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Introduction:
Meniere's disorder (MD) is characterized by of repeated episodes of vertigo, (the room moving or spinning), often preceded by a fullness or roaring in the affected ear, usually associated with nausea and possibly vomiting. Symptoms last a few hours to a day or so and are eventually associated with hearing loss, although the hearing loss may not be present or noticed in the early stages. In the later stages the vertigo dies down but the hearing loss persists and noises (tinnitus) may be troublesome. Episodes come periodically every few weeks, months, or, in some patients, only every few years. It tends to occur more in people who lean towards the type A personality. Stress and fatigue tend to precipitate attacks.
Background:
In 1861 Prosper Meniere, a physician in Paris, proposed that vertigo originated in the inner ear, not the brain, as was believed at that time. In 1927 Georges Portmann, an ear surgeon in Bordeaux, France, performed a drainage operation on the endolymphatic sac (a sac leading off the canals of the inner ear) to try to relieve pressure. It was not until eleven years later, in 1938, that Hallpike and Cairns, in London, described the presumed cause of excess fluid in the inner ear canals and sacs, a condition called endolymphatic hydrops.
Cause:
Despite much research the cause of the excess fluid build up in the inner ear remains uncertain. The mechanisms that control the composition and flow of the fluids of the inner ear in normal health remain unclear. This makes specific treatment difficult. It has even been suggested that the excess fluid may be the result of the disorder rather than the cause as such. Many people believe that there are different causes, including viral infection, allergy or auto-immune disorder.
Diagnosis:
There is no one specific test for Meniere's disorder. The diagnosis is usually made from a combination of a suggestive history, negative examination findings (except for hearing loss), along with appropriate investigations, such as audiology, vestibular tests (such as videonystagmography), imaging studies and blood work.
Treatment:
The majority of Meniere's sufferers (about 70%) will maintain control of their symptoms with conservative treatment, which may include labyrinthine sedatives, salt restriction, diuretics, anxiety and other medications as well as general lifestyle measures:
- Adequate rest and sleep, stress management, appropriate diet and exercise may be as important as any medication.
- It is important to investigate each patient thoroughly to be sure that other diagnoses are not missed and that natural concerns about tumors, strokes or other underlying disorders have been alleviated.
For the small percentage of cases that fail on the above measures, more aggressive measures (with varying effectiveness) are available. These include:
- Injection into the ear of gentamycin (an antibiotic which is toxic to the vestibular nerve cells).
- Endolymphatic sac drainage, section (cutting) the vestibular (balance) nerve, and other surgical procedures.
- Meniett device: this recent relatively simple device emits pressure waves towards the inner ear via a tube which has been placed in the eardrum. It is comparatively non-invasive and relatively risk free. Its mode of action is uncertain, but reports have suggested benefits and it is gaining in popularity. Some insurances may now cover the four figure cost. Details are available at Meniett.com.
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