In 1861, French physician Prosper Meniere spoke of the main symptoms of a disease that would later be named after him. Characterized by episodes of vertigo, tinnitus, and hearing loss, Meniere’s Disease is a disorder of the inner ear which affects primarily one ear but may later spread to the other. Symptoms of Meniere’s Disease include a ringing in the ears and a feeling of intense dizziness. Episodes are relapsing, and there is currently no known cause. These relapsing episodes can last anywhere from 20 minutes to several hours, which allows for some normality in the life of a patient . Unfortunately, the constant ringing and hearing loss that a patient experiences is often permanent. Typically, the severity of the disease can lessen over time, but increasingly pronounced hearing loss often results from the progression of the disease. It is a rare disease, with only about 615,000 known cases in the United States annually . Overall, 50% of cases become bilateral, affecting both ears, but if bilaterality is not developed within approximately five years after the onset of the condition, then the probability of a patient being afflicted by bilaterality drops substantially ,
Overview and Symptoms
The symptoms of Meniere’s Disease generally vary minimally between cases. At the onset of the disorder, a patient will experience more episodes of vertigo (spinning sensation), which last anywhere from approximately 20 minutes to upwards of 24 hours and can result in nausea and vomiting. Additionally, temporary hearing loss is a common problem experienced by patients with the disease. In some cases, this hearing loss may become permanent, especially during the latter stages of the disease. Tinnitus (ringing in the ear) is also another common sign of the disorder, which can provide a great deal of discomfort to the patient with the disorder. Aural Fullness (ear pressure) is also experienced and pressure can be felt in either of the affected ears or on the sides of the head. In short, Meniere’s Disease results in a somewhat narrow range of hearing and ear-related symptoms including vertigo, tinnitus, hearing loss, imbalance, nausea, ear pressure .
There is currently no known cause for Meniere’s Disease. As a result, the disorder is known as an idiopathic (unknown cause) disorder . Still, there are a number of potential causes that are being investigated currently. Some of these factors include blood vessel constriction, viral infections, and autoimmune reactions. Additional factors that have been speculated to result in Meniere’s Disease include allergies, genetic predispositions, vestibular migraines, head trauma, and abnormal fluid drainage. Since no single factor has been determined to cause the condition, many physicians contribute the onset of the disease to a combination of the factors that are thought to be involved in the onset of the condition .
There are several tests which a doctor may use on a patient in order to determine whether or not they have Meniere’s Disease. Some of the most common of these methods that are used include: audiometry, computed tomography, magnetic resonance imaging, electronystagmography (rotational testing), electrocochleography, and vestibular evoked myogenic potential (VEMP). Additionally, in order to determine if a patient has definite or probable Meniere’s Disease, doctors require the following symptoms from a patient :
Two episodes of vertigo, each lasting 20 minutes or longer but not longer than 24 hours
Hearing loss verified by a hearing test
Tinnitus or a feeling of fullness in your ear
Exclusion of other known causes of these problems
The pathology of Meniere’s Disease is poorly understood due to the absence of an established cause. However, there are many inflammatory factors that can lead to what is known as endolymphatic hydrops. This condition is closely associated with Meniere’s Disease, and it is the reason why Meniere’s Disease is sometimes referred to as idiopathic endolymphatic hydrops. The pathology of the disease can be broken down into three primary stages. During the first stage of the disease, a patient will succumb to unpredictable attacks of vertigo. This stage is also the defining feature of the disease, as it will affect patients the most. Hearing loss may also accompany the episodes of vertigo, as well as the feeling of fullness in the ears that are affected. The second stage of Meniere’s Disease also involves attacks of vertigo but to a lesser extent; however, patients may also begin to have difficulty with balance, and pronounced tinnitus may develop. The third and last stage results in increased hearing loss, causing permanent ear damage. In contrast, the attacks of vertigo lessen and often disappear entirely, although tinnitus and difficulty with balance continues .
Figure 1: Comparison of/between a healthy inner ear and one affected by Meniere’s disease .
There are a plethora of methods that can treat Meniere’s Disease. Patients can benefit from abstaining from alcohol and consuming low salt diets, and diuretics can be prescribed to manage some of the symptoms and frequency of the symptoms accompanying Meniere’s Disease. Antidepressants and sedatives are also useful in the treatment process, as well as antiemetics and antivert. Several surgeries may benefit patients also such as endolymphatic sac surgery and vestibular neurectomy. Intra-tympanic steroid injections and Intra-tympanic gentamicin (chemical labyrinthectomy) is also helpful in treatments as well.
Advocacy and Awareness
If you would like to get involved in advocacy efforts or know more information about how you can help patients living with Meniere’s Disease through increasing public awareness of the disorder, please visit the organizations listed below.
Vestibular Disorders Association - http://vestibular.org/Advocate
Prosper Meniere- French physician known for first identifying Meniere’s Disease
Vertigo- Perceived sensation of external objects spinning when they are in fact stationary
Tinnitus - Abnormal ringing in the ears not caused by an external source
Aural fullness - Feeling of pressure or fullness in the ears
Idiopathic - Related to a disease without a known cause
Vestibular migraine - Migraine associated vertigo that results in dizziness
Audiometry - Test for determining hearing range and sensitivity
Computed tomography - Imaging technique that uses X-rays to take photos of organs and other body parts
Magnetic resonance imaging - Imaging technique that uses magnetic fields to take photos of organs and other body parts
Electronystagmography - Diagnostic technique used to study involuntary eye movements
Electrocochleography - Diagnostic technique used to study electrical potentials in the ear in response to sound stimulation
Vestibular evoked myogenic potential - Diagnostic technique used to study the otolith of the inner ear and the vestibular system
Endolymphatic hydrops - Disease of the inner ear that results in vertigo
Antiemetics- Class of drugs taken to prevent nausea and vomiting
Antivert (Meclizine) - Antihistamine used to treat vertigo
Vestibular neurectomy - Surgery to improve vertigo through cutting the vestibular nerve
Gentamicin - Antibiotic used to treat bacterial infections
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