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Meniere's Disease

Meniere's disease is a disorder characterized by recurring attacks of disabling vertigo (a whirling sensation), hearing loss, and noise in the ear (tinnitus).

Symptoms include sudden, unprovoked attacks of severe, disabling vertigo, nausea, and vomiting.

  • Doctors usually perform hearing tests and sometimes magnetic resonance imaging.
  • A low-salt diet and a diuretic may lower the frequency of attacks.
  • Drugs such as meclizine,  lorazepam, or scopolamine ,transderm scop may help relieve vertigo.

Meniere's disease (also called endolymphatic hydrops) is thought to be caused by an imbalance in the fluid that is normally present in the inner ear. This fluid is continually being secreted and reabsorbed, maintaining a constant amount. Either an increase in production of inner ear fluid or a decrease in its reabsorption results in an imbalance of fluid. Why either happens is not known.

Symptoms include sudden, unprovoked attacks of severe, disabling vertigo, nausea, and vomiting. These symptoms usually last for 2 to 3 hours but can (rarely) last up to 24 hours. Periodically, a person may feel a fullness or pressure in the affected ear. Hearing tends to fluctuate but progressively worsens over the years. Tinnitus, which may be constant or intermittent, may be worse before, during, or after an attack of vertigo. Both hearing loss and tinnitus usually affect only one ear.

In one form of Meniere's disease, hearing loss and tinnitus precede the first attack of vertigo by months or years. After the attacks of vertigo begin, hearing may improve.

Diagnosis and Treatment

A doctor suspects Meniere's disease because of the typical symptoms of vertigo with tinnitus and hearing loss in one ear. Doctors usually perform hearing tests and sometimes magnetic resonance imaging (MRI) to look for other causes. A low-salt diet and a diuretic (a drug that increases the excretion of urine) may lower the frequency of attacks in some people.

Several procedures are available for people who are disabled by frequent attacks of vertigo despite drug treatment. The procedures aim to either reduce fluid pressure in the inner ear or destroy inner ear balance function. The endolymphatic shunt procedure, in which a thin sheet of flexible plastic material is placed in the inner ear, is the least destructive of these procedures. To destroy inner ear balance function, a solution of gentamicin can be injected through the eardrum into the middle ear. Gentamicin selectively destroys balance function before affecting hearing, but hearing loss is still a risk. The risk of hearing loss is lower if doctors inject the gentamicin only once and wait several weeks before repeating if necessary. Cutting the vestibular nerve permanently destroys inner ear balance, while preserving hearing, and is successful 95% of the time in controlling vertigo. This procedure is usually performed on people whose symptoms do not lessen after an endolymphatic shunt or on people who never want to experience another spell of vertigo. Finally, when vertigo is disabling and hearing has deteriorated in the involved ear, the entire semicircular canals can be drilled away in a procedure called a labyrinthectomy.

None of the surgical procedures that treat vertigo are useful in treating the hearing loss that often accompanies Meniere's disease.

ENT & Allergy
08/24/2010

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