Meniere’s disease is a disease of the inner ear named after the French physician Prosper Meniere (1799—1862), who first described this disease in 1861. Symptoms often include (1) loss of hearing, particularly in the lower-frequency bands, (2) tinnitus or ringing in the ears, and (3) vertigo, which is described as a “whirling” or spinning movement where patients feel as if they are moving when in fact they are not. It is often accompanied by nausea and/or vomiting as well as problems with balance and equilibrium. This is often the most severe presenting symptom of this disease.
At this time, there is no known definitive cause of Meniere’s disease. There is evidence it may be related to a buildup of excess fluid in the inner ear, and further studies are being done to determine other causes, if any. Diagnosis is often established through a review of patient symptoms. There are currently no reliable objective diagnostic tools available to determine if a patient has this disease. Treatment is aimed at decreasing the prevailing symptoms a patient might have.
Meniere’s disease is thought to be linked to changes in quantity and pressure of the fluids found within the inner ear. Current data suggest that individuals with Meniere’s disease have an excess of fluid in the inner ear and that this fluid “escapes” the inner ear proper and enters other areas of the cochlea. This condition is called hydrops of the inner ear. Under normal conditions, this fluid is constantly being produced and recycled. With hydrops, this fluid is unable to recycle, resulting in a pressure buildup within the cochlea, which is thought to cause swelling of the tissues of the vestibular and auditory systems of the ear. This pressure buildup is then thought to interfere with the normal function of the semicircular canals, which results in the nausea and vertigo that many patients exhibit.
Diagnosis of Meniere’s disease is difficult at best. It is considered an idiopathic disease, meaning there is at this time no known cause for the disease. There are currently no reliable diagnostic tests or imaging studies that can be done to definitively diagnose this disease. Physicians often make this diagnosis after ruling out other diseases such as bacterial/viral inner-ear infections, or nervous system tumors such as a vestibular schwannoma. This means that the diagnosis of Meniere’s disease is often a diagnosis of exclusion. It is diagnosed when as many other diseases/pathologies as possible are ruled out.
The American Academy of Otolaryngology has made an attempt to establish some minimal criteria that may help with the diagnosis of Meniere’s disease. These criteria were first introduced in 1972 and amended in 1985. They include (1) a fluctuating, progressive loss of hearing over an unspecified period of time, (2) incidents of vertigo lasting 20 minutes to 24 hours with no loss of consciousness and the presence of vestibular nystagmus, and (3) the onset of tinnitus or a ringing in the ears.
While there are currently no recognized medical treatments for Meniere’s disease, research has found some dietary and pharmacologic treatments that seem to help some patients to varying degrees. A growing body of evidence suggests that diets high in salt could be an exacerbating factor in the onset of Meniere’s disease as high salt concentrations in the body fluid tend to cause retention of fluid. Patients are often advised to maintain a low-sodium diet in an attempt to prevent fluid buildup within the inner ear. In addition to a low-salt diet, some patients have been prescribed medications called diuretics, which are designed to increase the frequency of urination and keep the buildup of body fluids to a minimum.
Individuals affected by this disease are also advised to avoid consuming significant quantities of alcohol or caffeine, and to avoid tobacco products, all of which have been shown to increase the severity of the symptoms of Meniere’s disease.
Currently, the prognosis for the successful treatment and elimination of the symptoms of Meniere’s disease is not very positive. While this disease often starts out only affecting one ear, most patients eventually develop symptoms in both ears. Many patients will eventually become disabled to the point of being unable to function normally in society. It is important to remember that the severity of symptoms is quite variable and that the differences between individuals as to the extent of disability are quite extreme.
Charles A. Ferguson
See also: Auditory System; Cochlea; Dizziness; Vestibular System
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