Ménière's disease
Encyclopedia
Ménière's disease is a disorder of the inner ear
that can affect hearing
and balance
to a varying degree. It is characterized by episodes of vertigo
and tinnitus
and progressive hearing loss, usually in one ear. It is named after the French physician Prosper Ménière
, who, in an article published in 1861, first reported that vertigo
was caused by inner ear disorders. The condition affects people differently; it can range in intensity from being a mild annoyance to a chronic, lifelong disability.
, Cogan's syndrome, autoimmune disease
of the inner ear, dysautonomia
, perilymph fistula
, multiple sclerosis
, acoustic neuroma, and both hypo-
and hyperthyroidism
.
The symptoms of Ménière's are variable; not all sufferers experience the same symptoms. However, so-called "classic Ménière's" is considered to have the following four symptoms:
Some may have parasitic symptoms, which aren't necessarily symptoms of Ménière's, but rather side effects from other symptoms. These are typically nausea
, vomiting
, and sweating
which are typically symptoms of vertigo, and not of Ménière's. Vertigo may induce nystagmus, or uncontrollable rhythmical and jerky eye movements, usually in the horizontal plane, reflecting the essential role of non-visual balance in coordinating eye movements. Sudden, severe attacks of dizziness or vertigo, known informally as "drop attacks," can cause someone who is standing to suddenly fall. Drop attacks are likely to occur later in the disease, but can occur at any time.
, but it is believed to be linked to endolymphatic hydrops, an excess of 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 is called "hydrops." The membranous labyrinth, a system of membranes in the ear, contains a fluid called endolymph. The membranes can become dilated like a balloon when pressure increases and drainage is blocked. This may be related to swelling of the endolymphatic sac
or other tissues in the vestibular system
of the inner ear, which is responsible for the body's sense of balance. In some cases, 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. 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 cigarette
s, or drinking alcohol. They may be further exacerbated by excessive consumption of salt
in some patients. It has also been proposed that Ménière's symptoms in many patients are caused by the deleterious effects of a herpes virus. Herpesviridae
are present in a majority of the population in a dormant state. It is suggested that the virus is reactivated when the immune system is depressed due to a stressor such as trauma, infection or surgery (under general anesthesia). Symptoms then develop as the virus degrades the structure of the inner ear.
Ménière's disease affects about 190 people per 100,000. Recent gender predominance studies show that Ménière's tends to affect women more often than men. Age of onset
typically occurs in adult years, with prevalence increasing with age.
. However, a detailed otolaryngological
examination, audiometry
and head MRI
scan should be performed to exclude a vestibular schwannoma or superior canal dehiscence which would cause similar symptoms. There is no definitive test for Ménière's, it is only diagnosed when all other causes have been ruled out. If any cause had been discovered, this would eliminate Ménière's disease, as by its very definition, as an exclusively idiopathic
disease, it has no known causes.
In 1972, the academy defined criteria for diagnosing Ménière's disease as:
In 1985, this list changed to alter wording, such as changing "deafness" to "hearing loss associated with tinnitus, characteristically of low frequencies" and requiring more than one attack of vertigo to diagnose. Finally in 1995, the list was again altered to allow for degrees of the disease:
Additionally, patients may be advised to avoid alcohol, caffeine, and tobacco, all of which can aggravate symptoms of Ménière's. Many patients will have allergy testing done to see if they are candidates for allergy desensitization, as allergies have been shown to aggravate Ménière's symptoms.
Both prescription and over-the-counter medicine can be used to reduce nausea and vomiting during an episode. Included are antihistamines such as meclozine
or dimenhydrinate
, trimethobenzamide
and other antiemetics, betahistine
, diazepam
, or ginger root. Betahistine, specifically, is of note because it is the only drug listed that has been proposed to prevent symptoms due to its vasodilation effect on the inner ear.
The antiherpes virus drug acyclovir has been used with some success to treat Ménière's Disease. The likelihood of the effectiveness of the treatment was found to decrease with increasing duration of the disease, probably because viral suppression does not reverse damage. Morphological changes to the inner ear of Ménière's sufferers have also been found in which it was considered likely to have resulted from attack by a herpes simplex virus
. It was considered possible that long term treatment with acyclovir (greater than six months) would be required to produce an appreciable effect on symptoms. Herpes viruses have the ability to remain dormant in nerve cells by a process known as HHV Latency Associated Transcript
. Continued administration of the drug should prevent reactivation of the virus and allow for the possibility of an improvement of symptoms. Another consideration is that different strains of a herpes virus can have different characteristics which may result in differences in the precise effects of the virus. Further confirmation that acyclovir can have a positive effect on Ménière's symptoms has been reported.
