Ménière’s disease: symptoms, causes and treatment.

A summary of the characteristics of Ménière's disease, a pathology affecting the inner ear.

Ménière's disease is a pathology of the inner ear, in which the patient in which the patient presents hearing loss and, above all, balance problems.

This medical condition usually affects only one ear and can occur in adulthood and middle age.

Although there is no known cure for Ménière's disease, there are some treatments that help reduce its symptoms and the frequency of vertigo attacks. Let's find out more about the particularities of this hearing disorder.

What is Ménière's disease?

Ménière's disease is an ENT disorder in which the inner ear is affected. The patient suffering from this disease suffers from episodes of dizziness and vertigo, as well as partial hearing loss..

In most cases, only one ear is affected. It can manifest itself at any age, but usually appears in early adulthood and middle age between 20 and 50 years. It is considered a chronic disease, although there are treatments to reduce the symptoms and long-term impact.

Symptoms of this pathology

Symptoms of Ménière's disease include the following.

1. Recurrent episodes of vertigo

Patients with Meniere's disease have the sensation of spinning with recurrent episodes of vertigo that begin and end spontaneously.. These occur without warning, lasting from about 20 minutes to several hours. In some severe cases they last 24 hours, but no longer. As a consequence of the intense vertigo the patient may feel nausea.

These episodes of vertigo can cause the patient to lose balance at sudden moments, which increases the risk of falls and accidents. As they are unpredictable, the affected person may suffer a lot of anxiety and stress, greatly affecting his or her quality of life.

2. Hearing loss

Hearing loss in this disease is a symptom that may come and go, especially in the beginning. With the passage of time, most Ménière's patients eventually lose some hearing permanently..

3. Tinnitus

Tinnitus is a kind of ringing sound heard inside the ear at different volumes and sonic frequencies.. They can also manifest themselves in the form of ringing, roaring or hissing in the ear, not produced by an apparent external auditory stimulus.

4. Auditory congestion

Patients with Ménière's disease often feel pressure in the affected ear. pressure in the affected ear.

After having suffered an episode associated with the disease, the signs and symptoms may improve and even temporarily disappear completely. In more than a few patients, the frequency of hearing loss and dizziness episodes decreases.

Causes

It is not very well known what causes Ménière's disease, although its symptoms have been associated with a number of symptoms have been associated with an abnormal amount of fluid in the ear, called endolymph (endolymphatic hydrops). (endolymphatic hydrops). This fluid is held in a pouch-like structure called the endolymphatic sac that is continually secreted and reabsorbed, and is maintained at a constant amount in the ear of healthy people.

Both an increase in the production of this fluid and a decrease in its reabsorption will result in an excess of endolymph. Although this phenomenon has been associated with Ménière's disease, it is not known why this pathological production and reabsorption of this fluid occurs.

Some possible causes could be an inadequate drainage of the fluid due to an obstruction or anatomical abnormality, as well as an abnormal immune response and viral infection.

Diagnosis

There are several diagnostic procedures to see if a patient has Ménière's disease or not. The person in charge of this diagnosis should be a medical professional specialized in otorhinolaryngology or who is knowledgeable about Ménière's disease and other disorders of the ear. The diagnosis of this disease requires that the following requirements be met.

• Two episodes of vertigo, each lasting 20 minutes or more, but no longer than 12 hours.
• Hearing loss verified by a hearing test
• Tinnitus or sensation of having a plugged ear
• Exclusion of other known causes for the above three problems.

1. Evaluation of balance

Between episodes of vertigo, the sense of balance returns to normal in most cases. However, it is possible that the patient has constant problems with balance, which is why different tests are applied to check the degree of balance. different tests are applied to check the degree of affectation and if there is a possibility of recovery..

Among the balance and hearing evaluation tests are the following.

2. Audiometry

In audiometry it is evaluated if the patient is able to detect sounds of different tones and volumes.The test also checks whether the patient is able to distinguish between words that sound similar. Patients with Ménière's disease usually have problems hearing at low frequencies or combinations of high and low frequencies. Their hearing is normal for mid-range frequencies.

3. Videonystagmography

Videonystagmography examines balance function by assessing eye movement.. There are sensors in the inner ear that are related to balance and are connected to the muscles that control eye movement. This connection is what allows us to move our head while keeping our eyes fixed on one point.

