Meniere's disease is a pathological lesion of the cavity of the inner ear, having a non-inflammatory genesis.
It is manifested by a number of symptoms - tinnitus, dizziness, hearing loss, which can turn into complete deafness. Parallel to this, there is staggering gait and incoordination. Such symptoms are due to the accumulation of large amounts of fluid in the maze with increasing pressure inside it.
In modern otolaryngology, such a deviation is divided into 2 types: Meniere's disease and Meniere's syndrome. In the first case we are talking about a separate disease with its own nosology. In a patient's syndrome, a symptom complex is observed, the occurrence of which is associated with other, primary pathologies. According to medical statistics, Meniere's syndrome occurs much more often than the same name disease.
What it is?
Meniere's disease is a non-pusiform lesion of the inner ear, characterized by accumulation of a labyrinth of fluid with a concomitant increase in pressure in the ear maze. As a result, periodic recurrences of hearing loss, dizziness, tinnitus, autonomic disorders and coordination disorders occur.
The first case of Meniere's disease was described 150 years ago. However, the mechanism of its development and the causes of its occurrence are still the subject of scientific debate.
But there are several factors that, according to experts, can provoke this pathology. These include:
- Viral infection. This theory is based on the penetration of cytomegalovirus and HSV into the bloodstream, which are capable of provoking the disease by triggering autoimmune mechanisms.
- Heredity. Doctors point to familial cases of the incidence of this pathology, thereby justifying its autosomal dominant inheritance.
- Allergy. This is another theory of the development of Meniere's disease, which some experts adhere to.
In recent years, a special place is given to the theory of the development of this disease, based on violations of the autonomic innervation of the vessels of the inner ear. Such a cause of Meniere's disease, such as a change in the secretory activity of labyrinth cells responsible for the production of adrenaline, norepinephrine, and serotonin, is also not excluded.
Most researchers are prone to the fact that the disease in question arises due to the accumulation of the endolymph, which subsequently leads to an increase in intra-maze pressure. The excess of the labyrinth fluid can be triggered by its hypersecretion, a violation of its circulation or absorption. Under this effect, it is difficult to conduct sound vibrations, and the nutrition of the sensory cells of the maze is also disturbed.
Note. Other possible provocateurs of the disease are ear injuries, vascular disorders, hypoestrogenism, and water-salt metabolism disorders.
Symptoms of Meniere's disease
In the initial stages of the development of the symptoms of Meniere's disease, relapses are replaced by remissions without treatment. Hearing is restored, performance is saved. Transient hearing loss occurs within 2 to 3 years from the onset of the disease.
As pathology progresses, hearing is not restored even with the onset of the remission phase. Other symptoms of Meniere's disease also join hearing loss in the form of:
- Systematic dizziness. They are often accompanied by nausea and vomiting, and can be so intense that it seems to a person that all surrounding objects rotate around him. The duration of the attack can be from 10 minutes to several hours. In this case, the condition worsens when turning the head, especially sharp.
- Decrease or loss of hearing. First of all, the perception of low-frequency sounds worsens, which distinguishes Meniere's disease from true hearing loss, for which the loss of perception of high-frequency sounds is characteristic. May increase sensitivity to loud sounds, earaches when in a noisy room. Some patients also complain of "muffled" tones.
- Tinnitus and tinnitus. These sounds appear suddenly, regardless of the location of the person and the surrounding sound environment. Patients note that the ringing is similar to the "streaks of cicadas", "ringing of the bell", etc. Also, these sounds can be combined with each other. During the next attack of the disease, the nature of the ringing can change significantly.
- Pressure or discomfort in the ear caused by the accumulation of fluid in the maze. Before the next attack, these sensations become more pronounced.
Sometimes during an attack, patients suffer from diarrhea, headache, abdominal pain. There may also be pain in the ear.
The average duration of the attack is 2 to 3 hours, and after it ends, the patient suffers from loss of strength, drowsiness, and general fatigue. However, the duration of symptoms in each patient may well be different.
A relatively dangerous manifestation of pathology is the possibility of loss of balance and spontaneous fall. Coordination disorder is associated with a sudden deformation of the structures of the inner ear, which provokes the activation of vestibular reflexes. As a result, the patient has a feeling that he is beginning to swing, to sway from side to side, although at this moment he may be in a completely level position. But because of this illusion, he has to change his posture to maintain balance.
This symptom is dangerous because it occurs without precursors, that is, suddenly. If an unsuccessful fall, a person can get serious injuries. If there is such a problem, then it is often solved through the use of radical therapeutic techniques - the so-called "destructive treatment": labyrintectomy or excision of the vestibular nerve.
