Meniere's Disease

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What is Meniere's disease ?

Disorder of the inner ear which causes episodes of

vertigo, ringing in the ears (tinnitus), a feeling of fullness or pressure in the ear, and fluctuating hearing loss. the area of the ear affected is the entire labyrinth, which includes both the semicircular canals and the cochlea. Named after French physician Prosper Mnire who first described it in 1861

Epidemiology (USA)
Meniere's affects roughly 0.2% of the population or 2

per 1000 people. Mnire's typically begins between the ages of 30 and 60 Affects men slightly more than women

What causes Meniere's Disease?

The membranous labyrinth is necessary for hearing and

balance and is filled with a fluid called endolymph. When your head moves, endolymph moves, causing nerve receptors in the membranous labyrinth to send signals to the brain about the body's motion.

 An increase in endolymph, can cause the membranous labyrinth to dilate, as endolymphatic

hydrops. this is happen when the drainage system, that endolymphatic duct or sac is blocked. the endolymphatic duct may be obstructed by scar tissue, or may be narrow from birth. in some cases there may be too much fluid secreted by the stria vascularis. Recently Research: autoimmune inner ear disease

Risk Factors
Middle ear infection
head trauma upper respiratory tract infection Aspirin Caffeine cigarettes alcohol excessive consumption of salt

Symptoms
Periodic episodes of vertigo or dizziness.
Fluctuating, progressive, unilateral (in one ear) or

bilateral (in both ears) hearing loss. Unilateral or bilateral tinnitus. A sensation of fullness or pressure in one or both ears. sudden fall or drop attacks

occasional symptoms
Headaches
abdominal discomfort Diarrhea nystagmus, or uncontrollable rhythmical and jerky eye

movements

Diagnosis
Doctors establish it with complaints and medical

history Diagnosis is based on a combination of the right set of symptoms. the process of diagnosis usually includes:
hearing testing (audiometry) ENG test VEMP test

several blood tests (ANA, FTA)

MRI scan of the head Electrocochleography (ECOG)

differential diagnosis
perilymph fistula
recurrent labyrinthitis Migraine congenital ear malformations of many kinds syphilis Lyme disease tumors such as acoustic neuroma multiple sclerosis posterior fossa arachnoid cysts

How do I manage an attack?

During an acute attack, lay down on a firm surface
Stay as motionless as possible, with your eyes open and fixed on a stationary object Do not try to drink or sip water immediately, as you'd be very likely to vomit Stay like this until the severe vertigo (spinning) passes, then get up SLOWLY After the attack subsides, you'll probably feel very tired and need to sleep for several hours

Treatment
vestibular training
methods for dealing with tinnitus stress reduction hearing aids to deal with hearing loss and medication to alleviate nausea and symptoms of

vertigo.

Medication
At the present time there is no cure for Meniere's

disease. The purpose of treatment between attacks is to prevent or reduce the number of episodes, and to decrease the chances of further hearing loss and damage to the vestibular system.

Medications commonly used for an acute attack include the following:

Meclizine (Antivert), chewable (Bonine). Dose ranges from

12.5 twice/day to 50 mg three times/day. Lorazepam (Ativan) 0.5 mg. Usual dose is twice/day or both at the same time at onset. Tiredness is expected. Phenergan, orally (12.5) or rectal suppository (25 mg). Usual dose is once every 12 hours as needed for vomiting. Compazine (orally or suppository). Usual dose is 5-10 mg every 12 hours as needed for vomiting. Zofran (orally or sublingual). Usual dose is 8mg q 12 hrs for vomiting. Although Zofran isn't very strong, and doesn't always work, it also doesn't have much side effects either. Decadron (dexamethasone) 4 mg orally for 4-7 days. Or a "medrol dose pack

Medications used between Attacks

Diuretics
Dyazide or Maxide (triamterine/HCTZ). Moduretic (amiloride/HCTZ) Diamox (acetazolamide)

Vestibular Suppressants
Clonazepam(Klonapin) 0.5 mg twice a day or as needed lorazepam (Ativan) 0.5mg twice a day or as needed diazepam (Valium) 2 mg twice a day or as needed meclizine (Antivert ) 12.5 mg to 25 mg as needed up to 3-

4 times/day

 Calcium Channel Blockers Verapamil 120-240 mg. Nimodipine Flunarizine/Cinnarizine Steroids Dexamethasone Prednisone Methylprednisoline

Surgery
Surgery may be recommended if medical management

does not control vertigo. This can be achieved through chemical labyrinthectomy, in which a drug (such as gentamicin) that "kills" the vestibular apparatus is injected into the middle ear. Alternatively, surgeons can cut the nerve to the balance portion of the inner ear in a vestibular neurectomy, or the inner ear itself can be surgically removed (labyrinthectomy).

to reduce the frequency and severity of Menieres disease attacks

Progression
Progression of Mnire's is unpredictable: symptoms

may worsen, disappear altogether, or remain the same.

References
NIDCD (National Institute on Deafness and other

Communication Disorders)

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