Meniere's Disease
Background:
Signs and Symptoms:
Treatment:
- Meniere's disease manifests with an over-accumulation of endolymphatic fluid in the inner ear. The particular etiology is unknown, but endolymphatic hydrops are the presumed pathology. The hydrops lead to build-up of pressure in the membranous labyrinth of the inner ear. This pressure results in micro-ruptures producing episodic attacks of vertigo (Lee, 2012). Several proposed causative factors include: ischemia of the inner ear or endolymphatic sac, trauma, genetic predisposition, developmental temporal bone abnormality, auto-immune mechanisms, or a viral infection of the inner ear or endolymphatic sac (Beyea, 2012). Meniere's disease is most commonly seen in middle-aged individuals and rarely in people over the age of 65 (Lee, 2012). Bilateral involvement occurs in 24% of cases in individuals with Meniere's disease (Lee, 2012).
Signs and Symptoms:
- Recurrent, but intermittent episodes of vertigo (Simonsen, 1996)
- Attacks last from minutes to hours (Simonsen, 1996)
- Episodes of vertigo are rotary in nature (Lee, 2012)
- Low-tone sensory neural hearing loss (Lee, 2012)
- Tinnitus (Lee, 2012)
- Aural fullness (Lee, 2012)
- Nausea and vomiting (Lee, 2012)
- When Meniere's disease is suspected the patient should be checked for nystagmus with various vestibular techniques, such as the head shaking test (Lee, 2012).
- Meniere's disease is classified as peripheral vertigo, the nystagmus will be horizontal or torsional (Lee, 2012).
- The nystagmus can be suppressed with visual fixation (Lee, 2013).
- Diagnosis should also be based on the patient's history, hearing loss, and duration of symptoms (Post, 2010).
Treatment:
- Hearing loss will return with healing of the micro-ruptures in the labyrinth. Spontaneous remission takes place in 60-80% of cases, while 10-20% have intractable symptoms (Lee, 2012).
- Medical treatment includes vestibular sedatives and anti-emetics during the acute attack (Lee, 2012).
- Diet modifications include a low-salt diet, diuretics, vasodilators, and avoidance of caffeine (Lee, 2012).
- For intractable symptoms, endolymphatic sac surgery or ablative surgery (vestibular neurectomy and labyrinthectomy) can be used (Lee, 2012).
- Intratympanic dexamethasone or gentamicin may resolve symptoms as well (Post, 2010).
- Patients should be referred to an Otolaryngologist (Post, 2010).
- Post operatively, after neurectomy, labyrinthectomy, or after gentamicin injections, patients compensate more quickly if they take part in vestibular rehabilitation (Alghadir, 2013). (See Treatment Tab)
- The head shaking test for 20 seconds, can be used to induce nystagmus (Post, 2010). (See Special Test Tab)
- A positive test indicates a peripheral cause of vertigo (Post, 2010).
- The direction of the nystagmus reveals the involved side (Post, 2010).
- Romberg test and observation of gait can also be used. Swaying towards one side during the Romberg test indicates vestibular dysfunction on the ipsilateral side (Post, 2010). (See Special Test Tab)