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Meniere’s Disease

Meniere’s Disease

Menir’s disease is a disorder characterized by recurrent attacks of disabling vertigo. Vertigo is a sensation of movement when none is actually occurring. The person may feel that he or she is spinning or rotating abnormally.
What is going on in the body?

Menir’s disease is a disorder of the inner ear. The inner ear is made up of the cochlea and the labyrinth. The cochlea is a snail-shaped structure involved in hearing. The labyrinth is made up of canals in the inner ear that control balance. Within the cochlea and labyrinth are two fluid-filled compartments. The separation between the two compartments is necessary for hearing and balance. It allows the nerves to communicate with each other within that space. 

Experts believe that damage to the inner ear starts the process of Menir’s disease. The injury causes fluid to build up in the two compartments. The pressure increases and damages the labyrinth. In some cases, the cochlea is also damaged.
What are the causes and risks of the disease?

In most cases, the cause of Menir’s disease is not known. There is some evidence that inflammation in the ear causes poor drainage of fluid. Possible causes of Menir’s disease are as follows:
allergies, particularly food allergies
an autoimmune disorder , or condition in which the person’s body creates antibodies against its own tissues
excessive intake of alcohol or caffeine
excessive sodium or sugar in the diet
genetic narrowing of parts of the inner ear
head injury
high cholesterol
hypothyroidism, or low levels of thyroid hormone
smoking
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viral infections of the inner ear

Menir’s disease is most common in people over age 40 and is as common in men as women.
Symptoms & Signs
What are the signs and symptoms of the disease?

As the pressure builds, there is a sensation of the ear being plugged. There is also a decline in low-frequency hearing. The person may have roaring or a ringing sound in the ear. The hearing impairment fluctuates. This means that the person hears better at some times and worse at others.

The episodes may occur in clusters or there may be years between episodes. In between episodes, some people may have a small degree of imbalance and ringing in the ears. Other people have no symptoms at all between episodes.

Following are other symptoms of Menir’s syndrome:
abnormal side-to-side eye movements, known as nystagmus
ataxia, or an abnormal, unsteady walking gait
diarrhea
dizziness
headache
nausea
vomiting

Diagnosis & Tests
How is the disease diagnosed?

Diagnosis of Menir’s disease begins with a medical history and physical examination. A hearing test can identify hearing impairments. Sometimes a cranial MRI may be ordered to rule out other conditions.
Prevention & Expectations
What can be done to prevent the disease?

Prevention of Menir’s disease is not always possible. Following sports guidelines for children, adolescents, and adults may prevent head injuries that cause inner ear problems. Some measures that may prevent or minimize attacks of vertigo include the following:
avoiding allergy triggers
avoiding smoking and secondhand smoke
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limiting caffeine and sodium in the diet
using a combination of diet, exercise, and medicines to lower high cholesterol
using synthetic thyroid hormone medicines to treat hypothyroidism

What are the long-term effects of the disease?

Recurrent episodes of Menir’s disease can lead to gradual loss of hearing and balance.
What are the risks to others?

Menir’s disease is not contagious and poses no risk to others.
Treatment & Monitoring
What are the treatments for the disease?

During an acute attack, individuals are advised to lie flat on a firm surface and focus on a fixed point. The person should avoid eating or drinking, which may bring on an episode of vomiting. After the vertigo gets better, the person will probably need to sleep.

Medicines are tailored for each person, but may include the following:
calcium channel blockers, such as verapamil, flunarizine with cinnarizine, and nimodipine, that dilate the small blood vessels of the inner ear
diuretics, such as triamterene with hydrochlorothiazide, to help the kidneys excrete excess fluid from the body
medicines that suppress the activity of the inner ear, such as lorazepam, meclizine, diazepam, and clonazepam

Steroids, such as prednisone, are used occasionally to treat Menir’s disease. Medicines that suppress the immune system, such as methotrexate, are used rarely.

People with infrequent symptoms may not need to be on medicine all the time. It may be best to treat the attacks as they occur. For those with more frequent attacks, diuretics can be useful. Otherwise known as “water pills”, diuretics work on the kidneys to excrete excess fluid from the body.

A person with Menir’s disease may also be advised to follow a special diet. A hydrops diet focuses on limiting the intake of sodium and sugar. This diet also includes restrictions on excess intake of caffeine, alcohol, and monosodium glutamate, which is also called MSG. MSG is found in Chinese foods and some prepackaged foods.

In some cases, a person may have frequent, untreatable spells of vertigo. The healthcare provider may recommend procedures to destroy hair cells or nerves in the inner ear. These procedures can take the form of surgery or medicines, such as certain antibiotics that are toxic to the ear. Surgery may include removal of the labyrinth or the entire inner ear. This procedure can be helpful, particularly in individuals who have lost their hearing. In those who still have reasonable levels of hearing, the balance nerve can be cut.
What are the side effects of the treatments?

Medicines used to treat Menir’s disease commonly cause drowsiness and dry mouth. Surgery carries a risk of bleeding, infection, hearing impairment, and allergic reaction to anesthesia.

Calcium channel blockers have long been used to treat Menir’s disease as well as high blood pressure. However, the findings of two recent studies show that people who take a calcium channel blocker have a much higher incidence of complications than people taking other medicines for high blood pressure. The findings of one study, for example, showed that the risk of heart attack was 27% greater. Also, the risk of congestive heart failure was 26% higher. The American Heart Association recommends discussing the risks and benefits of the medicine with a healthcare provider.
What happens after treatment for the disease?

An appropriate diet combined with medicines can help reduce the frequency and severity of the attacks. Those whose inner ear structures have been removed generally become permanently deaf. They may also have chronic problems with their balance.
How is the disease monitored?

Menir’s disease is monitored by evaluating the frequency of the attacks. The provider will also check for hearing impairment. Any new or worsening symptoms should be reported to the healthcare provider.

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