Meniere's Disease
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Wikipedia-Article "Meniere's Disease"
| Ménière's disease | ||
|---|---|---|
| ICD-10 code: | H810 | |
| ICD-9 code: | 386.0 | |
Ménière's disease (or syndrome, since its cause is unknown) was first described by French physician Prosper Ménière in 1861. It is a balance disorder of the inner ear.
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Symptoms
The symptoms of Meniere's are variable; not all sufferers experience the same symptoms. However, four symptoms are considered to comprise so-called "classic Meniere's":
- periodic episodes of rotary vertigo (the abnormal sensation of movement) or dizziness
- fluctuating, progressive, unilateral (in one ear) or bilateral (in both ears) hearing loss, often in the lower frequency ranges
- unilateral or bilateral tinnitus (the perception of noises, often ringing, roaring, or whooshing), sometimes variable
- a sensation of fullness or pressure in one or both ears
Meniere's often begins with one symptom, and gradually progresses. A diagnosis may be made in the absence of all four classic symptoms.
Attacks of vertigo can be severe, incapacitating, and unpredictable. In some patients, attacks of vertigo can last for hours or days, and may be accompanied by an increase in the loudness of tinnitus and temporary hearing loss in the affected ear(s). Hearing may improve after an attack, but often becomes progressively worse. Vertigo attacks are sometimes accompanied by nausea, vomiting, and sweating.
Some sufferers experience what are informally known as "drop attacks" -- a sudden, severe attack of dizziness or vertigo that causes the sufferer, if not seated, to fall. Some patients may find it impossible to get up for some time, until the attack passes or medication takes effect. There is also the risk of injury from falling.
In addition to low frequency hearing loss, sounds can seem tinny or distorted, and patients can experience unusual sensitivity to loud noises. Some sufferers also experience nystagmus, or uncontrollable rhythmical and jerky eye movements, usually in the horizontal plane.
Other symptoms include so-called "brain fog" (temporary loss of short term memory, forgetfulness, and confusion), deafness, exhaustion and drowsiness, headaches, vision problems, and depression.
Cause
The exact cause of Ménière's disease is not known, but it is believed to be related to endolymphatic hydrops or excess fluid in the inner ear. It is thought that endolymphatic fluid bursts from its normal channels in the ear and flows into other areas causing damage. This may be related to swelling of the endolymphatic sac or other issues in the vestibular system of the inner ear, which is responsible for the body's sense of balance. The symptoms may occur in the presence of a middle ear infection, head trauma or an upper respiratory tract infection, or by using aspirin, smoking cigarettes or drinking alcohol. They may be further exacerbated by excessive consumption of caffeine and even salt in some patients. Meniere's has many diseases that mimic it. The diagnosis is usually established by clinical findings and medical history. However, a detailed oto-neurological examination, audiometry and even head magnetic resonance imaging (MRI) scan should be performed to exclude a tumour of the cranial nerve VIII (vestibulocochlear nerve) which would cause similar symptoms. Because Meniere's is idiopathic without an understood cause it is only diagnosed when all other causes have been ruled out.
Treatment
Initial treatment is aimed at both dealing with immediate symptoms and preventing frequency of symptoms, and so will vary from patient to patient. Doctors may recommend training or other methods for dealing with tinnitus, stress reduction, hearing aids to deal with hearing loss, and medication to alleviate nausea and symptoms of vertigo.
Several environmental and dietary changes are thought to reduce the frequency or severity of symptom outbreaks. Most patients are advised to adopt a low-sodium diet, typically one to two grams (1000-2000mg) at first, but diets as low as 400mg are not uncommon. Patients are advised to avoid caffeine, alchohol and tobacco, all of which can aggravate symptoms of Meniere's. Some recommend avoiding Aspartame. Patients are often prescribed a mild diuretic (sometimes vitamin B6). Many patients will have allergy testing done to see if they are candidate for allergy desensitization as allergies have been shown to aggravate Meniere's symptoms.
Lipoflavanoid is also recommended for treatment by some doctors.
Many patients consider fluorescent lighting to be a big trigger for symptoms. The plausibility of this can be explained by how important a part vision plays in the overall mechanism of human balance.
Treatments aimed at lowering the pressure within the inner ear include antihistamines, anticholinergics, steroids, and diuretics. A medical device that provides transtympanic micropressure pulses is now showing some promise and is becoming more widely used as a treatment for Meniere's.
Surgery of the endolymphatic sac is becoming more common in cases that don't respond to traditional medical treatments. Surgery of the semicircular canals or the vestibular nerve is very rarely performed in some untreatable and most severe cases. Another treatment is chemical labyrinthectomy, in which a drug (such as gentamicin) that "kills" the vestibular apparatus is injected into the inner ear. These radical treatments eliminate vertigo, but they also eliminate the patient's normal sense of balance, and so are used only as a last resort.
Progression
Meniere's sometimes begins with one or two of the classic symptoms, but with time the others normally develop as well. Attacks of vertigo can become worse and more frequent over time, resulting in loss of employment, loss of the ability to drive, and inability to travel. Some patients become largely housebound. Hearing loss can become more profound and may become permanent. Some patients become deaf in the affected ear. Tinnitus can also worsen over time. Some patients with unilateral symptoms, as many as fifty percent by some estimates, will develop symptoms in both ears. Some of these will become totally deaf.
Yet the disease may end spontaneously and never repeat again. Some sufferers find that after eight to ten years their vertigo attacks gradually become less frequent and less severe; in some patients they disappear completely. In some patients, symptoms of tinnitus will also disappear, and hearing will stabilize (though usually with some permanent loss). In some patients, however, symptoms may be unresponsive to medications.
Famous sufferers
Alan B. Shepard, the first American astronaut, was diagnosed with Ménière’s disease in 1964, grounding him after only one brief spaceflight. Several years later, surgery (which was then at the experimental stage) was performed, allowing Shepard to fly to the Moon on Apollo 14.
It is suspected that Charles Darwin suffered from Ménière’s disease. It is based on a common list of symptoms which were present at Darwin's case, such as tinnitus, vertigo, dizziness, headaches, nausea, motion sickness, vomiting, gastrointestinal problems, continual malaise and tiredness, and a peculiar stance of the head, present in many pictures of Darwin. Motion sickness was present throughout his life, and became apparent very early, when he suffered horribly of sea sickness during the whole Beagle voyage. Darwin himself had the opinion that most of his health problems had an origin in his 4-years bout with sea sickness. Later, he could not stand travelling by carriage, and only horse riding would not affect his health. In addition, psychic alterations often accompany chronic Ménière's, such as agoraphobia, depersonalization and even paranoia. Darwin hunted a lot when he was young and could have damaged his inner ear with the repeated noise of shooting, and that one of diagnoses that he received from his physicians at the time was that of "suppressed gout", which was an early name for Ménière's. The source of Darwin's illness, though, is not known for sure. See Charles Darwin's illness for more details.
Jonathan Swift, author of Gulliver's Travels (1726), is generally thought to have had Ménière’s since age 23.