Studies done over the use of transtympanic micropressure pulses have indicated promise with patients who had not been previously treated by gentamicin or surgery. Other studies suggest less clear results and propose that micropressure devices are simply placebos.
, yoga
, t'ai chi., and meditation
. Greenberg and Nedzelski recommend education to alleviate feelings of depression or helplessness.
Nondestructive surgeries include those which do not actively remove any functionality, but rather aim to improve the way the ear works. Intratympanic steroid treatments involve injecting steroids (commonly dexamethasone
) into the middle ear in order to reduce inflammation and alter inner ear circulation. Surgery to decompress the endolymphatic sac
has shown to be effective for temporary relief from symptoms. Most patients see a decrease in vertigo occurrence, while their hearing may be unaffected. This treatment, however, does not address the long-term course of vertigo in Ménière's disease. Danish studies even link this surgery to a very strong placebo
effect, and that very little difference occurred in a 9-year followup, but could not deny the efficacy of the treatment.
Conversely, destructive surgeries are irreversible and involve removing entire functionality of most, if not all, of the affected ear. The inner ear itself can be surgically removed via labyrinthectomy although hearing is always completely lost in the affected ear with this operation. Alternatively, a chemical labyrinthectomy, in which a drug (such as gentamicin
) that "kills" the vestibular apparatus is injected into the middle ear can accomplish the same results while retaining hearing. In more serious cases surgeons can cut the nerve to the balance portion of the inner ear in a vestibular
neurectomy
. Hearing is often mostly preserved, however the surgery involves cutting open into the lining of the brain, and a hospital stay of a few days for monitoring would be required. Vertigo (and the associated nausea and vomiting) typically accompany the recovery from destructive surgeries as the brain learns to compensate.
The central nervous system (CNS) can be re-trained because of its plasticity, or alterability, as well as its repetitious pathways. During vestibular rehabilitation, physiotherapists take advantage of this characteristic of the CNS by provoking symptoms of dizziness or unsteadiness with head movements while allowing the visual, somatosensory and vestibular systems to interpret the information. This leads to a continuous decrease in symptoms.
Although a significant amount of research has been done regarding vestibular rehabilitation in other disorders, substantially less has been done specifically on Meniere’s disease. However, vestibular physiotherapy is currently accepted as part of best practices in the management of this condition.
Some Ménière's disease sufferers, in severe cases, may end up losing their jobs, and will be on disability until the disease burns out. However, a majority (60-80%) of sufferers will not need permanent disability and will recover with or without medical help.
Hearing loss usually fluctuates in the beginning stages and becomes more permanent in later stages, although hearing aid
s and cochlear implant
s can help remedy damage. Tinnitus can be unpredictable, but patients usually get used to it over time.
Ménière's disease, being unpredictable, has a variable prognosis. Attacks could come more frequently and more severely, less frequently and less severely, and anywhere in between. However, Ménière's is known to "burn out" when vestibular function has been destroyed to a stage where vertigo attacks cease.
Studies done on both right and left ear sufferers show that patients with their right ear affected tend to do significantly worse in cognitive performance. General intelligence was not hindered, and it was concluded that declining performance was related to how long the patient had been suffering from the disease.
Inner ear
The inner ear is the innermost part of the vertebrate ear. In mammals, it consists of the bony labyrinth, a hollow cavity in the temporal bone of the skull with a system of passages comprising two main functional parts:...
that can affect hearing
Hearing (sense)
Hearing is the ability to perceive sound by detecting vibrations through an organ such as the ear. It is one of the traditional five senses...
and balance
Balance (ability)
In biomechanics, balance is an ability to maintain the center of gravity of a body within the base of support with minimal postural sway. When exercising the ability to balance, one is said to be balancing....
to a varying degree. It is characterized by episodes of vertigo
Vertigo
Vertigo is a form of dizziness.Vertigo may also refer to:* Vertigo , a 1958 film by Alfred Hitchcock**Vertigo , its soundtrack** Vertigo effect, or Dolly zoom, a special effect in film, named after the movie...
and tinnitus
Tinnitus
Tinnitus |ringing]]") is the perception of sound within the human ear in the absence of corresponding external sound.Tinnitus is not a disease, but a symptom that can result from a wide range of underlying causes: abnormally loud sounds in the ear canal for even the briefest period , ear...
and progressive hearing loss, usually in one ear. It is named after the French physician Prosper Ménière
Prosper Ménière
Prosper Ménière , born in Angers, France. Ménière was lycée and university educated where he excelled at humanities and classics. He completed his gold medal in medical studies at Hôtel-Dieu de Paris in 1826, and his M.D...
