Menière’s disease

Vertigo is defined as the sensation in which objects spin around the patient. It usually appears in crisis that can last from minutes to hours and the causes are diverse. When a patient presents episodes of repetitive vertigo, progressive hearing loss, a feeling of occupation in the ear and the appearance of tinnitus that becomes more and more annoying, the patient could suffer what is known as Ménière's disease, called thus in honor of the French physician who first described it in 1861.

Each year about 15 new cases are diagnosed for every 100,000 inhabitants. It is a disease that usually appears in adulthood, between the ages of 20 and 60, and slightly more frequently affects women.

How is it produced?

Ménière's disease is caused by an alteration of the natural balance between the fluids of the inner ear, either because there is an increase in the production of endolymph, or because there is some defect in its reabsorption. This fact causes an increase in pressure inside the membranous labyrinth of the inner ear, which favors microcracks in the membranes that separate the endolymph from the perilymph; The mixture of these two fluids is responsible in part for the clinical manifestations of Ménière's disease.

The primary cause of the increased pressure is unknown. In addition to idiopathic Ménière's disease or of unknown origin, there are quite a few pathologies that can trigger it, such as:

• Autoimmune diseases.
• Acoustic trauma.
• Trauma to the inner ear.
• Injuries to the temporal bone.
• chronic mean.
• Otosclerosis
• Serous labyrinthitis.
• Viral labyrinthitis.
• Neurosyphilis.
• .

When Ménière's disease can be attributed to one of these causes, it is called Ménière's syndrome, reserving the name of Ménière's disease for cases of unknown origin.

Ménière's symptoms

Ménière's disease is characterized by the presence of crises of incapacitating rotary vertigo, of sudden onset and without previous triggers, lasting between 20 minutes and 24 hours, with an average of 2-3 hours, and accompanied by nausea and vomiting. This is the main and initial symptom, which is usually associated with a sensation of tightness in the ear, usually one-sided. Crises usually occur 5-10 times a year.

As the disease progresses, a variable, fluctuating hearing loss or decrease in hearing capacity is established, which is initially limited to bass sounds but which as the disease progresses it becomes progressively more extensive. Vertigo reaches its peak and a very annoying and intense tinnitus also appears.

In more advanced stages of Ménière's disease, vertigo decreases and gives way to head instability, limiting the activities of daily living of the patient from a functional, occupational, social and psychological point of view. Hearing loss is already severe and tinnitus can become the most annoying symptom of all.

Diagnosis

The diagnosis of Ménière's disease is based on the clinical history reported by the patient, as well as on the pertinent complementary tests, both analytical and imaging and assessment of auditory function. The basic physical examination should assess blood pressure, the presence of arrhythmias and cardiovascular disease, the cranial nerves, balance and coordination, the cervical spine, and an otoscopy. blood tests are important for screening for diabetes, severe anemia, dyslipidemia, hypothyroidism, neurosyphilis, and various autoimmune diseases that may be related to Ménière's disease.

Likewise, various complementary tests should be carried out, such as a complete one to assess hearing loss, auditory evoked potentials, a nuclear magnetic resonance (MRI) to rule out lesions of the nervous system such as tumors, vascular pathology or degenerative diseases, and vestibular tests, especially in order to assess the treatment.

The diagnosis of Ménière's disease cannot be established until a verification has been made by examining the affected tissue, but it is possible to speak of definitive Ménière's disease when there have been two or more episodes of vertigo associated with hearing loss, tinnitus and feeling of occupation of the affected ear having ruled out any other possible cause. Until then, the diagnosis of Ménière's disease is probable (if there has been a single crisis accompanied by symptoms) or possible (if it has not been accompanied by hearing loss).

Other pathologies that may be the cause of symptoms such as acoustic nerve neuroma, multiple sclerosis, a transient ischemic attack (TIA) or other organic causes must be ruled out.

Is there treatment?

The vast majority of patients lead normal lives. To adapt the treatment to each patient, age, general condition, hearing and vestibular function must be assessed.

In vertigo attacks it is useful to carry out pharmacological treatment with sulpiride or thiethylperazine every 8 hours. Betahistine is also often recommended, especially as a long-term treatment to control seizures, but it has not been shown to be effective in controlling seizures or in improving hearing loss or tinnitus.

When drug treatment is not enough, invasive techniques can be carried out. In the case of mild or nonexistent hearing loss, an intratympanic dexamethasone injection can be given, or pulsatile pressure applied to the external auditory canal, or the endolymphatic sac surgically decompressed. In cases where hearing loss is moderate, intratympanic injection of gentamicin may be chosen, with a risk of irreversible hearing loss of 30%.

In case of severe hearing loss, a labyrinthectomy can be performed, which entails complete loss of hearing in that ear but controls vertigo 100%. Likewise, it is possible to opt for the extirpation of the vestibular nerve, with which vertigo will be controlled in 95% of cases but the risk of hearing loss is almost 20%.

Precautionary measures

There are no specific measures against Ménière's disease. If you suffer from any otological pathology that could trigger it, it is necessary that the specialist always assess it and in case of presenting symptoms of vertigo and hearing loss, go to the otolaryngologist as soon as possible.

What you should know:

• Ménière's disease is caused by an alteration of the natural balance between the fluids in the inner ear.
• The most common symptom is a sensation of rotating vertigo, accompanied by nausea and vomiting. However, the pathology does not prevent a normal life.
• Each patient has a specific treatment according to age, general condition, hearing and vestibular function.