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What is it all about?

Menière's disease is a mainly unilateral disease of the cochleovestibular organ of the inner ear. It is characterized by sudden vertigo with vomiting, a ringing in the ear and a temporary hearing loss. The symptoms appear like attacks and improve or disappear after a few hours. These seizure symptoms occur very irregularly, but especially in stressful situations.

Below you will find important information about Menière's disease. We will inform you about the causes and development of Menière's syndrome, explain the symptoms and present the possibility of therapy. If you have any questions, we are of course available free of charge and without obligation.

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Menière's syndrome and its causes

Menière's disease is diagnosed in around 5-10% of patients with vertigo, so it is very rare overall. However, it occurs most frequently in patients between the ages of 30 and 50, and women are affected slightly more often than men.

The cause of Menière's disease has not yet been clarified. It is speculated whether, for example, heredity plays a role or whether previous traumatic inner ear damage could play a role.

Emergence

The cause of the disease is a so-called endolymphatic hydrops. In order to be able to understand this, one has to deal more closely with the structure of the human hearing or the inner ear. The inner ear basically consists of two units. On the one hand from the organ of equilibrium (vestibular organ) and on the other hand from the cochlea. In the following we will take a closer look at the structure of the cochlea, as it is affected by Menière's disease. The cochlea contains an outer bony labyrinth in which the inner membranous labyrinth is embedded.

The membranous labyrinth consists of three “chambers” from top to bottom: the Scala vestibuli, the Scala media and the Scala tympani below. The scala vestibuli and the scala media are separated from each other by the so-called Reissner membrane, and the so-called basilar membrane lies between the scala tympani and the scala media. The basilar membrane is part of the organ of Corti and on it sit the hair cells of different sizes (sensory cells), which are responsible for the actual hearing process. Scala tympani and scala vestibuli are filled with a liquid called perilymph. The scala media is filled with potassium-rich endolymphs.

Now back to the endolymphatic hydrops. This is an overproduction of the endolymph, which leads to a widening of the scala media. The result is a displacement of the basilar membrane. This in turn has a very unfavorable effect on the hair cells that sit on the basilar membrane. The consequences are hearing loss and noises in the ears (tinnitus). The endolymphatic hydrops and the associated widening of the scala media can also cause a rupture of the Reissner membrane, which lies between the scala media and the scala tympani. The endolymph from the scala media and the perilymph from the scala vestibuli now mix. This can then cause dizziness attacks. You can find out more about the inner ear in our article: The inner ear: structure and function

Symptoms

The three typical symptoms of Meniere's disease are varying degrees of hearing loss, tinnitus, and dizziness that lasts about three hours. Doctors also speak of a so-called symptom triad. Before and during the “seizure”, the severity of the hearing loss and tinnitus can change. Usually the hearing gets worse and the noise in the ear gets louder. Balance problems usually persist longer after the attack, until they finally recede.

Diagnosis

If the typical symptoms of Meniere's disease are present, this is usually sufficient to be able to confirm the diagnosis.

1. During the seizure, the patient's eyes twitch in the direction of the healthy ear. Doctors speak of what is known as failure nystagmus. Immediately after the attack, the eyes twitch in the direction of the diseased ear (recovery nystagmus).
2. The inner ear hearing loss mainly affects tones of low and medium frequencies, whereby this hearing loss disappears especially at the beginning after the attack. This hearing loss can be diagnosed very well with a tone audiogram.
3. If the disease has progressed further, the organ of equilibrium (vestibular organ) becomes under-excitable.

therapy

There are two therapeutic approaches in Menière's disease. On the one hand, the treatment during the attack and, on the other hand, the therapeutic measures that can be taken to prevent the next attack or at least reduce the number of attacks. Depending on how Ménière's disease progresses, the attending physician decides which therapy is used.

In the following, we will introduce you to the different treatment options for Menière's disease. This includes seizure therapy, interval therapy and surgery. You will also receive information on how to prevent Menière's disease.

Seizure therapy

This treatment only tries to combat the symptoms, but not the cause itself. Doctors also speak of so-called symptomatic therapy. Typical symptoms of Meniere's disease are tinnitus, hearing loss and dizziness. In the acute attack situation, nothing is initially done therapeutically against tinnitus and hearing loss, especially since these symptoms usually regress completely, at least at the beginning of the disease.

The attacks of dizziness are treated with an anti-vertiginous drug (against dizziness) or an anti-emetic (against nausea). The drug of choice here is dimenhydrinate, which has an inhibitory effect on the H1 receptors in the vomiting center of the central nervous system and can thus alleviate nausea and dizziness. Bed rest is also recommended. If vomiting occurs frequently and severely during an attack, this loss of fluids and electrolytes must be compensated for. This is usually achieved with appropriate infusions.

Prophylaxis of further seizures

To prevent an attack of Menière's disease, psychological stressful situations should be avoided as far as possible. It is also important for the family doctor to set the blood pressure correctly so that a drop in blood pressure (hypotension) is avoided. Treatment of the cervical spine may also be useful.

Interval therapy

Interval therapy is the treatment that takes place between the individual attacks. The drug of choice here is betahistine. This is an antiallergic drug that is also effective against dizziness. It is still uncertain whether betahistine really has a positive effect on Menière's disease, but it is still used regularly in treatment.

Operative treatment measures

If Menière's disease can no longer be controlled by drug therapy or prophylactic behavior, only surgical therapy remains. A distinction is made between two options:

1. On the one hand, a transection of the equilibrium nerve (vestibular nerve) comes into question. Doctors call this a vestibular neurotomy.
2. On the other hand, the labyrinth can be removed, a so-called labyrinthectomy. With this method, the organ of equilibrium and the hearing organ are removed and the patient is deaf after the operation. This is why this surgical procedure is only used on Menière's disease sufferers who have already lost their hearing and are deaf.

Intratympanic gentamicin instillation is a less invasive method of “switching off” the labyrinth. Gentamicin has a toxic effect on the inner ear or the labyrinth and destroys it when it comes into contact with the labyrinth. The gentamicin is instilled through the eardrum into the middle ear (= intratympanic) and from there gets into the inner ear, where it destroys the labyrinth.

forecast

How Menière's disease will progress in detail cannot be precisely predicted. In most cases, however, the disease is chronic. There can be only a few days between attacks, but months or even years. Attacks of dizziness usually decrease as the disease progresses, with the hearing loss progressing and leading to numbness.

Meniere's disease and hearing aids

Hearing impairment associated with Menière's disease can lead not only to acoustic but also to social isolation. Hearing aids are designed to help prevent this. The fluctuating hearing ability in the course of the illness requires regular regulation of the hearing aid - patients are nevertheless recommended not to forego this important communication aid.

  • Hearing impaired by Menière's disease is significantly improved with the help of hearing aids.
  • Easier hearing and understanding of fellow human beings and the entire environment.
  • Active participation in the environment is made easier through improved hearing.
  • Acoustic and social isolation is prevented.
  • Even if the hearing ability fluctuates in the course of Menière's disease and hearing aids have to be regulated regularly, they promise a valuable plus in quality of life.
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