, who, in an article published in 1861, first reported that vertigo
Vertigo (medical)
Vertigo is a type of dizziness, where there is a feeling of motion when one is stationary. The symptoms are due to a dysfunction of the vestibular system in the inner ear...
was caused by inner ear disorders. The condition affects people differently; it can range in intensity from being a mild annoyance to a chronic, lifelong disability.
Signs and symptoms
Ménière's often begins with one symptom, and gradually progresses. However, not all symptoms must be present for a doctor to make a diagnosis of the disease. Several symptoms at once is more conclusive than different symptoms at separate times. Other conditions can present themselves with Ménière's-like symptoms, such as syphilisSyphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
, Cogan's syndrome, autoimmune disease
Autoimmune disease
Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. In other words, the body actually attacks its own cells. The immune system mistakes some part of the body as a pathogen and attacks it. This may be restricted to...
of the inner ear, dysautonomia
Dysautonomia
Dysautonomia is a broad term that describes any disease or malfunction of the autonomic nervous system. This includes postural orthostatic tachycardia syndrome , inappropriate sinus tachycardia , vasovagal syncope, mitral valve prolapse dysautonomia, pure autonomic failure, neurocardiogenic...
, perilymph fistula
Perilymph fistula
A labyrinthine fistula is an abnormal opening in the bony capsule of the inner ear, resulting in leakage of the perilymph from the semicircular canals into the middle ear . This includes specifically a perilymph fistula , an abnormal connection between the fluid of the inner ear and the air-filled...
, multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
, acoustic neuroma, and both hypo-
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
and hyperthyroidism
Hyperthyroidism
Hyperthyroidism is the term for overactive tissue within the thyroid gland causing an overproduction of thyroid hormones . Hyperthyroidism is thus a cause of thyrotoxicosis, the clinical condition of increased thyroid hormones in the blood. Hyperthyroidism and thyrotoxicosis are not synonymous...
.
The symptoms of Ménière's are variable; not all sufferers experience the same symptoms. However, so-called "classic Ménière's" is considered to have the following four symptoms:
- Attacks of rotational vertigo that can be severe, incapacitating, unpredictable, and last anywhere from minutes to hours, but generally no longer than 24 hours. For some sufferers however, prolonged attacks can occur, lasting from several days to several weeks, often causing the sufferer to be severely incapacitated. This combines with an increase in volume of tinnitus and temporary, albeit significant, hearing loss. Hearing may improve after an attack, but often becomes progressively worse. NauseaNauseaNausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
, vomitingVomitingVomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
, and sweatingSweatingPerspiration is the production of a fluid consisting primarily of water as well as various dissolved solids , that is excreted by the sweat glands in the skin of mammals...
sometimes accompany vertigo, but are symptoms of vertigo, and not of Ménière's. - Fluctuating, progressive, unilateral (in one earEarThe ear is the organ that detects sound. It not only receives sound, but also aids in balance and body position. The ear is part of the auditory system....
) or bilateral (in both ears) hearing loss, usually in lower frequencies. For some, sounds can appear tinny or distorted, and patients can experience unusual sensitivity to noisesHyperacusisHyperacusis is a health condition characterized by an over-sensitivity to certain frequency ranges of sound...
. - Unilateral or bilateral tinnitusTinnitusTinnitus |ringing]]") is the perception of sound within the human ear in the absence of corresponding external sound.Tinnitus is not a disease, but a symptom that can result from a wide range of underlying causes: abnormally loud sounds in the ear canal for even the briefest period , ear...
. - A sensation of fullness or pressure in one or both ears.
