Ménière's disease
Ménière's disease, also known as endolymphatic hydrops, is a chronic inner ear disorder characterized by an excess of fluid in the cochlea and semicircular canals. This condition leads to a range of symptoms including hearing loss, tinnitus (ringing in the ears), dizziness, and episodes of vertigo. The underlying causes can vary and may include infections, allergies, blood vessel spasms, or small hemorrhages within the cochlear duct. Symptoms often manifest abruptly and can last from thirty minutes to several hours, with episodes occurring at irregular intervals.
The disease affects both balance and hearing, with its hallmark features being a sensation of fullness in the ears, fluctuating hearing impairment, and potentially severe attacks of vertigo that may lead to nausea and vomiting. Treatment approaches are tailored to individual cases and may include diuretics, dietary adjustments, and medications for motion sickness or antihistamines. In more severe situations, surgical interventions may be considered to alleviate symptoms or address fluid pressure in the inner ear. Understanding the complexities of Ménière's disease is essential for those affected and their caregivers, as it can significantly impact daily life and well-being.
Ménière's disease
ALSO KNOWN AS: Endolymphatic hydrops
ANATOMY OR SYSTEM AFFECTED: Ears
DEFINITION: A disease of the inner ear caused by excessive pressure in the cochlear fluid. Its symptoms are hearing loss, tinnitus (ringing in the ear), nausea, and episodes of vertigo
CAUSES: Excess fluid in inner ear as result of infection, allergies, blood vessel spasm, or small hemorrhage in cochlear duct
SYMPTOMS: Ringing and fullness in ears, dizziness, hearing impairment, rapidly progressing hearing loss, vertigo, loss of equilibrium, nausea and vomiting, rhythmic jerking motion of eyes, sometimes deafness
DURATION: Often chronic with recurrent attacks lasting thirty minutes to several hours
TREATMENTS: Diuretics, blood vessel dilators, low-salt diet, motion sickness medications, antihistamines, bed rest; in severe cases, destruction of cochlea through surgery or ultrasound
Causes and Symptoms
Ménière’s disease results from excess pressure caused by surplus fluids in the cochlea (inner ear) or the semicircular canals concerned with the sense of balance. Typically this condition results when the structure that reabsorbs excess fluid from the inner ear ceases to function properly. The cause may be an infection, allergies, a spasm of one of the tiny blood vessels in the semicircular canal, or a small hemorrhage in the cochlear duct. Ménière’s disease affects both the vestibular nerve (causing attacks of vertigo) and the auditory nerve (causing hearing impairment).
The classic symptoms of Ménière’s disease are tinnitus, a sensation of fullness in the ears, dizziness, hearing impairment (including fluctuating distortions of sound), and a rapidly progressing loss of hearing. The attacks are typically abrupt and momentary, but recur frequently. Dizziness may range from a mild whirling sensation and unsteady balance to severe attacks of vertigo and complete loss of equilibrium accompanied by and vomiting. The eyes often show a rhythmic jerking motion.
Treatment and Therapy
The treatment selected for Ménière’s disease depends on the theoretical diagnosed cause, as no single remedy is universally successful. Infections and can often be treated by drugs, sedative and blood vessel dilators, or low-salt diets, all intended to reduce cochlear fluid pressure. Anti-motion-sickness and antihistamine drugs may be used to treat the symptoms. Since attacks of violent dizziness can occur suddenly, the affected person must immediately lie down to avoid falling. During a severe attack, the patient should be confined to bed since any movement of the head produces the disturbing sensation that the room is rotating. A bout may last several weeks, during which time bed rest and medication are recommended. Attacks, which recur at irregular intervals of weeks, or months, may last a half hour to several hours. Mild attacks usually disappear within a year, but more severe cases require a medical regimen. In some cases surgery may be necessary to decompress the cochlea and/or semicircular canals. If all other medical measures fail, the disability is severe, and deafness is well advanced, destruction of the cochlea by surgery or ultrasound may be a last resort.
Perspective and Prospects
Ménière’s disease was first described and recorded in detail in 1861 by French physician Prosper Ménière. Formerly only the most severe and disabling cases were treated surgically because the operation required destruction of the hearing nerve. Since the advent of microsurgical instruments it has become possible to separate the hearing and balance filaments in the main nerve and clip only the balance filaments when the problem is in the semicircular canals. It is also now possible to use ultrasonic beams to selectively destroy balance filaments without damaging the sensitive auditory nerves.
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