Annually around 100000 individuals develop Meniere’s disease, accounting for about 0.2 % of the total US population. This disease refers to a condition where the individual experiences either dizziness or a ringing in the ear. The condition causes vertigo, and typically effects one ear. In addition to do these symptoms, there is a possibility of permanent hearing loss in the affected ear. By virtue of the symptoms, a total of 2% of the population in the US wrongly assume that they are affected with the condition. This in depth article will take a scientific look at the underlying causes, the symptoms, and treatment options available for Meniere’s disease.
Background of how the disease was named
In the 1860s, a French doctor by name Prosper Meniere claimed that the reasons for the condition was attributed to the inner ear. This was a contrarian opinion, as the medical fraternity at that time believed that the brain was responsible for the condition. After his findings were proven to be true, it was named after him – hence the name Meniere’s disease.
Reasons attributed for Meniere’s disease
As mentioned above, the medical fraternity had initially attributed the cause of the condition to the brain. After it was rightly pointed out by doctor Prosper Meniere, it is now being accepted that the disease is attributed to the inner ear. Specifically, the condition is attributed to the buildup of fluid in the inner ear that is medically known as the labyrinth. This labyrinth has a functional purpose of keeping structures in place in the ear. These structures are responsible for maintaining balance and help hearing ability. Excessive buildup of fluids results in interference of the signals received by the brain. As a consequence of this individuals with the condition experience hearing problems and vertigo. The actual reason behind the buildup of fluids is part of ongoing research. Presently medical scientists have theories about the reasons for the buildup of fluids in the inner ear, and do not have any conclusive research findings.
These are some of the theories that are presently assumed to be responsible for the build-up of fluid in the inner ear.
#(1) Overactive or incorrect auto immune response in the body which results in the healthy cells getting affected.
#(2) Improper draining of the fluids in the ear, which could be the result of any abnormal formation in the ear or blockage.
#(3) Other possible reasons include allergic reactions, viral infections, genetic inheritance and traumatic injuries to the head, or complications from migraine.
Common symptoms of Meniere’s disease
The condition is typically progressive, with symptoms manifesting and progressively deteriorating over a period of time. In a large number of cases, the condition starts with intermittent loss in hearing. This is typically followed by vertigo, where the individual feels off balance or experiences dizziness. In addition to the common symptoms associated with Meniere’s disease, other symptoms include, nausea, bouts of shivering, anxiety, breaking out into cold sweats, abnormally faster pulse rate, and blurring of vision. These symptoms are known to last from anywhere between 20 minutes to 1 full day. The frequency with which these symptoms manifest in a patient could be as frequently as many in a week, or could be very rare. For instance a patient may experience this condition once in a few months or maybe even once in a couple of years.
The symptoms keep manifesting and progressing over time. It is possible that the occasional loss of hearing will become more frequent. Additionally the patient is most likely to experience vertigo more frequently. Blurred vision, dizziness and loss of hearing are likely to progressively version over a period of time, both in terms of frequency and intensity.
Commonly used diagnosis for Meniere’s disease
Diagnosis presently used for determining the presence of the condition are mainly for the purpose of understanding the individual’s hearing ability and balance. Some of the ways that are typically used to understand the patient’s condition include the following, in addition to a detailed study of the patient’s medical history.
#(1) The fluid pressure in the inner ear of the patient is measured through electrocochleography.
#(2) The ability of the patient to balance himself or herself is measured through posturography. This test involves the use of a platform that moves in different directions. The patient is made to stand on the platform with a safety harness. As the platform moves in different directions, the specialist understands the manner in which the patient responds to the moving platform. This gives a good idea of the ability of the patient to balance himself.
#(3) One of the most frequently used hearing test is the auditory brain stem response test, commonly known as the ABT. This test is mainly used on patients who cannot be put through other diagnostic tests to determine hearing loss.
#(4) Tests to determine hearing loss are basically used to understand the ability of the individual in speech discrimination. Commonly known as audiometric exam, the purpose of these tests are to determine if the individual can differentiate between similar sounding words. Syllables that are actually different can sometimes sound similar, and this test helps to gauge this ability.