Some may have parasitic symptoms, which aren't necessarily symptoms of Ménière's, but rather side effects from other symptoms. These are typically nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
, vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
, and sweating
Sweating
Perspiration is the production of a fluid consisting primarily of water as well as various dissolved solids , that is excreted by the sweat glands in the skin of mammals...
which are typically symptoms of vertigo, and not of Ménière's. Vertigo may induce nystagmus, or uncontrollable rhythmical and jerky eye movements, usually in the horizontal plane, reflecting the essential role of non-visual balance in coordinating eye movements. Sudden, severe attacks of dizziness or vertigo, known informally as "drop attacks," can cause someone who is standing to suddenly fall. Drop attacks are likely to occur later in the disease, but can occur at any time.
Cause
Ménière's disease is idiopathicIdiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...
, but it is believed to be linked to endolymphatic hydrops, an excess of 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 is called "hydrops." The membranous labyrinth, a system of membranes in the ear, contains a fluid called endolymph. The membranes can become dilated like a balloon when pressure increases and drainage is blocked. This may be related to swelling of the endolymphatic sac
Endolymphatic sac
From the posterior wall of the saccule a canal, the ductus endolymphaticus, is given off; this duct is joined by the ductus utriculosaccularis, and then passes along the aquaeductus vestibuli and ends in a blind pouch, the endolymphatic sac, on the posterior surface of the petrous portion of the...
or other tissues in the vestibular system
Vestibular system
The vestibular system, which contributes to balance in most mammals and to the sense of spatial orientation, is the sensory system that provides the leading contribution about movement and sense of balance. Together with the cochlea, a part of the auditory system, it constitutes the labyrinth of...
of the inner ear, which is responsible for the body's sense of balance. In some cases, 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. The symptoms may occur in the presence of a middle ear
Middle ear
The middle ear is the portion of the ear internal to the eardrum, and external to the oval window of the cochlea. The mammalian middle ear contains three ossicles, which couple vibration of the eardrum into waves in the fluid and membranes of the inner ear. The hollow space of the middle ear has...
infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, head trauma, or an upper respiratory tract infection
Upper respiratory tract infection
Upper respiratory tract infections are the illnesses caused by an acute infection which involves the upper respiratory tract: nose, sinuses, pharynx or larynx...
, or by using aspirin
Aspirin
Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...
, smoking cigarette
Cigarette
A cigarette is a small roll of finely cut tobacco leaves wrapped in a cylinder of thin paper for smoking. The cigarette is ignited at one end and allowed to smoulder; its smoke is inhaled from the other end, which is held in or to the mouth and in some cases a cigarette holder may be used as well...
s, or drinking alcohol. They may be further exacerbated by excessive consumption of salt
Salt
In chemistry, salts are ionic compounds that result from the neutralization reaction of an acid and a base. They are composed of cations and anions so that the product is electrically neutral...
in some patients. It has also been proposed that Ménière's symptoms in many patients are caused by the deleterious effects of a herpes virus. Herpesviridae
Herpesviridae
The Herpesviridae are a large family of DNA viruses that cause diseases in animals, including humans. The members of this family are also known as herpesviruses. The family name is derived from the Greek word herpein , referring to the latent, recurring infections typical of this group of viruses...
are present in a majority of the population in a dormant state. It is suggested that the virus is reactivated when the immune system is depressed due to a stressor such as trauma, infection or surgery (under general anesthesia). Symptoms then develop as the virus degrades the structure of the inner ear.
Ménière's disease affects about 190 people per 100,000. Recent gender predominance studies show that Ménière's tends to affect women more often than men. Age of onset
Age of onset
The age of onset is a medical term referring to the age at which an individual acquires, develops, or first experiences a condition or symptoms of a disease or disorder...
typically occurs in adult years, with prevalence increasing with age.
Diagnosis
Doctors establish a diagnosis with complaints and medical historyMedical history
The medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...
. However, a detailed otolaryngological
Otolaryngology
Otolaryngology or ENT is the branch of medicine and surgery that specializes in the diagnosis and treatment of ear, nose, throat, and head and neck disorders....
examination, audiometry
Audiometry
Audiometry is the testing of hearing ability, involving thresholds and differing frequencies. Typically, audiometric tests determine a subject's hearing levels with the help of an audiometer, but may also measure ability to discriminate between different sound intensities, recognize pitch, or...
and head MRI
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
scan should be performed to exclude a vestibular schwannoma or superior canal dehiscence which would cause similar symptoms. There is no definitive test for Ménière's, it is only diagnosed when all other causes have been ruled out. If any cause had been discovered, this would eliminate Ménière's disease, as by its very definition, as an exclusively idiopathic
Idiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...
disease, it has no known causes.
