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by Alan R

Meniere's Disease

Definition

Meniere's disease is a disorder of the labyrinth in the inner ear that causes vertigo , tinnitus , and hearing problems. The labyrinth is a system of cavities and canals in the inner ear that affects hearing, balance, and eye movement.
The Inner Ear
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Causes

The cause of Meniere's disease is unknown, but it is thought to be a combination of factors. Possible causes include:
  • Rupture in part of the labyrinth, which allows fluid in different compartments to mix
  • Scar tissue, which may cause a blockage in the labyrinth
  • Inner ear injury

Risk Factors

Meniere's disease is more common in adults aged 20-60 years, and in Caucasians. Other factors that may increase your risk of getting Meniere's disease include:
  • Family history
  • Viral infection
  • Autoimmune disorders
  • Barometric pressure change
  • Stress
  • Hormonal disorders
  • Allergies
  • Certain medications, such as antibiotics and chemotherapy agents
  • Excess salt in the diet
  • Excess noise

Symptoms

Meniere's disease may cause fluctuating symptoms, which may come on suddenly. They typically involve only one ear, but may involve both. Symptoms include:
  • Episodes of vertigo, a spinning sensation while standing still. Vertigo may be accompanied by:
    • Nausea or vomiting
    • Sweating
    • Paleness of the skin
    • Weakness or falling
    • In some cases, headache or diarrhea
  • Fluctuating hearing loss
  • Ringing in one or both ears—tinnitus
  • Feeling of fullness or pressure in the ear
  • Poor sense of balance
  • A tendency for symptoms to worsen with movement

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. This will include an examination of your ears and a neurologic exam to evaluate for possible nerve damage.
Tests may include:
  • Blood tests
  • Hearing test
  • Electronystagmogram—looks for abnormal eye movements
  • Auditory brainstem response
  • Electrocochleogram—to check function of the hearing organ in the inner ear
  • MRI scan —to look at internal structures of the ear

Treatment

There is no cure for Meniere's disease. Treatment focuses on managing your symptoms. Talk with your doctor about the best treatment plan for you. Options may include one or more of the following:

Dietary and Lifestyle Changes

Dietary changes include:
  • Avoid foods that are high in salt and high in sugar
  • Avoid caffeine
  • Drink adequate fluids
  • Reduce alcohol intake
Lifestyle changes include:
  • Bed-rest during acute attacks of vertigo
  • Promptly begin replacing fluids lost to heat or exercise
  • Minimize stress
  • Avoid medications that seem to bring on or worsen symptoms
  • Consider a hearing aid, if necessary
  • Consider masking devices (white noise) to limit the effects of tinnitus
  • If you smoke, talk to your doctor about how you can quit
  • Take safety measures to avoid falling

Vestibular Rehabilitation

Your doctor may suggest specific vestibular exercises. These exercises use a series of eye, head, and body movements to get the body used to moving without dizziness. You may work with a physical therapist to learn these.

Therapy

Consider working with a therapist or joining a support group . These can help you to cope with your symptoms.

Medications

Your doctor may recommend:
  • Medications to treat vertigo
  • Antiemetics to control nausea
  • Medications that may improve hearing, control inner ear swelling, or limit overall symptoms, including:
    • Antihistamines
    • Diuretics
    • Antidepressants or anti-anxiety medications
    • Cortisone drugs for a short time
  • Aminoglycoside therapy to permanently destroy the part of the inner ear that deals with balance

Surgery

Ask your doctor if a Meniett device would be helpful to you. This device provides low-pressure pulses to the middle ear.
Surgical procedures are not always helpful, and include:
  • Endolymphatic sac decompression—removal of a portion of inner ear bone and placing a tube in the inner ear to drain excess fluid
  • Labyrinthectomy—destruction or removal of the entire inner ear, which controls balance and hearing
  • Vestibular nerve section

Prevention

There are no current guidelines to prevent Meniere's disease. However, to help reduce your risk, avoid the following risk factors:
  • High-salt and high-sugar diets
  • Excess noise
  • Excess alcohol
  • Stress
  • Smoking
  • Avoid medications that can be toxic to the ear

RESOURCES

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org
Meniere's
http://www.menieres.org

CANADIAN RESOURCES

Meniere's Disease
http://www.menieres-disease.ca
the College of Family Physicians of Canada
http://www.cfpc.ca

References

Meniere's disease. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/menieres-disease.html. Updated March 2014. Accessed August 18, 2014.
Meniere's disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 22, 2014. Accessed August 18, 2014.
Meniere's disease. National Institute of Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov/health/balance/Pages/meniere.aspx. Updated September 13, 2010. Accessed August 18, 2014.
12/3/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Hillier S, McDonnell M. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2010;(10):CD005397.

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