Meniere’s disease

Meniere’s disease: description

The French doctor Prosper Menière has already described the disease named after him Meniere disease in 1861. In 1938, physicians Hallpike and Yamakawa reported enlarged inner ear spaces in patients with Menière’s disease suspected to be associated with the condition.

The inner ear contains the cochlea and the organ of balance, as well as two different fluids – including the so-called endolymph. According to the current state of knowledge, the absorption of this fluid in the inner ear of Meniere’s Disease is disturbed. This accumulates too much endolymph. Since the inner ear is lined by a membranous membrane, the liquid can expand only limited. The result is a pressure increase in the inner ear, which damages the cochlea at a certain place (see causes and risk factors).

It is estimated that about ten percent of all dizzy spells are caused by Meniere’s disease. Meniere’s disease often occurs between the ages of 40 and 60 years. But also people in young adulthood get sick of Meniere’s disease. Men are affected more frequently than women. In total, around half a million people in Europe suffer from Meniere’s disease.

Meniere’s disease: symptoms

Typical of Meniere’s disease is the vertigo occurring in attacks in combination with tinnitus and unilateral hearing loss. In a swindle, those affected feel that the environment is spinning around them very quickly (similar to driving on the carousel). The dizziness can be so strong that those affected have to lie down. Dizziness-related falls and nausea with vomiting can also occur. The vertigo is described by those affected as the most distressing of the Meniere’s Disease Symptoms, as this dizziness occurs without warning and can last for hours to days.

There are also tinnitus and deafness, which mainly affects low notes. Often sufferers also feel pressure on the ear during Meniere’s attack. While at the beginning of the disease usually only one ear is affected, the Meniere’s disease may extend to the second ear in the further course.

In addition to these main characteristics of Ménière’s disease, sufferers often become pale and sweat. The eyes can start to shiver (Nytagmus).

The attacks of Meniere’s disease come suddenly and abruptly. Mostly between ten and twenty minutes, they can last for hours. Then the attacks usually stop by themselves. Because Meniere’s attacks are extremely stressful due to the vertigo and are completely unpredictable, psychological problems such as anxiety disorders and depression can develop. This can create a vicious circle between the attacks and the mental health of the person affected. The resilience in stressful situations is often reduced as a result.

Meniere’s disease: causes and risk factors

The cause of Meniere’s Disease, according to current knowledge, is a disorder of the inner ear. This assumption is based on the fact that the majority of those affected have enlarged spaces in the inner ear. Nevertheless, it is unclear to this day whether this finding is also causally related to Meniere’s disease.

The inner ear is responsible for the sense of hearing and balance. It consists of a complicated duct system filled with two different fluids (endolymph and perilymph). These are in a sensitive balance and are essential for the function of the organ.

Doctors assume that Ménière’s disease is caused by a fluid excess (hydrops) of the endolymph. The surplus can arise from disturbed discharge or inflow. The increased endolymph creates a high pressure in the inner ear, which causes the so-called Reissner membrane to break down again and again – the suspected trigger for Meniere’s disease. The Reissner membrane is a thin cell membrane inside the cochlea. It is equipped with sensory cells for hearing and balance and separates the endo- and perilymph from each other. Cracks in the membrane mix the two fluids (endo- and periplymphe), which disturbs the fine balance of the salts (electrolytes) in these fluids. The crack also leads to a sudden change in pressure conditions. Overall, this results in a malfunction of the sensory cells, which could explain the symptoms of Meniere’s disease.

Among other things, the rare inflammation of the inner ear (labyrinthitis) or a concussion may be the cause of the excess fluid. In most cases, the cause remains unclear.

Meniere’s disease: examinations and diagnosis

The first contact for suspected Menière’s disease is the family doctor. Depending on the symptoms, this person will refer the affected person to the ENT specialist or neurologist if necessary. Many clinics also have special “vertigo centers”, which are the contact persons, especially in severe cases.

At the doctor’s talk, the doctor will first inquire about your complaints and any pre-existing conditions. Possible questions from the doctor could be:

• Could you describe to me how the vertigo attack works for you?
• Is the dizziness accompanied by tinnitus and deafness in this ear?
• How long does the dizziness attack last?
• Can the vertigo attack be provoked by a certain movement, for example, by a twisting of the neck? (This would speak against Meniere’s disease.)
• Do you take any medicine?

Physical examination

During the physical examination, the doctor sees with a so-called otoscope on the eardrum in the ear. Although the injury in Meniere’s disease is located in the inner ear and is therefore not visible from the outside, yet existing diseases of the eardrum and the middle ear should be excluded by inspection with the otoscope.

Standard examinations in ear, nose and throat medicine include the Weber and Rinne tuning fork test. An oscillating tuning fork is placed on the vertex or behind the ear. The patient must specify when he can no longer hear the tone of the tuning fork, or whether he can hear him again when the tuning fork is held in front of the ear (gutter test). He should also indicate whether the sound of the attached on the crown tuning fork appears louder in one of the two ears (Weber test). Through these tests, conclusions can be drawn as to whether the discomfort caused by an inner ear or middle ear damage.

As part of the clarification of Meniere’s disease is also checked whether the patient may have involuntary eye movements (“nystagmus”). Typical for a Meniere’s disease are twitching eye movements to one side (horizontal nystagmus), which usually only occur during the seizure.

Further investigations

In order to estimate an existing deafness more accurately, a hearing test (threshold audiometry) must be performed. In Meniere’s Disease, hearing in one ear is significantly reduced. In addition, in particular, the hearing performance for low frequencies is reduced. The hearing recovers in many cases after the attack, but sometimes there remains a permanent hearing loss.