History
Ménière's disease had been recognized as early as 1860s, but it was still relatively vague and broad at the time. The American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium (AAO HNS CHE) set criteria for diagnosing Ménière's, as well as defining two sub categories of Ménière's: cochlear (without vertigo) and vestibular (without deafness).In 1972, the academy defined criteria for diagnosing Ménière's disease as:
- Fluctuating, progressive, sensorineural deafness.
- Episodic, characteristic definitive spells of vertigo lasting 20 minutes to 24 hours with no unconsciousness, vestibular nystagmus always present.
- Usually tinnitus.
- Attacks are characterized by periods of remission and exacerbation.
In 1985, this list changed to alter wording, such as changing "deafness" to "hearing loss associated with tinnitus, characteristically of low frequencies" and requiring more than one attack of vertigo to diagnose. Finally in 1995, the list was again altered to allow for degrees of the disease:
- Certain - Definite disease with histopathologicalHistopathologyHistopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...
confirmation - Definite - Requires two or more definitive episodes of vertigo with hearing loss plus tinnitus and/or aural fullness
- Probable - Only one definitive episode of vertigo and the other symptoms and signs
- Possible - Definitive vertigo with no associated hearing loss
Management
Several environmental and dietary changes are thought to reduce the frequency or severity of symptom outbreaks. It is believed that since high salt diets cause water retention, it can lead to an increase (or at least preventing the decrease) of fluid within the inner ear, although the relationship between salt and the inner ear is not fully understood. High-salt intake is thought to alter the concentrations of fluid in the inner ear and Ménière's episodes could be accelerated by high-salt binges. Recommended salt intake is often around one to two grams per day. Diuretics have traditionally been prescribed to facilitate a low-salt diet although there is no definite supportive evidence.Additionally, patients may be advised to avoid alcohol, caffeine, and tobacco, all of which can aggravate symptoms of Ménière's. Many patients will have allergy testing done to see if they are candidates for allergy desensitization, as allergies have been shown to aggravate Ménière's symptoms.
Both prescription and over-the-counter medicine can be used to reduce nausea and vomiting during an episode. Included are antihistamines such as meclozine
Meclozine
Meclozine is an antihistamine considered to be an antiemetic. It is sold under the brand names Bonine, Bonamine, Antivert, Postafen, Sea Legs, and Dramamine . Emesafene is a combination of meclozine and pyridoxine...
or dimenhydrinate
Dimenhydrinate
Dimenhydrinate is an over-the-counter drug used to prevent nausea and motion sickness...
, trimethobenzamide
Trimethobenzamide
Trimethobenzamide is an antiemetic used to prevent nausea and vomiting. It is often prescribed for patients with gastroenteritis, medication-induced nausea, and other illnesses...
and other antiemetics, betahistine
Betahistine
Betahistine hydrochloride is an antivertigo drug. It was first registered in Europe in 1970 for the treatment of Ménière's disease...
, diazepam
Diazepam
Diazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
, or ginger root. Betahistine, specifically, is of note because it is the only drug listed that has been proposed to prevent symptoms due to its vasodilation effect on the inner ear.
The antiherpes virus drug acyclovir has been used with some success to treat Ménière's Disease. The likelihood of the effectiveness of the treatment was found to decrease with increasing duration of the disease, probably because viral suppression does not reverse damage. Morphological changes to the inner ear of Ménière's sufferers have also been found in which it was considered likely to have resulted from attack by a herpes simplex virus
Herpes simplex virus
Herpes simplex virus 1 and 2 , also known as Human herpes virus 1 and 2 , are two members of the herpes virus family, Herpesviridae, that infect humans. Both HSV-1 and HSV-2 are ubiquitous and contagious...
. It was considered possible that long term treatment with acyclovir (greater than six months) would be required to produce an appreciable effect on symptoms. Herpes viruses have the ability to remain dormant in nerve cells by a process known as HHV Latency Associated Transcript
HHV Latency Associated Transcript
HHV Latency Associated Transcript is a length of RNA which accumulates in cells hosting long-term, or latent, Human Herpes Virus infections. The LAT RNA is produced by genetic transcription from a certain region of the viral DNA...
. Continued administration of the drug should prevent reactivation of the virus and allow for the possibility of an improvement of symptoms. Another consideration is that different strains of a herpes virus can have different characteristics which may result in differences in the precise effects of the virus. Further confirmation that acyclovir can have a positive effect on Ménière's symptoms has been reported.
