Ménière's disease: symptoms, causes and treatment

Ménière's disease is a pathology of the inner ear in which the patient has hearing loss and, above all, balance problems.

This medical condition usually affects only one ear, and can present in adulthood and middle age.

Although there is no known cure for Ménière's disease, there are some treatments that help reduce your symptoms and the frequency of vertigo attacks. Let's find out more about what are the peculiarities of this hearing disorder.

• Related article: "The 10 parts of the ear and the process of receiving sound"

What is Ménière's disease?

Ménière's disease is an ENT disorder in which the inner ear is affected. The patient suffering from this disease suffers episodes of dizziness and vertigo, in addition to partial hearing loss.

In most cases, only one ear is affected. It can manifest at any age, but it usually appears in early adulthood and middle age between the ages of 20 and 50. It is considered a chronic disease, although there are treatments to reduce the symptoms and the long-term impact.

Symptoms of this pathology

Among the symptoms of Ménière's disease we find the following.

1. Recurrent episodes of vertigo

Patients with Ménière's disease have a spinning sensation with recurring episodes of vertigo that begin and end spontaneously. These are given without prior notice, lasting between about 20 minutes and several hours. In some severe cases they last 24 hours, but not longer. As a consequence of the intense vertigo, the patient may feel nauseous.

These episodes of vertigo can cause the patient to lose balance in sudden moments, which increases the risk of falls and accidents. As they are unpredictable, the affected person can suffer a lot of anxiety and stress, greatly conditioning her quality of life.

2. Hearing loss

Hearing loss from this disease is a symptom that can come and go, especially at first. Over time, most Ménière patients end up losing some of their hearing permanently.

• Related article: "The 8 types of hearing impairment (and their characteristics)"

3. Tinnitus

Tinnitus are a kind of chime that is heard inside the ear, at different volumes and sonic frequencies. They can also manifest as buzzing, roaring or hissing in the ear, not produced by apparent external auditory stimulus.

4. Auditory congestion

Patients with Ménière's disease often feel a pressure in the affected ear.

After having suffered an episode associated with the disease, the signs and symptoms may improve and even temporarily disappear completely. There are few cases of patients in whom the frequency of episodes of hearing loss and dizziness decreases.

• Related article: "Tinnitus or tinnitus: symptoms, causes and treatment"

Causes

It is not very well known what causes Ménière's disease, although your symptoms have been associated with an abnormal amount of fluid in the ear, called endolymph (endolymphatic hydrops). This fluid is kept in a bag-like structure called the endolymphatic sac that is continuously secreted and reabsorbed, maintaining a constant amount in the ear of healthy people.

Both an increase in the production of this liquid and a decrease in its reabsorption will result in an excess of endolymph. Although this phenomenon has been associated with Ménière's disease, it is not known why this pathological production and reabsorption of this fluid occurs.

Some possible causes would be an inadequate drainage of the fluid due to an obstruction or anatomical abnormality, in addition to an abnormal immune response and viral infection.

• You may be interested in: "The 4 types of pathogens (and their characteristics)"

Diagnosis

There are several diagnostic procedures to see if a patient has Ménière's disease or not. The person in charge of this diagnosis must be a medical professional specialized in ENT or who has knowledge about Ménière's disease and other ear disorders. Diagnosis of this disease requires the following requirements to be met.

• Two episodes of vertigo, each lasting 20 minutes or more, but not longer than 12 hours
• Hearing loss verified with a hearing test
• Tinnitus or a feeling of having a blocked ear
• Exclusion of other known causes for the three previous problems.

1. Balance assessment

In the time between episodes of vertigo, the sense of balance returns to normal in most cases. However, the patient may have constant problems with balance, which is why different tests are applied to check the degree of affectation and if there is a possibility of recovery.

Among the balance and hearing evaluation tests we have the following.

2. Audiometry

In audiometries it is evaluated if the patient is able to detect sounds of different tones and volumesIn addition to checking if you are able to distinguish between words that are heard in a similar way. Patients with Ménière's disease often have trouble hearing at low frequencies or combinations of high and low frequencies. Your hearing is normal for mid-range frequencies.

3. Videonystagmography

Videonystagmography examines balance function by evaluating eye movement. In the inner ear there are sensors that are related to balance and connect with the muscles that control the movement of the eyes. This connection is what makes us move our heads while keeping our eyes fixed on one point.

