Meniere’s disease (or idiopathic endolymphatic hydrops) is characterized by the accumulation of endolymph (clear fluid) in the inner ear, which causes an increase in pressure in the labyrinth.
This rare condition affects the inner ear and can cause the following symptoms:
People with Meniere’s disease experience sudden seizures that last for two or three hours; these symptoms may disappear completely on their own after a day or two.
Meniere’s disease occurs bilaterally in at least one in three patients.
As a rule, people between 40 and 60 years of age are affected, children usually not.
Causes of Meniere’s disease
Meniere’s disease is caused by fluid accumulation in some special compartments of the inner ear, especially in the labyrinth.
The labyrinth consists of:
- an anterior or auditory area where the cochlea is located,
- a posterior or vestibular part, in which the vestibular organs are located, more precisely semicircular canal and balance receptors.
Inside the labyrinth is a fluid called endolymph, which signals the body’s movements to the receptors of the vestibular organs. These send nerve signals to the brain via position and movement.
In the cochlea, the endolymph is compressed by the sound vibrations. This stimulates the auditory sensory cells to send the sound information to the central nervous system.
Essentially, in Meniere’s disease, the accumulation of endolymph in the labyrinth interferes with normal balance and with the transmission of acoustic signals between the inner ear and the brain: hence the characteristic symptoms:
- feeling of a filled ear,
- sometimes tinnitus.
Cochlear Meniere’s disease is a variant in which fluid accumulates mainly in the cochlear part of the labyrinth. In this case, the symptoms affecting hearing are more severe than the dizziness.
The dizziness can also be caused by problems in the cervical spine, but there is no connection between Meniere’s disease and the neck.
Risk factors for Meniere’s disease
Although the exact cause of Meniere’s disease is unknown, the following factors increase the risk of developing this disease:
- Autoimmunity – the immune system mistakenly attacks its own organs and tissues.
- Genetic factors and heritability – if, for example, a family is affected by this pathology.
- Chemical-electrolytic imbalance of the inner ear fluid, which is the result of an excess or lack of salt or potassium in the organism.
- Circulatory disorders – there is a link between Meniere’s disease and migraine. They are thought to be caused by the narrowing and dilation of blood vessels.
- Viral infection – for example, meningitis, an infection of the meninges that surrounds the brain and spinal cord.
- Cranial trauma – Meniere’s disease may be caused by bleeding in the inner ear.
- Psychosomatic disorders – Stress does not cause Meniere’s disease, but it can worsen symptoms and promote recurrence.
Signs and symptoms of Meniere’s disease
Recurrent dizziness episodes. The dizziness is similar to the feeling when you have turned around your own axis several times and then suddenly stop. You lose your balance because of the feeling that space is still in a rotational motion. The dizziness episodes occur suddenly and last about 20 minutes to two hours or more, in the most severe cases up to 24 hours. Severe dizziness can cause nausea and vomiting.
Hearing loss. Hypakusis in Meniere’s disease can be subject to fluctuations, especially in the first stages of the disease. Over time, most people get permanent partial or total hearing loss.
Tinnitus or ringing in the ears. It is the perception of a sound, hum, whistling or hissing in the ear.
Feeling of a filled ear. People affected by Meniere’s disease often have the feeling of “closed ears”, “stuffy ears” or increased ear pressure.
Pain. Headache occurs in 58% of cases, mainly at the occipital level (Eklund S -Department of Otolaryngology, University Hospital of Helsinki, Finland.
A typical episode in this condition begins with a feeling of stuffy ears, tinnitus, and hearing loss, followed by severe dizziness, often accompanied by nausea and vomiting. Such an event lasts from 20 minutes to four hours, after which the signs and symptoms of the disease improve. There are often long periods of remission with mild symptoms or without any sign of illness between these episodes.
The severity, frequency, and duration of each of these perceptual problems vary, especially at the onset of the disease.
For example, the following could occur:
- frequent episodes of severe dizziness and only mild hearing impairment,
- the patient suffers from mild dizziness and rare hearing loss, but often from tinnitus that disturbs sleep.
There are no contraindications to air travel.
Diagnosis of Meniere’s disease
The doctor you turn to is the ear doctor.
During the examination, it is necessary to describe the duration, frequency and severity, as well as the nature of the seizure; In addition, the doctor must know whether the hearing loss has changed and whether tinnitus or the feeling of blocked ears occurs in one or both ears.
In addition, the doctor wants to know whether in the past there were:
- inflammation of the parotid gland (parotitis),
- inflammatory eye disease,
- autoimmune disorders,
- Ear surgery.
Also, the overall state of health of the person is important, for example:
- whether she suffers from diabetes or high blood pressure (hypertension),
- cholesterol is elevated,
- whether there are disorders of the thyroid gland, neurological or mental disorders.
Examinations for Meniere’s disease
Audiometric examinations are performed to assess hearing.
These examinations reveal the type of sensory hearing loss of the affected ear.
The equilibrium is examined by means of an electronystagmography. In this examination, electrodes are positioned near the eyes in a darkened room. After the electrodes are correctly placed, both warm and cold air is slowly blown into each ear canal. In this examination, eye movements are used to study the balance system, because eyes and ears function in a coordinated manner via the nervous system.
The rotation test or the swivel chair examination can also be used to assess balance.
As a rule, the nystagmus, which is caused by a problem in the labyrinth, hits the opposite side of the diseased ear, while in Meniere’s disease it hits the side of the affected ear.
Other examinations for Meniere’s syndrome are:
- MRI (magnetic resonance imaging))
- electrocochleography; it is used to assess the pressure of the inner ear fluid, which is increased in certain forms of meniere.
- The auditory brain response is a computerized examination to study the auditory nerves and upper nerve pathways that conduct sound information to the brain.
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