Studies done over the use of transtympanic micropressure pulses have indicated promise with patients who had not been previously treated by gentamicin or surgery. Other studies suggest less clear results and propose that micropressure devices are simply placebos.
Coping
Sufferers tend to have high stress and anxiety due to the unpredictable nature of the disease. Healthy ways to combat this stress can include aromatherapyAromatherapy
Aromatherapy is a form of alternative medicine that uses volatile plant materials, known as essential oils, and other aromatic compounds for the purpose of altering a person's mind, mood, cognitive function or health....
, yoga
Yoga
Yoga is a physical, mental, and spiritual discipline, originating in ancient India. The goal of yoga, or of the person practicing yoga, is the attainment of a state of perfect spiritual insight and tranquility while meditating on Supersoul...
, t'ai chi., and meditation
Meditation
Meditation is any form of a family of practices in which practitioners train their minds or self-induce a mode of consciousness to realize some benefit....
. Greenberg and Nedzelski recommend education to alleviate feelings of depression or helplessness.
Surgery
If symptoms do not improve with typical treatment, more permanent surgery is considered. Unfortunately, because the inner ear deals with both balance and hearing, few surgeries guarantee no hearing loss.Nondestructive surgeries include those which do not actively remove any functionality, but rather aim to improve the way the ear works. Intratympanic steroid treatments involve injecting steroids (commonly dexamethasone
Dexamethasone
Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid drugs. It acts as an anti-inflammatory and immunosuppressant...
) into the middle ear in order to reduce inflammation and alter inner ear circulation. Surgery to decompress the endolymphatic sac
Endolymphatic sac
From the posterior wall of the saccule a canal, the ductus endolymphaticus, is given off; this duct is joined by the ductus utriculosaccularis, and then passes along the aquaeductus vestibuli and ends in a blind pouch, the endolymphatic sac, on the posterior surface of the petrous portion of the...
has shown to be effective for temporary relief from symptoms. Most patients see a decrease in vertigo occurrence, while their hearing may be unaffected. This treatment, however, does not address the long-term course of vertigo in Ménière's disease. Danish studies even link this surgery to a very strong placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...
effect, and that very little difference occurred in a 9-year followup, but could not deny the efficacy of the treatment.
Conversely, destructive surgeries are irreversible and involve removing entire functionality of most, if not all, of the affected ear. The inner ear itself can be surgically removed via labyrinthectomy although hearing is always completely lost in the affected ear with this operation. Alternatively, a chemical labyrinthectomy, in which a drug (such as gentamicin
Gentamicin
Gentamicin is an aminoglycoside antibiotic, used to treat many types of bacterial infections, particularly those caused by Gram-negative organisms. However, gentamicin is not used for Neisseria gonorrhoeae, Neisseria meningitidis or Legionella pneumophila...
) that "kills" the vestibular apparatus is injected into the middle ear can accomplish the same results while retaining hearing. In more serious cases surgeons can cut the nerve to the balance portion of the inner ear in a vestibular
Vestibular nerve
The vestibular nerve is one of the two branches of the Vestibulocochlear nerve . It goes to the semicircular canals via the vestibular ganglion...
neurectomy
Neurectomy
Neurectomy is the surgical removal of a nerve or a section of a nerve. This procedure may be performed, for example, in cases of chronic pain where other treatments have failed. However the removal of the nerve can also cause negative effects, such as permanent numbness...
. Hearing is often mostly preserved, however the surgery involves cutting open into the lining of the brain, and a hospital stay of a few days for monitoring would be required. Vertigo (and the associated nausea and vomiting) typically accompany the recovery from destructive surgeries as the brain learns to compensate.
Physiotherapy
Physiotherapists also have a role in the management of Meniere’s disease. In vestibular rehabilitation, physiotherapists use interventions aimed at stabilizing gaze, reducing dizziness and increasing postural balance within the context of activities of daily living. After a vestibular assessment is conducted, the physiotherapist tailors the treatment plan to the needs of that specific patient.The central nervous system (CNS) can be re-trained because of its plasticity, or alterability, as well as its repetitious pathways. During vestibular rehabilitation, physiotherapists take advantage of this characteristic of the CNS by provoking symptoms of dizziness or unsteadiness with head movements while allowing the visual, somatosensory and vestibular systems to interpret the information. This leads to a continuous decrease in symptoms.
