Meniere’s disease

Overview

1. Meniere’s disease is a medical condition of the inner ear that affects your hearing and balance. This disorder is mainly characterised by sudden bouts of severe dizziness (vertigo), a ringing sound in your ears (tinnitus), a feeling of fullness or pressure in your ears and difficulty in hearing. Some people experience nausea and vomiting along with dizziness and are unable to continue their daily routine. 
2.  
3. Meniere’s disease affects 12 in 1000 people globally. Most people get affected by Meniere’s disease in only one ear. But in about 15-40% of the cases, it can affect both ears. It often starts in one ear and progresses to both ears. 

 

 

Causes 

1. The exact cause of Meniere’s disease is unknown. This condition has been associated with a combination of genetic and environmental factors. Meniere’s disease is associated with abnormalities of the inner ear. The inner ear consists of a fluid and anything that affects this fluid can result in Meniere’s disease. 
2. Factors that disturb the fluid resulting in Meniere’s disease are:
3. Viral infections
4. Abnormal immune system response
5. Genetic factors
6. Poor fluid drainage due to a blockage or anatomic abnormality
7. Allergies
8. Autoimmune diseases

Overview

1. Meniere’s disease is a medical condition of the inner ear that affects your hearing and balance. This disorder is mainly characterised by sudden bouts of severe dizziness (vertigo), a ringing sound in your ears (tinnitus), a feeling of fullness or pressure in your ears and difficulty in hearing. Some people experience nausea and vomiting along with dizziness and are unable to continue their daily routine. 
2. Meniere’s disease affects 12 in 1000 people globally. Most people get affected by Meniere’s disease in only one ear. But in about 15-40% of the cases, it can affect both ears. It often starts in one ear and progresses to both ears. 

 

 

Signs & symptoms 

1. Recurring attacks of vertigo
2. You feel either you are spinning or the world around you is spinning. It starts and stops on its own. Vertigo lasts for about 20 minutes to several hours. It does not go beyond 24 hours. The spinning sensation comes on without any warning and can occasionally cause nausea.
3.  Ringing in the ears (tinnitus)
4. You may experience a ringing, roaring, buzzing, hissing or whistling sound in your ear. This is known as tinnitus.
5. . Hearing loss
6. Some people experience fluctuations in hearing. The hearing loss may fluctuate and eventually become permanent.
7.  Feeling of fullness
8. You will often feel pressure and a sensation of fullness in your affected ear. This is known as aural fullness.

 

Signs & symptoms 

1. Recurring attacks of vertigo
2. You feel either you are spinning or the world around you is spinning. It starts and stops on its own. Vertigo lasts for about 20 minutes to several hours. It does not go beyond 24 hours. The spinning sensation comes on without any warning and can occasionally cause nausea.
3.  Ringing in the ears (tinnitus)
4. You may experience a ringing, roaring, buzzing, hissing or whistling sound in your ear. This is known as tinnitus.
5. Hearing loss
6. Some people experience fluctuations in hearing. The hearing loss may fluctuate and eventually become permanent.
7. Feeling of fullness
8. You will often feel pressure and a sensation of fullness in your affected ear. This is known as aural fullness.

 

Diagnosis

Diagnosis of Meniere’s disease is made by observing the presence of the following:

1. Two attacks of vertigo that each last for 20 minutes or more but lesser than 12 hours
2. Tinnitus 
3. Hearing loss confirmed by a hearing test
4. Ruling out other known causes of the above symptoms
5. 1. Patient history
6. Your physician will ask you about the following to ascertain the diagnosis of Meniere’s disease:
7. Severity of symptoms
8. Frequency and intensity of the symptoms
9. Overall health
10. Medications that are taken by you
11. Any past history of ear problems
12. History of allergies or infectious diseases
13. Family history of inner ear issues
14.  Clinical examination

Your physician will examine you for the symptoms experienced by you in the following way:

a. Audiometric exam

The physician will examine your ability to tell the difference between similar-sounding words to ascertain the hearing loss in your affected ear. The process is known as ‘speech discrimination’ and your doctor will say words like ‘fit’ and ‘sit’ to confirm the diagnosis.

b. Rotatory chair testing

You will be made to sit on a chair that keeps turning and is controlled by a computer. The doctor will observe how your eye movement affects your inner ear.

c. Balance assessment

People with Meniere’s disease experience difficulty in balancing themselves while walking. The poor sense of balance gets resolved when the vertigo episode subsides.

