Meniere’s disease is a disease in which symptoms such as rotational vertigo and hearing loss, tinnitus, and a feeling of fullness in the ears occur simultaneously, and was first described in 1861 by a French doctor, Meniere. Although the pathology and physiological mechanisms have not yet been fully elucidated, endolymphatic hydrops is thought to be the main pathological phenomenon. Meniere’s disease is the most common inner ear disease causing acute vertigo.
Symptoms
Hearing loss, which varies in severity at the beginning of the onset, begins in the low frequency band, which is a characteristic symptom of Meniere’s disease. Then, as the disease progresses, hearing loss occurs in the high-pitched range. In some cases, hearing changes begin first in the high range. Hearing loss is the most common symptom, initially appearing only in one ear, and as the disease progresses, symptoms appear on both sides in about 20-50% of patients. Initially, rotational vertigo presents with severe symptoms, is accompanied by nausea and vomiting, occurs suddenly, and lasts from 20 to 30 minutes to several hours.
The degree of tinnitus is directly related to the degree of hearing loss, and the intensity or pitch fluctuates greatly.
In addition, the patient may feel that the ear is full or clogged, which is called a feeling of fullness in the ears. A feeling of fullness in the ears can be a sign of seizures and is a symptom in about half of patients. In addition, symptoms such as autonomic nervous system stimulation accompanied by nausea and vomiting, that is, headache, stiff neck, and diarrhea may be accompanied.
Causes
Although the pathology and physiological mechanisms of Meniere’s disease have not yet been fully elucidated, there are reports that endolymphatic edema occurs due to malabsorption of endolymphatic fluid, and that allergies are the cause. The prevalence of endolymphatic edema increases with age, progressing over time, and bilateral recurrent characteristics are observed. Therefore, autoimmune diseases are attracting attention as an important mechanism for the development of endolymphatic edema.
Human leukocyte antigens known to be related to Meniere’s disease include B8/DR3 and Cw7, and an increase in autoimmune antibodies to type II collagen among the inner ear protein antigens is observed in Meniere’s disease. In addition, it is speculated that these stress hormones play an important role in the pathogenesis of this disease through clinical trial results showing that there is a correlation between Meniere’s disease symptom seizures and overwork and stress, especially in women, with the menstrual cycle.
In addition, when sodium accumulates in the body due to other causes, it may be caused by systemic metabolic disorders or hypothyroidism.
Diagnosis
Most important for diagnosis are characteristic symptoms of the disease, such as rotational vertigo, hearing loss, tinnitus, and feeling of fullness in the ears. Usually, these seizure symptoms are accompanied by nausea and vomiting, which are stimulatory symptoms of the autonomic nervous system, and last for several hours, and balance disturbances may persist for several days. The duration of vertigo with a sense of rotation is very important information in differentiating it from other diseases. Hearing tests are the most important in diagnosis after clinical symptoms. In addition, important information can be obtained through vestibular function tests and electrocochleargraphy (ECoG) tests.
Tests
In the early stages of the disease, hearing tests characteristically show sensorineural hearing loss of variability in the low range and hearing loss in the high range. Because the symptoms of hearing loss progress gradually, a hearing test is the best test method to detect the inner ear condition according to the progress of the disease. Meanwhile, vestibular function tests play an important role in the differential diagnosis of vertigo caused by abnormalities in the central nervous system during acute vertigo attacks. Electrocochlear test is a test that uses the phenomenon of increasing the summating potential (SP) due to the distortion of the basement membrane due to Meniere’s disease, and measures the action potential (AP) of the auditory nerve at the same time.
The dehydration test is a test that confirms the improvement of hearing by reducing the endolymph pressure in patients with Meniere’s disease using the diuretic furosemide or glycerol. At frequencies from 250 Hz to 4000 Hz, it is judged as positive if there is 15 dB of hearing or 12% or more improvement in speech discrimination. In addition, with imaging diagnosis, signs of narrowing of the endolymphatic canal can be detected through CT scan of the temporal bone or MRI. These imaging tests are mainly used for the purpose of differentiating temporal bone malformations or pathological changes in the central nervous system.
Treatments
Before treating Meniere’s disease, it is important to consider that, unlike other common diseases, about 80% of early-onset patients with Meniere’s disease can be cured spontaneously, and the frequency of seizure symptoms varies from patient to patient. In addition, a treatment plan should be established according to the frequency, intensity, degree of hearing loss, and bilaterality of vertigo attacks. Treatments should be selected differently depending on the acute and chronic period of vertigo attack.
The effectiveness of drug treatment for Meniere’s disease is controversial. Although the drug is very effective in treating acute vertigo symptoms, it is not yet clear how much effect it has on hearing preservation and how much it can prevent the progression of the disease. Currently, the drugs reported to be generally effective are beta-histidine and diuretics.
1) Treatment of acute vertigo attacks
Vestibular depressants and nausea and vomiting suppressants are needed to treat acute vertigo in patients with Meniere’s disease. Antihistamines such as dimenhydrinate, meclizine and diphenhydramine are mainly used. In this case, attention should be paid to glaucoma or prostate problems due to the anticholinergic effect of antihistamines. Diazepam is the most used vestibular inhibitor. During the attack of acute vertigo, hydration and electrolyte replenishment are required to prevent water and electrolyte balance disturbance due to severe vomiting.
2) Treatment of chronic Meniere’s disease
Beta-histidine is known to be the most effective drug in the drug treatment of chronic Meniere’s disease, and it can be used at a dose of 12 mg per day for a long period of at least 6 weeks or more. Also, diuretics such as thiazide, acetazolamide, and urea are used. Although there are reports that these drugs are effective for vertigo, the long-term effect on hearing is unclear.
3) Surgical treatment
In patients who do not improve with drug treatment, various surgical treatments may be considered. The most frequently performed surgical technique is endolymphatic sac decompression, but its therapeutic effectiveness is controversial.
Course and complications
It usually improves after severe acute symptoms, but chronic course is not uncommon.
Preventive measures
Limiting salt intake is the most important, avoiding alcohol, coffee, tobacco, stress, and getting enough sleep can help prevent it. Avoiding the trigger can be achieved by making lifestyle changes before the patient has a vertigo attack, which can help prevent disease progression.
Daily life tips
It is known that stress, overwork, insomnia, and physical fatigue play a major role among the main factors that cause vertigo seizures. Avoiding these triggers can be an adjunct to the treatment of Meniere’s disease.
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