Although a significant amount of research has been done regarding vestibular rehabilitation in other disorders, substantially less has been done specifically on Meniere’s disease. However, vestibular physiotherapy is currently accepted as part of best practices in the management of this condition.
Prognosis
Ménière's disease usually starts confined to one ear, but it often extends to involve both ears over time. The number of patients who end up with bilaterial Ménière's is debated, with ranges spanning from 17% to 75%.Some Ménière's disease sufferers, in severe cases, may end up losing their jobs, and will be on disability until the disease burns out. However, a majority (60-80%) of sufferers will not need permanent disability and will recover with or without medical help.
Hearing loss usually fluctuates in the beginning stages and becomes more permanent in later stages, although hearing aid
Hearing aid
A hearing aid is an electroacoustic device which typically fits in or behind the wearer's ear, and is designed to amplify and modulate sound for the wearer. Earlier devices, known as "ear trumpets" or "ear horns", were passive funnel-like amplification cones designed to gather sound energy and...
s and cochlear implant
Cochlear implant
A cochlear implant is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing...
s can help remedy damage. Tinnitus can be unpredictable, but patients usually get used to it over time.
Ménière's disease, being unpredictable, has a variable prognosis. Attacks could come more frequently and more severely, less frequently and less severely, and anywhere in between. However, Ménière's is known to "burn out" when vestibular function has been destroyed to a stage where vertigo attacks cease.
Studies done on both right and left ear sufferers show that patients with their right ear affected tend to do significantly worse in cognitive performance. General intelligence was not hindered, and it was concluded that declining performance was related to how long the patient had been suffering from the disease.
In history
- Alan B. ShepardAlan ShepardAlan Bartlett Shepard, Jr. was an American naval aviator, test pilot, flag officer, and NASA astronaut who in 1961 became the second person, and the first American, in space. This Mercury flight was designed to enter space, but not to achieve orbit...
, the first AmericanUnited StatesThe United States of America is a federal constitutional republic comprising fifty states and a federal district...
astronautAstronautAn astronaut or cosmonaut is a person trained by a human spaceflight program to command, pilot, or serve as a crew member of a spacecraft....
and fifth man on the Moon, was diagnosed with Ménière’s disease in 1964, grounding him after only one brief spaceflight. Several years later, an endolymphatic shunt surgery (which was then at the experimental stage) was performed, allowing Shepard to fly to the MoonMoonThe Moon is Earth's only known natural satellite,There are a number of near-Earth asteroids including 3753 Cruithne that are co-orbital with Earth: their orbits bring them close to Earth for periods of time but then alter in the long term . These are quasi-satellites and not true moons. For more...
on Apollo 14Apollo 14Apollo 14 was the eighth manned mission in the American Apollo program, and the third to land on the Moon. It was the last of the "H missions", targeted landings with two-day stays on the Moon with two lunar EVAs, or moonwalks....
. - Jonathan SwiftJonathan SwiftJonathan Swift was an Irish satirist, essayist, political pamphleteer , poet and cleric who became Dean of St...
, Anglo-Irish satiristSatireSatire is primarily a literary genre or form, although in practice it can also be found in the graphic and performing arts. In satire, vices, follies, abuses, and shortcomings are held up to ridicule, ideally with the intent of shaming individuals, and society itself, into improvement...
, poetPoetryPoetry is a form of literary art in which language is used for its aesthetic and evocative qualities in addition to, or in lieu of, its apparent meaning...
, and cleric, is known to have suffered from Ménière’s disease. - Varlam ShalamovVarlam ShalamovVarlam Tikhonovich Shalamov , baptized as Varlaam, was a Russian writer, journalist, poet and Gulag survivor.-Early life:Varlam Shalamov was born in Vologda, Vologda Governorate, a Russian city with a rich culture famous for its wooden architecture, to a family of a hereditary Russian Orthodox...
, a Russian writer, was affected. - Su YuSu YuSu Yu was a Chinese Communist military leader. He was considered by many to be among the best commanders of the PLA only next to Lin Biao and Liu Bocheng. Su Yu fought in the Sino-Japanese War and in the Chinese Civil War...
