Disease (syndrome) ménière's disease

Meniere's disease is a pathology that affects the inner ear with non-inflammatory in nature. The disease is expressed in attacks of vertigo, intermittent noises in the ear, and hearing loss.

The disease is the eponym of the French physician P. ménière, who, in 1861, first described the clinical picture typical for this disease. According to statistics, most often the disease is diagnosed in people aged 25 to 50 years, in Pediatrics it is found, but rarely. The number of cases is equal to 1:1000. Affected to a greater degree of Meniere's disease the European race, in particular, workers in the intellectual sphere, living in large settlements.

The vast majority of cases, there is a unilateral lesion of the ear. Both the organ of hearing are involved in the pathological process in no more than 15% of cases. However, as the disease progresses, it moves to the second ear in 17-75% of cases over a period of 5 to 30 years.

Meniere's disease was struck by such famous people as: A. Shepard (1st American astronaut), D. swift (satirist, poet, priest), V. Shalamov (Russian writer), R. Adams (American musician).

The content of the article:

• The symptoms of Meniere's disease
• The causes of Meniere's disease
• Diagnosis of Meniere's disease
• Treatment of Meniere's disease
• Disability for Meniere's disease

The symptoms of Meniere's disease

The symptoms of Meniere's disease are manifested in the form of attacks, during which the patient is experiencing:

• Dizziness. Often this condition is accompanied by feeling of nausea and vomiting that occurs repeatedly. Sometimes the dizziness is so strong that the person the impression as if it rotates around all the space around him and subjects. You may feel falling body, or his bias, even though the person is stationary. An attack may last from several minutes to several hours. The patient's condition is aggravated when trying to turn his head, so he instinctively tries to sit or lie down with his eyes closed. (see also:Vertigo – types and causes)

• The loss or marked impairment of hearing. While the sound with lowest frequency people can't hear at all. This clinical sign to differentiate ménière's disease from hearing loss, in whichthe patient does not hear high frequency sounds. At the same time to loud sound vibrations the person has a special sensitivity and an increased noise on time maintenance can be pain in the ear.
• Ringing in the ears. Ringing occurs regardless of whether the environment the source of the noise. Ringing whooshing, muffled, some patients compare it with the ringing of the bell. Before the attack, the ringing tends to increase, and during the attack is capable of change.
• The feeling of pressure and stuffiness in the ear. The feeling of discomfort and fullness is caused by accumulation of fluid in the cavity of the inner ear. This feeling is particularly strong before the attack.

• Diarrhea, abdominal pain.

• Headaches.
• Shortness of breath, tachycardia, pallor of integuments of the face, increased sweating.
• During an attack observed nystagmus – rapid oscillatory movements of the eyeballs. The gain of the nystagmus noted at the time, when the patient lies on the damaged ear.
• A sudden drop. It's pretty terrible symptom that occurs because of a disorder. This violation is associated with the deformation structures of the inner ear that causes activation of the vestibular reflexes. While the patient swings from side to side, sometimes it falls or changes position in an attempt to maintain balance. The main danger is that the harbingers of the upcoming activation of the vestibular reflexes no. Therefore, during the fall people can get serious injuries.
• After a seizure, a person remains a hearing losscan be noise in the ear, a feeling of heaviness in the head. Also, there is unsteady gait and coordination disorders. The patient feels a sense of weakness. As the progression of the disease all these symptoms have a tendency to strengthen, and in time become longer.
• Violations of the ear are progressing. If at the beginning of Meniere's disease, one barely discerns low frequency sounds, then he does not hear the entire sound range. The hearing loss eventually becomes absolute deafness. When a person is deaf, dizzy spells stopped.

Onset of the disease is characterized by periods of exacerbation followed by periods of remission during which the hearing is completely restored, the disability does not occur. Transient hearing loss, usually saved onfor the first 2-3 years of the disease. As the progression of the disease even in the period of remission does not fully restore hearing, preserved vestibular disorders, performance declines.

