What is Ménière's disease?

Causes and Symptoms

Ménière’s disease results from excess pressure caused by surplus fluids in the cochlea (inner ear) or the semicircular canals concerned with the sense of balance. Typically this condition results when the structure that reabsorbs excess fluid from the inner ear ceases to function properly. The cause may be an infection, allergies, a spasm of one of the tiny blood vessels in the semicircular canal, or a small hemorrhage in the cochlear duct. Ménière’s syndrome affects both the vestibular nerve (causing attacks of vertigo) and the auditory nerve (causing hearing impairment).

The classic symptoms of Ménière’s disease are tinnitus, a sensation of fullness in the ears, dizziness, hearing impairment (including fluctuating distortions of sound), and a rapidly progressing loss of hearing. The attacks are typically abrupt and momentary, but recur frequently. Dizziness may range from a mild whirling sensation and unsteady balance to severe attacks of vertigo and complete loss of equilibrium accompanied by nausea and vomiting. The eyes often show a rhythmic jerking motion.

Treatment and Therapy

The treatment selected for Ménière’s disease depends on the theoretical diagnosed cause, as no single remedy is universally successful. Infections and allergies can often be treated by diuretic drugs, sedative and blood vessel dilators, or low-salt diets, all intended to reduce cochlear fluid pressure. Motion sickness and antihistamine drugs may be used to treat the symptoms. Since attacks of violent dizziness can occur suddenly, the affected person must immediately lie down to avoid falling. During a severe attack, the patient should be confined to bed since any movement of the head produces the disturbing sensation that the room is rotating. A bout may last several weeks, during which time bed rest and medication are recommended. Attacks, which recur at irregular intervals of weeks, or months, may last a half hour to several hours. Mild attacks usually disappear within a year, but more severe cases require a medical regimen. In some cases surgery may be necessary to decompress the cochlea and/or semicircular canals. If all other medical measures fail, the disability is severe, and deafness is well advanced,
destruction of the cochlea by surgery or ultrasound may be a last resort.

Perspective and Prospects

Ménière’s disease was first described and recorded in detail in 1861 by French physician Prosper Ménière. Formerly only the most severe and disabling cases were treated surgically because the operation required destruction of the hearing nerve. Since the advent of microsurgical instruments it has become possible to separate the hearing and balance filaments in the main nerve and clip only the balance filaments when the problem is in the semicircular canals. It is also now possible to utilize ultrasonic beams to selectively destroy balance filaments without damaging the sensitive auditory nerves.

Bibliography

Alan, Rick. "Meniere's Disease." Health Library, September 10, 2012.

Griffith, H. Winter. Complete Guide to Symptoms, Illness, and Surgery. 6th ed. New York: Perigee, 2012.

Harris, Jeffrey P., ed. Ménière’s Disease. The Hague, the Netherlands: Kugler, 1999.

MedlinePlus. "Meniere's Disease." MedlinePlus, May 7, 2013.

Paparella, Michael M., ed. Pathogenesis of Ménière’s Disease: Treatment Considerations. Philadelphia: W. B. Saunders, 2002.

Weber, Peter C., ed. Ménière’s Disease. Philadelphia: W. B. Saunders, 1997.