, PLA General who achieved many victories for the communists during the Chinese Civil WarChinese Civil WarThe Chinese Civil War was a civil war fought between the Kuomintang , the governing party of the Republic of China, and the Communist Party of China , for the control of China which eventually led to China's division into two Chinas, Republic of China and People's Republic of...
was hospitalized in 1949 and that prevented him from taking command in the Korean WarKorean WarThe Korean War was a conventional war between South Korea, supported by the United Nations, and North Korea, supported by the People's Republic of China , with military material aid from the Soviet Union...
, and Mao ZedongMao ZedongMao Zedong, also transliterated as Mao Tse-tung , and commonly referred to as Chairman Mao , was a Chinese Communist revolutionary, guerrilla warfare strategist, Marxist political philosopher, and leader of the Chinese Revolution...
selected Peng DehuaiPeng DehuaiPeng Dehuai was a prominent military leader of the Communist Party of China, and China's Defence Minister from 1954 to 1959. Peng was an important commander during the Second Sino-Japanese War, the Chinese civil war and was also the commander-in-chief of People's Volunteer Army in the Korean War...
instead. - Ryan AdamsRyan AdamsDavid Ryan Adams is an American alt-country/rock singer-songwriter, from Jacksonville, North Carolina. Initially part of the group Whiskeytown, Adams left the band and released his first solo album Heartbreaker in 2000...
, an American musician, had to take a two year break from music because the disease became so degenerative to him, and needed to undergo therapy to get back on stage to overcome the anxiety the disease afforded him.
Possible cases
- Marilyn MonroeMarilyn MonroeMarilyn Monroe was an American actress, singer, model and showgirl who became a major sex symbol, starring in a number of commercially successful motion pictures during the 1950s....
, American actress and cultural icon was known to experience the vertigo and compromised hearing associated with Ménière’s. - Charles DarwinCharles Darwin's illnessFor much of his adult life, Charles Darwin's health was repeatedly compromised by an uncommon combination of symptoms, leaving him severely debilitated for long periods of time...
may have suffered from Ménière’s disease. This idea is based on a common list of symptoms which were present in Darwin's case, such as tinnitus, vertigo, dizziness, motion sickness, vomiting, continual malaise and tiredness. The absence of hearing loss and 'fullness' of the ear (as far as known) excludes, however, a diagnosis of typical Ménière’s disease. Darwin himself had the opinion that most of his health problems had an origin in his 4-year bout with sea sickness. Later, he could not stand traveling by carriage, and only horse riding would not affect his health. One of the diagnoses that he received from his physicians at the time was that of "suppressed goutGoutGout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected . However, it may also present as tophi, kidney stones, or urate...
". The source of Darwin's illness is not known for certain. See Charles Darwin's health. - Martin LutherMartin LutherMartin Luther was a German priest, professor of theology and iconic figure of the Protestant Reformation. He strongly disputed the claim that freedom from God's punishment for sin could be purchased with money. He confronted indulgence salesman Johann Tetzel with his Ninety-Five Theses in 1517...
wrote in letters about the distresses of vertigo, and suspected Satan was the cause. - Julius CaesarJulius CaesarGaius Julius Caesar was a Roman general and statesman and a distinguished writer of Latin prose. He played a critical role in the gradual transformation of the Roman Republic into the Roman Empire....
was known to have suffered from the "falling sickness" as noted in PlutarchPlutarchPlutarch then named, on his becoming a Roman citizen, Lucius Mestrius Plutarchus , c. 46 – 120 AD, was a Greek historian, biographer, essayist, and Middle Platonist known primarily for his Parallel Lives and Moralia...
's Parallel LivesParallel LivesPlutarch's Lives of the Noble Greeks and Romans, commonly called Parallel Lives or Plutarch's Lives, is a series of biographies of famous men, arranged in tandem to illuminate their common moral virtues or failings, written in the late 1st century...
, and has been cited by Shakespeare, noting that Caesar was unable to hear fully in his left ear. - It has been suggested that Vincent Van GoghVincent van GoghVincent Willem van Gogh , and used Brabant dialect in his writing; it is therefore likely that he himself pronounced his name with a Brabant accent: , with a voiced V and palatalized G and gh. In France, where much of his work was produced, it is...
, the Dutch Post-Impressionist, may have suffered from Ménière's, though this is now considered conjectural. See Vincent van Gogh's medical conditionVincent van Gogh's medical conditionThere is no consensus on Vincent van Gogh's health. His death in 1890 occurred after a self-inflicted bullet wound. Many competing hypotheses have been put forward about possible medical conditions he had...
for a discussion of the range of possible alternative diagnoses.