4. Rotary chair testing

Rotary chair testing, as the name suggests, consists of having the patient sit in a computer-controlled rotating chair that will stimulate the inner ear. This test measures inner ear function according to eye movement, as does the previous test.as does the previous test.

5. Posturography

The human sense of balance depends not only on our inner ear, but also on vision, skin sensations, muscles, tendons and joints, and if any of them fail, it may explain the patient's vertigo and dizziness.

Posturography is a computerized test that looks at which part of the patient's looks at which part of the patient's balance system the patient relies on most and which parts may be behind the problem.. In this test, the patient is asked to put on a safety harness, walk barefoot on a platform and maintain balance under various conditions.

6. Cephalic impulse test with video

The cephalic impulse test consists of measuring eye reactions to abrupt eye movements..

The patient will have to concentrate on one point, looking at a target through which they will be recording their eye behavior. While the test is being performed, he will be made to turn his head rapidly and unpredictably. In case he takes his eyes off the target while his head is being turned, it will mean that he has abnormal reflexes.

7. Electrocochleography

Electrocochleography makes it possible to observe the inner ear's response to sounds. This technique can be helpful in determining if there is any accumulation of endolymph in the inner ear, although it is not specific.although it should be noted that it is not specific for Meniere's disease.

Treatments

Ménière's disease does not have a complete cure at this time, although treatments are available that can help reduce the severity of symptoms and the frequency of vertigo episodes. However, there are no treatments for the hearing loss associated with this medical condition. The following is the set of therapeutic options for this disease.

1. Vertigo medications

The physician may prescribe drugs for episodes of vertigo to lessen their severity while an attack is occurring. Among them we can highlight meclizine or diazepam, which can reduce the spinning sensation and help control nausea and vomiting.. In addition, anti-nausea drugs such as promethazine are also prescribed.

In anticipation of the possible long-term effects of the disease, the physician may prescribe drugs for fluid retention such as diuretics, as well as suggest limiting salt intake. For some patients, this combination helps to control the severity and frequency of Ménière's disease symptoms.

2. Non-invasive treatments

Some people with Ménière's disease may benefit from non-invasive therapies and procedures. The two main ones are rehabilitation and the implantation of a hearing aid..

Vestibular rehabilitation therapy may significantly improve the balance of people suffering from vertigo episodes.

Hearing aids for the ear affected by Ménière's disease can improve the patient's hearing. A referral to an audiologist is essential for the physician to see which hearing aid options are best for the patient in his or her case.

3. Middle ear injections

In some patients, more invasive interventions are necessary, including middle ear injections. Drugs are injected into the middle ear and then absorbed by the inner ear, improving symptoms associated with vertigo.The drugs used in these techniques are as follows. The drugs used in these techniques are the following.

3.1. Gentamicin

Gentamicin is an Antibiotic that is toxic to the inner ear. This substance reduces the balance function of the ear, causing the unaffected ear to take over the responsibility for balance.. It is considered a risky treatment as there is a risk of aggravating the hearing loss.

3.2. Steroids

Steroids such as dexamethasone may help control vertigo attacks in some patients.. In the specific case of this drug, this substance is less effective than gentamicin but is less likely to aggravate hearing loss.

4. Surgical interventions

Surgery is used when Ménière's disease is severe and debilitating and other treatments have proven not to help. Among the surgical procedures to treat this disease we have the following.

4.1. Endolymphatic sac procedure

As we have seen above, the endolymphatic sac is responsible for regulating endolymphatic levels. In Ménière's disease, this structure is altered, which is the reason why a therapeutic procedure consists of decompressing this structure, which can reduce the excess fluid in the endolymphatic sac.. In some cases, this surgical intervention is combined with the placement of a tube that drains the excess fluid from the inner ear.

4.2. Labyrinthectomy

In labyrinthectomy the balance portion of the inner ear is removed, consisting of a very aggressive treatment. since both the hearing function and the sense of balance of the affected ear are lost. This procedure is only performed when there is a total loss in that ear.

4.3. Section of the vestibular nerve

Finally, one of the surgical treatments to correct Ménière's disease is vestibular nerve section. Basically, it consists of cutting the nerve that connects the vestibular nerve to the vestibular nerve, involves cutting the nerve that connects the balance and motion sensors in the inner ear to the brain.. It is applied with the intention of preserving hearing in the affected ear, but eliminating the sense of balance in the affected ear.