Most patients with ménière's disease are able to anticipate the oncoming attack, as it is preceded by a definite aura. It is expressed in loss of coordination, appears in the ears growing ringing. In addition, there is a feeling of pressure and filling in the ear. In some cases before the attack occurs a temporary improvement in hearing.

Depending on what the symptoms of Meniere's disease, can determine the degree of progression of the pathology:

• For the first stage is the main symptom is considered to be dizziness with vomiting and nausea, thus there is blanching of the skin, there is hyperhidrosis. The rumor persists between attacks.
• For the second stage of the disease characterized by the development of hearing loss, dizziness, have a maximum degree of expressiveness, with the subsequent tendency to decrease.
• For the third stage is characterized by hearing loss and bilateral deafness. The dizziness disappear altogether, but poor coordination persist and intensify in finding the patient in the dark.

These three stages are characterized by classic for Meniere's disease, that is the beginning of the pathological process is manifested by a combination of auditory and vestibular disorders. This form of the disease suffer 30% of all patients. In addition, there is a cochlear (starts with just hearing) and vestibular (vestibular disorders) form of the disease. They account for 50% and 20%, respectively.

The causes of Meniere's disease

The causes of Meniere's disease to establish exactly still failed, although clinical signs of the disease were described more than 150 years ago. Naturally, scientists have several hypotheses regarding the factors influencing the etiology of this disease.

The basic theory of developing the disease:

• Anatomical theory. Scientists believe that the disease can develop as a result of anatomical pathology of the structure of the temporal bone.
• Genetic theory indicates that the disease develops due to its transmission by inheritance. According to recent research, it was found that the pathology is transmitted throughautosomal dominant type of inheritance.
• The viral theory. According to her, the disease occurs as a result of the influence of viral infections, for example, as a result of exposure to cytomegalovirus or herpes simplex virus.
• Allergic theory indicates that there is a connection between allergies and ménière's disease. Found that unlike the General population, allergic reactions in people with Meniere's disease is much more common.

• The vascular theory relates the disease with migraine. This fact pointed out himself Meuniere.

• Immunological theory indicates that in the endolymphatic SAC at people with Meniere's disease detected immune complexes.
• Metabolic theory links the disease with a delay of potassium in the endolymphatic space. For this reason, is intoxication of the hair cells, which causes dizziness and formation of hearing loss.

The majority of scholars are of the opinion that Meniere's disease – pathology polietiologichesky, that is, its development is influenced by several factors simultaneously.

Provocative reasons can be:

• A viral disease of the middle ear;
• Injuries to the head and ear;
• Congenital abnormalities of the hearing;
• Error in the diet with violation of water-salt metabolism;
• The lack of estrogen in the body;
• Occupational hazards.

To provoke another attack, and capable of the following influences:

• Physical fatigue;
• Stressful situation;
• Overeating;
• Inhalation of tobacco smoke;
• The intake of alcohol beverages;
• The increase in body temperature;
• Medical procedures performed in the ear;
• Expressed noise environment.

Diagnosis of Meniere's disease

Diagnosis of Meniere's disease presents no special difficulties and is built on the basis of clinical signs and the data of instrumental examinations, among which is the leading audiometry.

The American Academy surgery and otolaryngology have identified the following diagnostic criteria, confirming the presence of Meniere's disease:

• More than two dizzy spells with a duration of 20 minutes or longer;
• Drop hearing accordingaudiometry;

• Noise in the ears, complaints of a feeling of stuffiness in the ear;

• The absence of other causes of the symptoms.

While performing audiometry revealed mixed hearing loss. At the initial stage of the disease the hearing reduced in the low frequency range, and the progression of the disease, hearing is lost at all frequencies.

Used several types of diagnosis of Meniere's disease:

1. Using such a diagnostic method as acoustic impedance measurements it is impossible to estimate the mobility of the auditory ossicles and work in-the-ear muscles.

2. Promotionally test to determine the presence of disorders in the auditory nerve.

3. To exclude the presence of inflammation gives opportunity methods such as otoscopy and microeconomia.

4. Brain MRI is indicated for confirmation of the absence of neuroma the auditory nerve.

5. Deviations in functioning of the vestibular apparatus are detected by indirect otlichaetsia, vestibulometry, stabilography.

