a disorder of the labyrinth in the inner ear. The labyrinth is a system of cavities and canals in the inner ear that affects hearing, balance, and eye movement.

The Inner Ear

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Causes

An increase in the volume or pressure of fluid in the labyrinth can result in Meniere's disease. The cause of these fluid changes is unknown. Possible causes may include:

• Part of the labyrinth ruptures, allowing fluid in different compartments to mix
• Scar tissue causes a blockage in the labyrinth
• Inner ear injury due to:
  • Viral infection
  • Syphilis , a sexually-transmitted disease
  • Autoimmune disorders
  • Blood vessel problems
  • High cholesterol or other fats in the blood
  • Hormonal disorders
  • Medications, such as antibiotics and chemotherapy agents

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for Meniere's disease include:

• Age: 20 to 60
• Race: Caucasian
• Family history of Meniere's disease
• Stress
• Allergies
• Excess salt in the diet
• Excess noise

Symptoms

The intensity of symptoms can vary from one person to another. Symptoms usually come on suddenly. They typically involve only one ear, but may involve both.

Symptoms may include:

• Episodes of vertigo (spinning sensation), often accompanied by:
  • Nausea or vomiting
  • Sweating
  • Paleness of the skin
  • Weakness or falling
  • In some cases, headache or diarrhea
• Hearing loss may worsen during attacks of vertigo
• Tinnitus (ringing in the ears)
• Feeling of fullness or pressure in the ear
• Poor sense of balance
• A tendency for symptoms to worsen with movement

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. This will include an examination of your ears and a neurologic exam to evaluate for possible nerve damage.

Tests may include:

• Blood tests—to check for an underlying cause
• Hearing test —this is also called an audiometry
• Electronystagmogram—a type of eye movement test
• Auditory brainstem response—measures electrical activity in the hearing nerve and brain stem
• Electrocochleogram—measures electrical response of the inner ear to sound
• MRI scan —a test that uses magnetic waves to make pictures of structures inside the ear

Treatment

Treatment may include:

Dietary and Lifestyle Changes

These may help limit symptoms:

• Bed-rest during acute attacks of vertigo
• Avoid foods that are high in salt and high in sugar
• Drink adequate fluids
• Promptly begin replacing fluids lost to heat or exercise
• Avoid caffeine, aspirin, and smoking
• Minimize stress
• Avoid medications that seem to bring on or worsen symptoms
• Consider a hearing aid, if necessary
• Consider masking devices (white noise) to limit the effects of tinnitus
• Take safety measures to avoid falling
• Restrict chocolate consumption
• Reduce alcohol intake

Vestibular Exercises (Vestibular Rehabilitation)

Your doctor may suggest specific vestibular exercises. These exercises use a series of eye, head, and body movements to get the body used to moving without dizziness. You may work with a physical therapist to learn these.

Medications

Medications include:

• Drugs to treat vertigo, such as meclizine or scopolamine
• Antiemetics—medications to help control nausea
• Other medications that may improve hearing, control inner ear swelling, or limit overall symptoms, including:
  • Antihistamines
  • Cortisone drugs for a short time
  • Antidepressants or anti-anxiety medications
  • Diuretics
• Aminoglycoside therapy (such as streptomycin or gentamicin) to permanently destroy the part of the inner ear that deals with balance

Surgery

Surgical procedures are not always helpful, and include:

• Endolymphatic sac decompression—removal of a portion of inner ear bone and placing a tube in the inner ear to drain excess fluid
• Labyrinthectomy—destruction or removal of the entire inner ear, which controls balance and hearing
• Vestibular nerve section

Prevention

There are no specific guidelines for preventing Meniere's disease. However, to help reduce your risk, avoid the following risk factors:

• High-salt diet
• High-sugar diet
• Excess noise
• Excess alcohol
• Stress
• Smoking
• Use of drugs that can be toxic to the ear such aminoglycosides, aspirin, and quinine

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