Exacerbations can occur at short time intervals in the form of "clusters" - a series of attacks that occur one after another. In many patients, the gap between attacks may take several years. During remission, the patient may feel an unexpressed coordination disorder, or complain of mild tinnitus.
Meniere's disease is a difficult to diagnose disease. To make a preliminary diagnosis, a study of the patient’s symptoms, medical history and otolaryngological examination data is carried out. In addition, if this pathology is suspected, additional instrumental research procedures may be assigned to patients.
During the initial examination, the doctor notes that the patient has:
- horizontal rotatory nystagmus;
- changes in vestibular reflexes;
- decrease in the severity of hearing and other previously listed symptoms, if any.
However, in the case of such a complex ailment as Meniere's disease, verification of the diagnosis is mandatory. It is based on:
- Tonal threshold audiometry. The procedure helps to reveal a progressive increase in tonal thresholds of hearing by a neurosensory type.
- Above threshold audiometry.
- Vestibulometricheskie tests. With their help, nystagmus is detected, the fast component of which is directed to the diseased side during the next bout of pathology. In the interictal period, he changes direction in a healthy way. In the remission phase, the specialist fixes the reduced sensory sensitivity on the affected side.
- Dehydration samples. Based on the results of this study, the labyrinth dropsy is detected. It is advisable to conduct a test only in the first two stages of the development of the disease - only during these periods will their data be positive.
- Electrocochler. The procedure helps to fix the electrical activity of the cochlea and the auditory nerve. In parallel, it helps to identify signs of labyrinth hydrops.
If necessary, the doctor can significantly expand the list of diagnostic procedures - everything depends on the situation. A CT scan or MRI of the head with a subsequent study of hemodynamics can be included in the examination scheme.
Important! The important role played by the differential diagnosis. It helps to completely eliminate errors in the diagnosis, and prescribe adequate treatment.
Meniere's disease must be differentiated from:
- labyrinth syndrome, developing on the background of cerebral blood flow disorders in case of vertebrobasilar insufficiency;
- syndrome of the pomi-cerebellar corner;
- benign positional vertigo, which occurs when a sharp change in the position of the body and head, and is not accompanied by noise or ringing in the ears;
- neuroma of the pre-vesicular nerve;
- posttraumatic dizziness;
- vasocompression syndrome;
- psychogenic disorders, etc.
How to treat Meniere's disease?
To cure Meniere's disease is completely impossible for today. Therefore, all therapeutic measures are aimed at stopping the progression of pathology, and establishing control over its symptoms.
Of great importance is the identification and determination of the exact factors provoking the recurrence of pathology. If we exclude their effects on the body, then the remission phase can be stretched for quite a long period of time.
In addition, it is important to follow the diet and rules of a healthy lifestyle, stop smoking, minimize alcohol consumption, and, importantly, do not overeat. As for the medical treatment of Meniere's disease, to eliminate unpleasant symptoms most often prescribed:
- Antiemetic drugs. Such drugs are selected individually, and can affect both the smooth muscles of the gastrointestinal tract and the nervous system. With their help, nausea, vomiting, bouts of dizziness are stopped. They are used only in the period of exacerbation of the disease, in the remission phase of their reception is impractical.
- Diuretic drugs. Their reception is carried out by courses, and can be appointed both in the period of exacerbation, and during the remission phase. Under the influence of drugs in this group, excess fluid is excreted from the body, which helps reduce edema and prevent endolymph accumulation in the labyrinth. But not all experts recommend the use of diuretics in Meniere's disease, so this possibility must be coordinated with the ENT doctor.
- Vasodilators The drugs in this group dilate the blood vessels, and in some cases help to eliminate headaches and alleviate the general well-being of the patient. But even this group of medications is not given to all patients with Meniere's disease or syndrome.
- Nootropics Drugs in this category are aimed at improving cerebral circulation. They normalize metabolism in the brain tissues and regulate the tone of blood vessels. Nootropic drugs can be taken not only during the exacerbation, but also during remission. However, the use of such medicines should be carried out by courses, and carried out only with the consent of the attending physician.
- Antispasmodic. These drugs have an effect on the tone of smooth muscles, including vascular. They are prescribed as needed to improve the general well-being of the patient.
In most cases, you can eliminate the attack at home. However, with repeated or persistent vomiting, the patient may be hospitalized in an inpatient hospital for intravenous anti-emetic medication.
To reduce the volume of fluid in the body, diuretics are used, which allow to reduce intra-atomic pressure. The most commonly prescribed combination is hydrochlorothiazide and triamterene. Diuretic medicines are intended for long-term use, therefore, in parallel, the patient must eat food with a high content of minerals.