4. Rotary chair tests

Rotary chair tests, as the name suggests, consist of having the patient sit in a computer controlled rotating chair that will stimulate the inner ear. This test measures the function of the inner ear according to eye movement, just like the previous test does.

• You may be interested in: "Interoception: listening to one's own body"

5. Posturography

The sense of human balance not only depends on our inner ear, but also on vision, the sensations of the skin, muscles, tendons and joints and, if any of them fail, it can explain the vertigo and dizziness of the patient.

Posturography is a computerized test in which It is observed which part of the balance system the patient depends more on and which parts may be the ones behind the problem. In this test, the patient is asked to put on a safety harness, walk barefoot on a platform, and balance under various conditions.

• Related article: "Cochlea: what is it, parts, functions and associated pathologies"

6. Video Head Impulse Test

The head impulse test consists of measuring eye reactions to abrupt movements.

The patient will have to concentrate on a point, looking at a target for which they will be recording their ocular behavior. While the test is taking place, they will turn your head quickly and unpredictably. If you take your eyes off the target while turning your head, it means you have abnormal reflexes.

7. Electrocochleography

Electrocochleography allows you to observe the response of the inner ear to sounds. This technique can be helpful in determining if there is any accumulation of endolymph in the inner ear., although it can be said that it is not specific for Ménière's disease.

Treatments

Ménière's disease does not have a total cure for now, although there are treatments that can help reduce the severity of symptoms and the frequency of vertigo episodes. However, there are no treatments for hearing loss associated with this medical condition. Below we present the set of therapeutic options for this disease.

1. Medications for vertigo

Your doctor can prescribe drugs for vertigo episodes and decrease their severity while an attack occurs. Among them we can highlight meclizine or diazepam, that can reduce the sensation of spinning and help control nausea and vomiting. In addition, anti-nausea drugs such as promethazine are also prescribed.

In anticipation of the possible long-term effects of the disease, the doctor may prescribe drugs for fluid retention such as diuretics, in addition to suggesting limiting salt intake. For some patients, this combination helps control the severity and frequency of the symptoms of Ménière's disease.

2. Non-invasive treatments

Some people with this disease can benefit from non-invasive therapies and procedures. The main two are rehabilitation and implantation of a hearing aid..

Vestibular rehabilitation therapy may dramatically improve balance for people with vertigo episodes.

Hearing aids for the ear affected by Ménière's disease can improve the patient's hearing. It is essential that the doctor refer to an audiologist to see what the best hearing aid options are for the patient.

3. Middle ear injections

In some patients, more invasive procedures are necessary, including injections into the middle ear. Drugs are injected into the middle ear and then absorbed by the inner ear, improving the symptoms associated with vertigo. The drugs used in these techniques are as follows.

3.1. Gentamicin

Gentamicin is an antibiotic toxic to the inner ear. This substance reduces the balancing function of the ear, leaving the unaffected ear to take responsibility for balance. It is considered a risky treatment since there is a risk of aggravating hearing loss.

3.2. Steroids

Steroids such as dexamethasone can help control vertigo attacks in some patients.. In the specific case of this drug, this substance is less effective than gentamicin but is less likely to aggravate hearing loss.

4. Surgical interventions

Surgery is a resource used when Ménière's disease is severe and debilitating and other treatments have been shown not to help. Among the surgical procedures to treat this disease we have the following.

4.1. Endolymphatic sac procedure

As we have seen before, the endolymphatic sac is responsible for regulating endolymph levels. In Ménière's disease, this structure is altered, which is why a therapeutic procedure consists of decompressing this structure which can reduce excess fluid. In some cases, this surgery is combined with the placement of a tube that drains excess fluid from the inner ear.

4.2. Labyrinthectomy

In labyrinthectomy the balance portion of the inner ear is removed, consisting of a very aggressive treatment since both the auditory function and the sense of balance of the affected ear are lost. This procedure is only carried out when there is already total loss in that ear.

4.3. Vestibular nerve section

Finally, one of the surgical treatments to correct Ménière's disease is the section of the vestibular nerve. Basically involves cutting the nerve that connects balance and motion sensors in the inner ear to the brain. It is applied with the intention of preserving hearing in the affected ear, but eliminating the sense of balance of the affected ear.