Menieres disease affects the inner ear and consists of episodes of hearing impairment, ringing in the ears (tinnitus) and loss of balance (vertigo). The disease is named after a French doctor – Prosper Meniere – who initially described the condition. The disease was accepted as a separate entity in 1972 when Committees at the Academy of Ophthalmology and Otolaryngology finally defined it according to set criteria.
MINERES DISEASE: CAUSES
Menieres disease can result from many different causes, the most common of which are ear infections, Herpes virus, syphilis and ear trauma. All these lead to excess fluid in the inner ear causing tinnitus and hearing impairment, and a spill over of this fluid to the vestibular system causes vertigo.
MENIERES DISEASE: SYMPTOMS
Menieres disease is characterised by four symptoms:
1. Fluctuating, progressive, sensorineural deafness.
2. Episodic, characteristic definitive spells of vertigo lasting 20 minutes to 24 hours with no unconsciousness, vestibular nystagmus always present.
3. Usually tinnitus.
4. Attacks are characterized by periods of remission and exacerbation.
The symptoms occur in episodic form with sudden onset, hence usually described as an ‘attack’. The dizziness is sudden and can be so severe that sufferers need to hold on to some support to avoid falling. The attack may last up to 12 hours.
The disease can occur in two variant forms also, without vertigo (Cochlear form) and without deafness (Vestibular form).
MENIERES DISEASE: TREATMENT
Treatment of Menieres disease is targeted at reducing the pressure within the inner ear. It is attempted by three methods, medication, diet and surgery.
MENIERES DISEASE: MEDICATION
Medication for this disease consists of anti-histamines like promethazine (Phenergan), anti-cholinergics, steroids and diuretics, all of which reduce the pressure of fluid in the inner ear which causes to all vital structures in the inner ear. Anti-herpes medicine Aciclovir has also proved beneficial in some cases. Tranquilisers like Diazepam can also provide relief in some cases.
MENIERES DISEASE: DIET
Patients suffering from Menieres Disease are usually advised to avoid alcohol, smoking, caffeine and aspartame. A low sodium diet also helps in reducing fluids in inner ear. Lipoflavonoid, a proprietary nutritional supplement has been shown to provide relief in Menieres disease in one medical study, but has not been approved by the FDA for this purpose.
MENIERES DISEASE: SURGERY
Surgery can be done in the form of decompressive surgery for reducing the endolymphatic pressure or for total removal of inner ear on one side, in cases where damage is extensive and disease is not responding to medication, provided other ear is unaffected. Another option is ‘chemical labyrinthectomy’ wherein labyrinth is destroyed by the injection of gentamycin in it coupled with surgical removal of vestibular nerve behind the ear.