3. Investigations

The following tests are advised by your physician to diagnose Meniere’s disease:

a. Electronystagmogram

Evaluation of your balance by placing you in a dark room. Warm and cool air is blown through your ear canal and your eye movements are measured.

b. Electrocochleography

Measurement of the fluid pressure in your inner ear to check if there is any abnormal built up of fluid in the inner ear

c. Vestibular-evoked myogenic potential (VEMP)

Measurement of your reaction to sudden, loud noises.This test helps not only in diagnosis of  Meniere's disease but also monitoring of meniere's disease.

d. Posturography

The test measures your balance and how well you are able to manage it. You are made to stand barefoot on a platform that moves in several directions. A harness is strapped around  your body to allow your doctor to see your response to the movement of the platform.

e. Video head impulse test (VHIT)

To measure your eye’s response to sudden movement and their ability to focus while seeing video images.This test is done to check the reflex action of your body to measure eye reactions to abrupt movement.

f. Auditory brainstem response test (ABR)

In this test, you will be made to wear headphones and a computer will measure the brain waves occurring during your response to different sounds.

g. Other tests

Your doctor may also recommend an MRI scan or a CT scan to rule out other conditions like brain tumours or multiple sclerosis that may cause your symptoms. 

 

Diagnosis

Diagnosis of Meniere’s disease is made by observing the presence of the following:

1. Two attacks of vertigo that each last for 20 minutes or more but lesser than 12 hours
2. Tinnitus 
3. Hearing loss confirmed by a hearing test
4. Ruling out other known causes of the above symptoms
5. 1. Patient history
6. Your physician will ask you about the following to ascertain the diagnosis of Meniere’s disease:
7. Severity of symptoms
8. Frequency and intensity of the symptoms
9. Overall health
10. Medications that are taken by you
11. Any past history of ear problems
12. History of allergies or infectious diseases
13. Family history of inner ear issues

 Clinical examination

Your physician will examine you for the symptoms experienced by you in the following way:

 Audiometric exam

The physician will examine your ability to tell the difference between similar-sounding words to ascertain the hearing loss in your affected ear. The process is known as ‘speech discrimination’ and your doctor will say words like ‘fit’ and ‘sit’ to confirm the diagnosis.

  Rotatory chair testing

You will be made to sit on a chair that keeps turning and is controlled by a computer. The doctor will observe how your eye movement affects your inner ear.

 Balance assessment

People with Meniere’s disease experience difficulty in balancing themselves while walking. The poor sense of balance gets resolved when the vertigo episode subsides.

3. Investigations

The following tests are advised by your physician to diagnose Meniere’s disease:

a. Electronystagmogram

Evaluation of your balance by placing you in a dark room. Warm and cool air is blown through your ear canal and your eye movements are measured.

b. Electrocochleography

Measurement of the fluid pressure in your inner ear to check if there is any abnormal built up of fluid in the inner ear

c. Vestibular-evoked myogenic potential (VEMP)

Measurement of your reaction to sudden, loud noises.This test helps not only in diagnosis of  Meniere's disease but also monitoring of meniere's disease.

d. Posturography

The test measures your balance and how well you are able to manage it. You are made to stand barefoot on a platform that moves in several directions. A harness is strapped around  your body to allow your doctor to see your response to the movement of the platform.

e. Video head impulse test (VHIT)

To measure your eye’s response to sudden movement and their ability to focus while seeing video images.This test is done to check the reflex action of your body to measure eye reactions to abrupt movement.

f. Auditory brainstem response test (ABR)

In this test, you will be made to wear headphones and a computer will measure the brain waves occurring during your response to different sounds.

g. Other tests

Your doctor may also recommend an MRI scan or a CT scan to rule out other conditions like brain tumours or multiple sclerosis that may cause your symptoms. 