In addition, brain waves that occur after a sound signal (= auditory evoked potentials) can be analyzed to check the connections of the auditory pathway in the brain. These compounds are not affected in Meniere’s disease.

Symptoms, such as Meniere’s disease, can also be found in other diseases. These alternative causes of Meniere’s Disease Symptoms must be ruled out. For example, the auditory nerve is examined to ensure that it is not damaged. To make pictures of the head and inner ear, computed tomography (CT) and magnetic resonance imaging (MRI) can be used. Thus, for example, tumor and inflammatory processes can be excluded.

Diagnosis of Meniere’s disease:

Menière’s diagnosis can be made on the basis of four criteria established by an American specialist association of specialists. If all four of these criteria apply, Meniere’s disease can be assumed:

• Two or more vertigo attacks, each with a minimum duration of 20 minutes
• Hearing deterioration confirmed by examination
• Tinnitus (tinnitus) or ear pressure in the affected ear
• Exclusion of other causes

Meniere’s disease: treatment

The Meniere therapy has two main goals: Firstly, the severity of the symptoms in an acute attack to be reduced to a tolerable level. On the other hand, attempts are made with preventive measures to prevent further attacks (prophylaxis), so that they occur as rarely as possible.

Acute therapy

Various anti-vertebrate medicines (antivertiginosa) can be used to combat dizziness and vomiting caused by Meniere’s disease. Standard drug is the active ingredient Dimenhydrinat. This should always carry Meniere-affected people with it to be able to respond immediately in the event of a sudden attack.

In severe cases of Ménière’s disease, diazepam, which belongs to the so-called benzodiazepines, can also be used. Benzodiazepines should only be used for a short time, as they may diminish brain function and, in some cases, lead to dependence.

Prevention (prophylaxis)

The most important goal besides the acute therapy is the reduction of the number of attacks. There are a number of therapy options. The current recommendation for seizure prophylaxis in Meniere’s disease is the gift of Betahistine. A high dose of this drug can significantly reduce the number of Meniere’s attacks. Betahistine stimulates the docking sites (receptors) for a certain messenger substance (histamine) and thereby improves the blood circulation in the inner ear. Due to the higher blood flow, the excess fluid (endolymph) in the inner ear is probably transported away faster – the pressure in the inner ear drops.

The doctor prescribes Betahistine for the treatment of Meniere’s disease. In order to avoid gastric irritation, the intake should take place after the meal. Other possible side effects include headache, vomiting and allergic reactions. In known gastrointestinal ulcers, the drug should not be taken. After six to twelve months you can try to reduce the therapy slowly.

Also, the anti-inflammatory cortisone can be used to prevent Ménière’s attacks. He can be injected through the eardrum into the middle ear under local anesthesia (intratympanic corticoid therapy). From there, the cortisone passes through diffusion into the inner ear, where it acts anti-inflammatory and Vascular sealing. This therapy has been used for a few years especially for the therapy of a hearing loss.

Psychological care

In addition to the medication Meniere therapy, psychological support in Meniere’s disease is very important. The sudden and unpredictable attacks can be a serious psychological burden.

Elimination of the organ of equilibrium

If the above therapies are unsuccessful in Meniere’s Disease, there are very radical procedures that completely and permanently eliminate the affected organ of balance: this can be done either by medication or by destruction of the organ of balance with surgery. These procedures lead to deafness or deafness and loss of sense of balance. They are also irreversible (irreversible). The healthy side can partially take over these functions. However, the radical operative procedures are only used in severe cases, as Menière’s disease can affect the other side as well, and once the functions are destroyed, they can not be restored.

Drug elimination of the inner ear consists in injecting the antibiotic gentamicin into the middle ear in order to render the organ of balance in the inner ear unserviceable. This can be repeated every few weeks. The large gap between gentamicin supplements is necessary to avoid unwanted damage to the cochlea (also in the inner ear) as much as possible. Gentamicin can lead to deafness. For this reason, especially Menière’s patients are treated with gentamicin, which already show significant hearing damage before therapy.

If one does not achieve sufficient success in this way, as a last resort in Meniere’s disease, a part of the inner ear, the so-called labyrinth, can be removed (labyrinthectomy). However, this therapy is controversial. Surgical therapies are not recommended at the moment.

Alternative therapies

Apart from conventional medicine, there are also alternative therapies for the treatment of Meniere’s disease. Homeopathy can help, especially to reduce the often agonizing dizziness. It is recommended to take Cocculus D6 three times a day for several weeks. The seizure is interrupted by Tabacum D12.

Certain diets (especially salt-free diet) relieve the symptoms in some people with Menière’s disease. Other supportive therapies are acupuncture, Feldenkrais or balance training.

Meniere’s disease: disease course and prognosis

The course of Meniere’s disease is very different. It is possible that it will stay with a single seizure. In most cases, however, the attacks are repeated. But even after five years, Meniere’s disease can end spontaneously and never occur again. However, damage to hearing and balance that has occurred up to this point usually remains permanent in this case as well. These sequelae of Meniere’s disease can range to complete deafness on the affected side. After five years of illness, the symptoms affect both sides in 50 percent of the cases.

Certainly professions that place high demands on the sense of balance are sometimes no longer possible as a result of Meniere’s disease. However, recognition as a disability is possible for those affected by Meniere’s disease. Severe disability, however, is only attested in serious cases in the case of very numerous and / or serious illnesses.

Decisive for the prognosis of Meniere’s disease is not least, how great the influence of the symptoms on the psyche of a person affected is. The fear of new attacks is very stressful and can in turn provoke new attacks. Breaking this vicious cycle, possibly with therapeutic support as well, is an important therapeutic goal in the treatment of Meniere’s disease.