#(5) Other tests include determination of the effect of the eye movement on the inner ear. Known as rotary testing, this test involves a turning chair that is computer controlled. The patient is made to sit on the chair and as the chair turns the doctor ascertains if the movement of the eye has an impact on the inner ear.
#(6) The ability of the individual to balance himself or herself under different circumstances is measured through an electronystagmoggram. This test involves a darkened room where the patient’s movements are monitored when the ear canal is exposed to different conditions. Warm air and cool air are blown across the ear canal and the eye movements are measured to determine the impact.
#(7) The patients are also put through tests to understand the natural response to loud noises that are sudden in nature. Known scientifically as vestibular revoked myogenic potential, this test measures the impact and response of the individual to high sound levels.
#(8) Imaging tests such as CT scan and MRI scan also used as part of the battery of tests by doctors to eliminate the possibility of other conditions. As mentioned earlier, the disease could be a result of other conditions, and the use of tests help to conclusively eliminate other possibilities.
#(9) The use of video head impulse test is also part of the range of tests. This involves the use of video images to understand the ability of the individual to focus and the response mechanism to swift, sudden movements.
Treatment options for Meniere’s disease
At present there are no recorded or proven treatments for the disease. However, there are multiple options that are presently in use for managing the condition. This includes medications, surgical interventions, periodic injections and therapies, apart from home care. Here is a brief look at some of the common treatments presently in use for managing/treating Meniere’s disease.
One of the most commonly used methods, is the hearing aid. This is intended to deliver multiple benefits. For instance, individuals suffering from partial hearing loss, will find hearing aid to be extremely useful. Additionally, the use of a hearing aid also helps in mitigating vertigo and to reduce the buildup of fluids in the ear.
Two different types of medications are generally used for managing the condition. This typically includes diuretics to reduce the buildup of fluid in the ear, and steroids to help treat the immune system, if it is determined to be the cause of the problem. The use of diuretics are prescribed by doctors to flush out fluids from the body. This is typically accompanied by advice to reduce salt intake. The mechanism of action of diuretics results in preventing the body from building up or holding fluids. Patients who are diagnosed with Meniere’s disease that is attributed to a problem in the immune system are put on steroids. This is typically a short course and is meant to help manage the problem with the immune system. In addition to these two medications, patients are also likely to receive medications for motion sickness, vertigo and nausea. One of the side effects of dizziness is vomiting, and medications are prescribed to manage these symptoms.
Various therapies are also help manage the symptoms. This includes physical therapy through exercises that help correct imbalance. Individuals who experience physical manifestations of the conditions such as dizziness or imbalance will find relief through physical therapy. It is however necessary to ensure that the exercises are performed routinely. Patients are advised to choose some form of physical activity or exercises, to remain active. Other therapies include vestibular rehabilitation therapy and positive pressure therapy. The first – VRT, refers to an exercise that is targeted at the brain. The purpose of this exercise is to help the brain retrain and utilize all faculties to improve and achieve balance. This therapy helps the brain to make use of vision for achieving greater balance. The second – positive pressure therapy involves the use of a device to increase pressure on the ear canal. Also known as the Meniett, the purpose of this therapy is to apply pressure on the ear canal. The intended consequence of this action is to improve the flow of fluid through the ear.
Injections are also used to help treat the vertigo. These are targeted interventions and in a large number of cases, specialists rely on gentamicin antibiotics for these injections. The formulation which is toxic to the inner ear helps to fully reduce the functionality of the ear that is affected. As a consequence, the ear that is properly functioning will take over the role of balancing. Administering of this injection is performed in the office of the specialist. It typically begins with the use of local anesthetic to reduce the pain sensation when the injection is administered.
