Ménière’s disease

May 15, 2011 by David Mayer

Ménière’s disease

Ménière’s disease is a disorder of the inner ear that is characterized by a triad of symptoms: episodes of vertigo, tinnitus and hearing loss.

Ménière’s disease is caused by an increase in pressure of the fluid in the inner ear. The quantity of fluid in the membranous labyrinth becomes excessive due to the overproduction or under absorption of endolymphatic fluid. Abnormal ion homeostasis in the inner ear may also be the cause. Etiology is uncertain. Among the hypotheses are suggestions of an anatomical problem, an immunological mechanism, a genetic predisposition, or a viral or vascular cause. Most of the time, the condition only affects one ear, but in approximately 25% to 35% of cases, both ears are affected.

Epidemiology

Ménière’s disease may strike at any age but more often appears around the age of 40 (often between the ages of 40 and 60) and tends to be hereditary. When it occurs at a young age, the disease is usually associated with congenital malformations of the inner ear. The number of actual cases is difficult to determine because of the lack of standardized criteria for the diagnosis. However, the number ranges from 10 to 150 people out of 100,000. In fact, only a post-mortem histopathological exami-nation can definitively confirm the diagnosis. To diagnose Ménière’s disease, we have to rely on clinical symptoms. The American Academy of Otolaryngology and Head and Neck Surgery recommends a diagnosis of Ménière’s disease if the patient has suffered two spontane-ous episodes of rotational vertigo lasting at least 20 minutes, and an audiometric assessment confirms sensorineural hearing loss plus tinnitus and/or aural fullness.

Symptoms

Vertigo episodes, sometimes with nausea and vomiting, are generally rotational (often violent) and may last a few minutes (20 minutes) to a few hours (24 hours). Intervals between the attacks vary greatly, from a few weeks to a few years. With the passage of time, the attacks tend to be shorter and less violent. Nystagmus is always present.

The hearing loss is sensorineural, generally fluctuating, and affects low frequencies at first. In time (usually 8 to 10 years) hearing loss becomes permanent and convex, ultimately affecting all frequencies (flat configuration). Deafness increases, often becoming severe to profound.

In most cases, low-frequency tinnitus (humming noise) is present, sometimes involving a distortion of sounds and intolerance for loud noises (hyperacusis).

Patients may also experience aural fullness, diplacusis (echo) and headaches, and stress may exacerbate attacks.

Solutions

One of the first recommendations is to adopt a low-salt diet (frequently recommended, but little evidence can be found for its efficacy). As well, excessive caffeine, alcohol, nicotine and stress should be avoided. From a medical standpoint, doctors may prescribe anti-emetics, diuretics and anti-vertigo medication (Serc©) or vestibular suppressants. In the most complex cases, surgical treatments may also be considered, such as chemical ablation or surgical ablation, as well as more controversial procedures such as endolymphatic sac decompression or the endolym-phatic shunt. Persons living with Ménière’s disease may also receive transtympanic steroid injections or be candidates for a hearing aid and/or vestibular rehabilitation (to reduce the incidence of residual vertigo). The solutions are designed to minimize inconvenience but do not provide a cure.

Ménière’s is a complex disease. Hearing health specialists are there to help you find the right solutions; don’t hesitate to see someone.

References available upon request.