Meniere’s disease is a disorder of the inner ear. The exact cause of this disorder is unknown. It appears to result when too much fluid collects in the inner ear, or when the consistency of the fluid is not of the right chemical composition. This lack of consistency or defect in composition causes too much pressure and an inability for the fluid to properly distribute itself . Therefore, there could be several possible causes, including allergies, viruses, head injuries, blockage caused by structural abnormalities, viruses, genetic inheritance, or some type of autoimmune dysfunction.
Meniere’s disease can present itself in a patient at any time, even in childhood, but is most likely to show its first symptoms in persons between forty and fifty years of age.
An initial sign of Meniere’s disease is often a feeling of pressure or a feeling that the ear is clogged. Another common symptom is dizziness, known as vertigo. The onset of vertigo is sudden, and can last briefly or continue for a day or more. Nausea and vomiting often accompanies the dizzy sensation. Early in the disease, the patient may experience some hearing loss, as though the hearing is fading in and out but returning to normal. Sometimes there is a low-pitched ringing or other tone in the ear. The sensation of “hearing something” like a tone, whistling, ringing or whooshing is called tinnitus. There can be rather lengthy periods of time in which the Meniere’s patient experiences no symptoms at all.
Diagnosis of Meniere’s disease requires extensive testing along with relating anecdotal information about how symptoms are experienced and medical history. Since other diseases may cause the same symptoms, some conditions will need to be ruled out, including multiple sclerosis and brain tumor. To rule them out, often imaging techniques such as MRI or CT scans should be performed. There may be computerized brainstem response test performed to measure nerve response of the hearing centers within the brain.
To definitely diagnose Meniere’s disease, hearing and balance tests will be done including rotary-chair testing, which measures eye movement to determine inner ear function. Another test for inner ear function may be done, called ENG, or electronystagmography. Postural tests are usually done to determine which parts of the individual’s balancing system are used most and most affected when attempting to balance in different positions. Another test called VEMP, or vestibular evoked myogenic potentials, measures sensors in the inner ear that aid in determining movement on acceleration. A basic hearing test is performed as well.
No cure has been found for Meniere’s disease, but its symptoms can be carefully managed to achieve a better quality of life.
Some medications can be used to control vertigo and nausea, and diuretics can be prescribed to decrease fluid retention. Because diuretics can deplete the body of necessary minerals, dietary supplements may be given along with recommendations to increase intake of certain foods, particularly those rich in potassium. A low sodium diet may be followed, since too much salt can cause fluid retention.
Two types of injection into the middle ear may assist in controlling vertigo: steroid injections, or an injection of a type of antibiotic known as gentamacin. The antibiotic, when injected into one ear reduces the ear’s ability to affect balance in that ear, transferring the balancing function to the other ear. There is a risk with either type of injection that the injections could adversely affect hearing in the future.
Physical rehabilitation may be done in which exercises are performed in an attempt to retrain the brain and ear to process balancing information correctly.
There is a new therapy available called a Menniett device. The device is a pulse generator that uses a ventilation tube to apply various amounts of pressure to the middle ear to redistribute fluids in the ear. The device is used a few times a day in sessions of about five minutes each. An easing of vertigo and tinnitus symptoms has been reported in patients using the device. However, since it is still a new device the cost may be prohibitive for many patients until it becomes routinely covered by insurance carriers.
Meniere’s disease is not a life-threatening condition in and of itself, although those suffering from it are more prone to suffering accidents and falls. It is hoped that once causes can be more accurately determined, a cure can be found for this debilitating condition.
Signet/Mosby Medical Encyclopedia
National Institute of Health