Surgical procedures are often the last resort in the management of Meniere’s disease. Patients who do not respond to applicable interventions are recommended surgical interventions. There are four different types of surgical procedures performed for Meniere’s disease. This includes cochleosacculotomy, which is a procedure intended for draining fluid from the ear. The procedure lasts for about 20 or 25 minutes and involves the use of local anesthetics. However, the procedure can also result in loss of hearing in in certain cases. Another procedure that is used as a surgical intervention is endolymphatic sac shunt surgery. This procedure involves the draining of fluid from a part of the ear that reabsorbs the fluid. This procedure involves the use of anesthesia, and hospitalization for a day. During the procedure, the part of the ear that retains the fluid is cut open, and followed by draining. The patient will be sedated throughout the procedure. The third procedure is labryinthectomy, which is basically for patients with extreme vertigo. One of the side effects of this procedure is loss of hearing after the surgery. This is therefore only for individuals who have already lost most of their hearing ability, and those with extreme vertigo. The fourth procedure is vestibular nerve sectioning which is perhaps the longest in terms of hospitalization requirement. The purpose of this procedure is to offer relief for patients with extreme vertigo. During this procedure, a neurosurgeon will completely eliminate nerve that is responsible for transmitting balance related signals to the brain. By removing this nerve, the procedure helps to completely stop the transmission of messages that are responsible for the vertigo.
Home based treatment options for Meniere’s disease
While it may not be possible to prevent the onset of the condition or its manifestation, it is possible to manage the conditions effectively. A few standard practices help patients to get over the condition to a certain extent. For instance, patients who suffer from a sudden attack of vertigo are advised to adopt a seated position, and remain relaxed with as little motion/activity as possible. Patients suffering from vertigo are advised to always avoid exposure to certain conditions that trigger an attack of vertigo. This includes loud noise, dazzling lights, and swift movements. It is always essential for patients with vertigo to focus on stationary objects, rather than moving objects with different intensity of light or reflection.
Individuals who are diagnosed with Meniere’s disease are advised to stay away from intoxicants such as alcohol. It is essential for patients to cut down on the salt intake and consumption of caffeinated drinks. Smoking can also cause possible aggravation in patients diagnosed with the condition. This is attributed to the large number of chemicals in tobacco which have an impact on blood vessels. Hearing loss is often attributed to the impact of conditions that result in the restriction of blood vessels in the ear. A simple comparison among patients who smoke and do not smoke clearly proves that smokers are more likely to experience hearing loss.
How to determine the onset or progression of Meniere’s disease?
Listed below are some of the symptoms that are typically known to occur in patients who have Meniere’s disease. By carefully tracking the presence or aggravation of any of the following symptoms, it is possible to determine the condition.
Vertigo – if you experience what is medically known as episodic rotational vertigo, it is possible that you have the condition. This attack of vertigo typically lasts anywhere between 20 minutes and 4 hours. In a limited number of cases, the duration of the attack is known to be longer. If you experience a feeling of disability during the attack or if you feel tired and sleepy after the attack, it is a possible indication of the condition. You are also likely to feel off balance for a long period.
Tinnitus – if you experience ringing sound in the ear that can be defined as roaring or buzzing, it is an indication of tinnitus. This could be an attack that you experience alongside vertigo or it could be separate. In a large number of cases this experience is most likely to either start before an attack of vertigo or will worsen before vertigo.
Loss of hearing – if you experience the loss of hearing which is gradually deteriorating, it is an indication that this will turn into permanent hearing loss. The first stages may typically begin with difficulty in hearing in the lower frequencies, and this will slowly turn into hearing loss in all frequencies. If you also experience any kind of distortion of loud sounds or noises in the affected ear, it is a strong indication of Meniere’s disease.
Simple precautions that are necessary for managing the condition more effectively
It is essential to limit salt intake and cut consumption of alcohol or caffeinated drinks. Smokers need to quit the habit, while all patients are advised to rely on therapies to modify their responses and lead an adjusted life that is as near normal as possible. A combination of the right methods will help individuals to easily cope with the condition and manage the symptoms that are typically associated with Meniere’s disease. The biggest impact on individuals with the condition are the attacks of vertigo. It is possible to preempt and ensure that vertigo attacks do not affect routines. Avoiding loud noises, bright lights, driving, and other activities such as swimming are some of the basic precautions that can help patients to avoid dangerous situations.