Meniere's disease

Ménière's disease (or syndrome, since its cause is unknown) was first described by French physician Prosper Ménière in 1861. It is a balance disorder of the inner ear. more...

Symptoms

The symptoms of Meniere's are variable; not all sufferers experience the same symptoms. However, four symptoms are considered to comprise so-called "classic Meniere's":

• periodic episodes of rotary vertigo (the abnormal sensation of movement) or dizziness
• fluctuating, progressive, unilateral (in one ear) or bilateral (in both ears) hearing loss, often in the lower frequency ranges
• unilateral or bilateral tinnitus (the perception of noises, often ringing, roaring, or whooshing), sometimes variable
• a sensation of fullness or pressure in one or both ears

Meniere's often begins with one symptom, and gradually progresses. A diagnosis may be made in the absence of all four classic symptoms.

Attacks of vertigo can be severe, incapacitating, and unpredictable. In some patients, attacks of vertigo can last for hours or days, and may be accompanied by an increase in the loudness of tinnitus and temporary hearing loss in the affected ear(s). Hearing may improve after an attack, but often becomes progressively worse. Vertigo attacks are sometimes accompanied by nausea, vomiting, and sweating.

Some sufferers experience what are informally known as "drop attacks" -- a sudden, severe attack of dizziness or vertigo that causes the sufferer, if not seated, to fall. Some patients may find it impossible to get up for some time, until the attack passes or medication takes effect. There is also the risk of injury from falling.

In addition to low frequency hearing loss, sounds can seem tinny or distorted, and patients can experience unusual sensitivity to loud noises. Some sufferers also experience nystagmus, or uncontrollable rhythmical and jerky eye movements, usually in the horizontal plane.

Other symptoms include so-called "brain fog" (temporary loss of short term memory, forgetfulness, and confusion), deafness, exhaustion and drowsiness, headaches, vision problems, and depression.

Cause

The exact cause of Ménière's disease is not known, but it is believed to be related to endolymphatic hydrops or excess fluid in the inner ear. It is thought that endolymphatic fluid bursts from its normal channels in the ear and flows into other areas causing damage. This may be related to swelling of the endolymphatic sac or other issues in the vestibular system of the inner ear, which is responsible for the body's sense of balance. The symptoms may occur in the presence of a middle ear infection, head trauma or an upper respiratory tract infection, or by using aspirin, smoking cigarettes or drinking alcohol. They may be further exacerbated by excessive consumption of caffeine and even salt in some patients. Meniere's has many diseases that mimic it. The diagnosis is usually established by clinical findings and medical history. However, a detailed oto-neurological examination, audiometry and even head magnetic resonance imaging (MRI) scan should be performed to exclude a tumour of the cranial nerve VIII (vestibulocochlear nerve) which would cause similar symptoms. Because Meniere's is idiopathic without an understood cause it is only diagnosed when all other causes have been ruled out.

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