Meniere's Disease

Ménière's disease (or syndrome, since its cause is unknown) was first described by French physician Prosper Ménière in 1861. It is a balance disorder of the inner ear.

Cause

The exact cause of Ménière's disease is not known, but it is believed to be related to endolymphatic hydrops or excess fluid in the inner ear. It is thought that endolymphatic fluid bursts from its normal channels in the ear and flows into other areas causing damage. This may be related to swelling of the endolymphatic sac or other issues in the vestibular system of the inner ear, which is responsible for the body's sense of balance. The symptoms may occur in the presence of a middle ear infection, head trauma or an upper respiratory tract infection, or by using aspirin, smoking cigarettes or drinking alcohol. They may be further exacerbated by excessive consumption of caffeine and even salt in some patients. Meniere's has many diseases that mimic it. The diagnosis is usually established by clinical findings and medical history. However, a detailed oto-neurological examination, audiometry and even head magnetic resonance imaging (MRI) scan should be performed to exclude a tumour of the cranial nerve VIII (vestibulocochlear nerve) which would cause similar symptoms. Because Meniere's is idiopathic without an understood cause it is only diagnosed when all other causes have been ruled out.

Treatment

Initial treatment is aimed at both dealing with immediate symptoms and preventing frequency of symptoms, and so will vary from patient to patient. Doctors may recommend training or other methods for dealing with tinnitus, stress reduction, hearing aids to deal with hearing loss, and medication to alleviate nausea and symptoms of vertigo.

Several environmental and dietary changes are thought to reduce the frequency or severity of symptom outbreaks. Most patients are advised to adopt a low-sodium diet, typically one to two grams (1000-2000mg) at first, but diets as low as 400mg are not uncommon. Patients are advised to avoid caffeine, alcohol and tobacco, all of which can aggravate symptoms of Meniere's. Some recommend avoiding Aspartame. Patients are often prescribed a mild diuretic (sometimes vitamin B6). Many patients will have allergy testing done to see if they are candidate for allergy desensitization as allergies have been shown to aggravate Meniere's symptoms.

Lipoflavanoid is also recommended for treatment by some doctors.

Many patients consider fluorescent lighting to be a big trigger for symptoms. The plausibility of this can be explained by how important a part vision plays in the overall mechanism of human balance.

Treatments aimed at lowering the pressure within the inner ear include antihistamines, anticholinergics, steroids, and diuretics. A medical device that provides transtympanic micropressure pulses is now showing some promise and is becoming more widely used as a treatment for Meniere's.

Surgery of the endolymphatic sac is becoming more common in cases that don't respond to traditional medical treatments. Surgery of the semicircular canals or the vestibular nerve is very rarely performed in some untreatable and most severe cases. Another treatment is chemical labyrinthectomy, in which a drug (such as gentamicin) that "kills" the vestibular apparatus is injected into the inner ear. These radical treatments eliminate vertigo, but they also eliminate the patient's normal sense of balance, and so are used only as a last resort.