6. In addition, it is possible to consult the patient to a neurologist, who sends the patient to the ECHO-EG, EEG, REG, duplex scanning of brain vessels.

7. Glycerol test allows to assess the state of the endolymphatic pressure, the improvement of which is the basis of the disease. For this test patient need to drink calculated from his body weight mixture fruit juice and glycerin. After 2 hours carry out audiometry and evaluate the hearing status of the patient. If 3 frequencies it is reduced by 10 dB, then the test is considered positive.

It is important during diagnosis to differentiate ménière's disease from other pathological conditions of the organ of hearing, such as otosclerosis, Eustachian, otitis media, tumor, vestibular neurons, etc.

Treatment of Meniere's disease

Treatment of Meniere's disease is aimed at stopping progression and to achieving control of symptoms of disease. To cure ménière's disease is completely modern medicine not.

When you consider the factors provocateurs that stimulate the development of seizures, to control their frequencyit is quite simple. For this it is necessary to lead a healthy lifestyle, to diet, to refrain from eating, drinking alcoholic beverages and Smoking.

To control the attack, you can assign the following:

• Antihistamines (Trimethobenzamide, Meklozin);
• Proceeds from nausea;
• Vasodilator drugs common actions (Nikoshpan, But-shpa);
• Neuroleptics (Triftazin, Aminazin);
• Betahistin as the drug expands the blood vessels of the inner ear.

Most often stop an attack is possible without hospitalization. However, if the patient has occur multiple vomiting, he will need intravenous antiemetics.

With the aim of reducing the volume of the detained fluid recommended diuretics. This allows to normalize the pressure, which is created in the inner ear. The most common combination is the prescription hydrochlorothiazide and triamterene.

Diuretics are recommended for admission to long term, therefore, parallel to the patient should follow the diet with a high content of mineral substances. The fact that drugs of this group together with the excess liquid eluted from the body with useful substances.

Meniere's syndrome is treated by administering injections directly into the middle ear. This conservative method has an effect similar to the effect of the operation.

The introduction shall be the following:

• The antibiotic Gentamicin, which can reduce the number of attacks and reduce their intensity. However, the risk of such treatment is associated with the possibility of complete hearing loss.
• Hormones, Prednisolone, Dexamethasone also allow you to control the condition of the patient. However, hormones are not as effective as injections with Gentamicin. But the risk of hearing loss decreases, which is their unquestionable advantage.

When the effect of the therapy is absent, it is possible to perform surgical treatment. However, even surgery cannot guarantee the preservation of hearing.

Operations can be of the following types:

• Destructive interference is the removal of the maze, crossing the 8 branches of the nerve, lateregistration maze, etc.
• Drainage interventions are aimed at strengthening the outflow Andolini of the ear cavity. This can be performed drainage of the labyrinth, perforation of the footplate, the drainage of the endolymphatic SAC.
• Operations on the autonomic nervous system are reduced to resection of the drum the strings to the junction of the tympanic plexusor cervical sympathectomy.

As for the forecast for the development of the disease, Meniere's disease does not lead to fatal outcomes, although it is at this time incurable. Timely medical treatment can slow the progression of hearing loss. If hearing continues to deteriorate, it is advisable to wear a hearing aid or implant placement.

Disability for Meniere's disease

Disability for Meniere's disease most often not assigned.

It to can only those patients who have other incurable chronic diseases on the background of Meniere's disease and under the following conditions:

• Severe and irreversible loss of hearing;
• The presence of severe concomitant disease;
• The lack of efficacy of the treatment on the background of frequent prolonged seizures that were documented;
• The presence of vestibulopathies syndrome moderate (group 3), severe (group 2) or pronounced (group 1) degree.

In any case, the decision on granting to the patient of a particular disability group will be decided by a special medical Commission. Most often the disability is given to people of retirement age, whose illness made his debut in youth or in childhood.