DIZZINESSPart ThreeMÉNIÈRE’S DISEASE
Ménière’s disease is a condition of the inner ear that is typically associated with the three symptoms of vertigo, hearing loss and tinnitus. The inner ear is one of the most important sense organs. It contains the sense of hearing and the sense of balance.
The disease most often manifests between the ages of 30 and 60 years, with man being slightly more affected than woman. Many patients have family members suffering Ménière’s disease. That suggests a genetic component.
The cause of Ménière’s disease has not yet been conclusively discovered. It is suspected a pathological increase of the so-called endolymph in the inner ear. The endolymph is a body fluid in the inner ear, which is rich of potassium and low in sodium similar to the liquid inside the body cells. The increase in the endolymph may be caused either by a disturbed outflow or by a resorption disorder (reuptake disorder) or by an overproduction of the endolymph. This increase of the endolymph volume is said to result from the rupture of an inner membrane that normally separates two compartments. The crack leads to a shift of the potassium from one compartment to the other and thus changes the function of the inner ear cells. The consequences are disorders of balance and hearing. The attacks can last from a few minutes to hours.
The symptoms in an acute attack are characterized by:
– Dizziness: mostly rotatory vertigo, often accompanied by nausea, vomiting and loss of orientation. The patients describe the dizziness in many different ways. Some as if they are loosing ground under their feet, other as if the environment is rotating.
– Hearing loss: fluctuating, unilateral hearing loss during the attack, initially only for low tones, later for all frequencies.
– Tinnitus: ear noises on the diseased side, possible sensation of pression in the affected ear.
In the symptom-free period, the patients have no dizziness. However, tinnitus, pressure in the ear and hearing loss can persist chronically. Rarely, both ears are affected. The hearing loss can increase over the time. It does not come to a complete deafness.
Accompanying the main symptoms of Ménière’s disease may be a nystagmus (uncontrolled eye movements) with the difficulty to fix an object with the eyes, as well as vegetative symptoms such as accelerated cardiac frequency and sweating.
The diagnosis of Ménière’s disease can be made when at least 2 spontaneous attacks lasting at least 20 minutes ouccure, tinnitus is present and the hearing loss can be confirmed by objective audiometric measurement.
Currently there is no causal therapy for Ménière’s disease. There are several medications available to reduce attack severity and frequency, and to treat concomitant symptoms. In severe cases, which do not respond sufficiently to the pharmacotherapy, medications and surgical interventions can be considered which disactivate definitely the organ of the equilibrium.
All measures should be discussed with the attending physician.
There is an increased risk of falling during the attacks. Absolut rest is recommended.