 

Treatment  for Meniere's disease

1. Medications

 You will be provided medicines to lessen the severity of the  vertigo attack.These medicines can be 

1)Motion sickness medications to  help reduce the spinning sensation and help control the  nausea.

2)Diuretics drugs that help to reduce the fluid retention in the body.

2. Surgery

There are different surgical options available to manage Meniere’s disease. These include:

a. Endolymphatic sac decompression

b. Labyrinthectomy

.c. Vestibular nerve section

This surgery is done for patient with severe Meniere's disease with attacks of vertigo that continue despite aggressive medical management and still have good hearing in the affected ear. If all other therapies are exhausted and the patient’s hearing is still useful in the affected ear, then this surgery is considered.

The surgery involves sectioning  off the vestibular nerve. This nerve connects your balance and movement sensors from your inner ear to your brain.This an excellent option in terms of vertigo control, hearing preservation, and postoperative quality of life

3. Positive pressure treatment

Pressure is applied to your middle ear to ease the fluid build-up. This is done with the help of a device known as the Meniett pulse generator. That applies pressure in pulses to your ear canal through the ventilation tube. The pressure is applied three times a day for five minutes each time.

4. Vestibular rehabilitation therapy

It provides  customised Exercises and activities are  planned to ifrom the findings of the clinical assessment, laboratory testing and imaging studies, and input from patients. There are different factors that can impact the potential for recovery including activity level, pain, other medical conditions, medications, and emotional concerns through this therapeutic way.

How to prepare for the doctor consultation?

1. Consult your physician when you experience any of the above symptoms, like severe vertigo, tinnitus, nausea or vomiting.
2. Your physician will recount on your medical history, family history and dietary habits.
3. You may need to get a series of tests done for the physician to understand your clinical condition. 
4. Sort your queries with your physician regarding the status of your condition. Understand from your doctor what signs you need to be wary of and when you need to consult in case of an emergency. 

 

 

Diuretics are the most commonly prescribed maintenance medications for Meniere's disease.

1. Diuretics work by restricting the overproduction of fluid in the inner ear. Diuretics are long-term medications. They help reduce the number of vertigo attacks, and in some cases, they help stabilize hearing.

2. Endolymphatic sac surgery controls vertigo in 60-90% of patients, it has a low risk of hearing loss, and it can improve the patient's hearing over time.

3. Wheras , vestibular nerve sectioning have success rates of about 95-98%.It is attempt to eliminate recurrent attacks of vertigo

Risks if not treated in time (complications) 

1. Unpredictable attacks of severe vertigo
2. Possible permanent hearing loss
3. Fatigue
4. Stress
5. Loss of balance due to vertigo resulting in falls and accidents

Disease progression 

Meniere’s disease usually develops in two stages. You may not experience symptoms between these two stages for a long time.

1. Early stage

1. Sudden unpredictable vertigo
2. Mild loss of hearing that gets better once vertigo subsides
3. Your ear may feel blocked with a feeling of fullness or pressure
4. Tinnitus with ringing or roaring in the ears
5. Exhaustion that lasts for a few hours
6. Diarrhoea
7. Blurry vision
8. Jerky eye movements
9. Cold sweat
10. Nausea
11. Vomiting
12. Trembling
13. Palpitations

2. Late stage

1. Less frequent vertigo attacks
2. Balance problems 
3. Vision disturbances
4. Hearing issues
5. Tinnitus that is steadily getting worse
6. You are unable to perform tasks in the dark
7. Sudden drop attacks that involve losing posture or sudden falls while being conscious