In Meniere's syndrome, the patient is injected into the middle ear. Thus, it is possible to achieve an effect that is as close as possible to the result of surgery. The following drugs are used for this:
- Gentamicin is an antimicrobial agent that helps reduce the intensity of attacks and reduce their frequency. But such therapy is fraught with hearing loss, so it is carried out strictly according to the indications.
- Prednisolone or Dexamethasone - hormonal drugs that allow you to control the course of pathology. And although they are less effective than Gentamicin, they are safer, since the risk of hearing loss when they are used is much lower.
Physical therapy is carried out only in the period of remission, and is aimed at improving the blood supply to the affected area and normalizing the microcirculation of the brain. So, in Meniere's disease, they help well:
- UFO on the area of the neck area. Therapy begins with 2 biodoses, followed by an increase of 1 biodoze during each procedure. The course consists of 5 sessions held every other day.
- Darsonvalization of the neck area. 1 procedure lasts 3 minutes, the number of sessions per course is from 10 to 15.
- Electrophoresis using novocaine, sodium bromide, diazepam, magnesium sulfate. Such a PT has a calming, relaxing, analgesic effect. The duration of 1 procedure is from 10 to 15 minutes, the number of sessions per course is 10.
- Balneotherapy. With Meniere's disease, coniferous, marine, and bromine baths are indicated. The water temperature is 36 - 37 degrees, the procedure itself lasts 10 minutes. Duration of treatment is 10-15 days.
- Massage of the head and neck area. One course lasts 10 to 15 days.
Nutrition and Diet
Often, an excessive amount of endolymph is combined with the presence of excess fluid in the body or elevated blood pressure. In this situation, to get rid of the symptoms is recommended to follow a certain diet.
Food should be such that excess water is eliminated from the body, and new volumes of fluid do not accumulate in the tissues. This is especially important during the exacerbation period, although adherence to certain rules in the remission phase will be an excellent prevention of disease recurrence.
Thus, the diet for this pathology is based on:
- limited fluid intake;
- minimum salt intake (no more than 2 - 3 g per day);
- the rejection of spices, fatty dishes, smoked meats, preservation and pickles;
- the exclusion of strong black tea and coffee;
- abstaining from alcohol.
In Meniere's syndrome, in contrast to the same-name disease, edema is not always observed, therefore, it is recommended to follow the diet only during an attack. At the same time there are no special products that could help in the soonest stabilization of the patient’s condition. The diet has only one goal - to eliminate the impact on the body of food factors that can cause fluid retention in the body, thereby causing a worsening of the patient's condition, and an increase in the frequency of relapses of the disease or Meniere's syndrome.
In the absence of the effect of conservative treatment, patients are prescribed surgery. But not even the operation is the key to preserving hearing. Such therapy may be:
- Destructive. During such surgery, the doctor removes the ear labyrinth, crosses the 8th nerve branch, conducts laser destruction of the maze, or performs other destructive actions.
- Draining. Such surgical therapy is designed to stimulate active endolymph outflow from the cavity of the affected ear. To do this, the doctor may resort to drainage of the labyrinth or base of the endolymphatic bag, perforation of the base of the stirrup, etc.
It is possible to perform surgery on the autonomic nervous system, which is based on the resection of the tympanic string, the intersection of the tympanic plexus, or cervical sympathectomy. Such operations are carried out for the sole purpose: to stop the attacks of vertigo and, if possible, to preserve hearing. Due to this, it becomes possible to return the ability to work (albeit not fully, but only partially), and improving the quality of life of the patient.
The need for surgical treatment of Meniere's disease is determined individually for each patient. There are no specific indications for such a therapeutic technique, so the choice is given to both the attending physician and the patient himself.
Is Meniere's Cure Curable?
In the overwhelming number of cases, patients cannot completely get rid of this disease. This is due primarily to the fact that the causes of the development of ear pathology are still not fully understood. Thus, all the applied methods of treatment are aimed mainly at reducing the intensity of symptoms and improving the quality of life. Sometimes during surgery, doctors destroy the vestibular apparatus, causing death of receptor cells.
However, in many cases, all therapeutic measures only help to ease dizziness, improve hearing and prolong the remission phase of Meniere's disease. In general, patients have to learn to live with their pathology, since it is still impossible to completely cure it. But a person can prevent the relapse of the disease - for this it is only necessary to determine the provoking factors, and, if possible, to avoid their effects on the body.
More favorable is the prognosis of Meniere's syndrome, which is not an independent disease. Endolymph accumulation is a secondary process, the reason for which the ENT doctor knows. As a rule, the prescribed therapy is effective, and the unpleasant symptoms go away completely.
If the patient adheres to all the prescriptions of his doctor, and avoids the factors provoking the aggravation of the pathological process, he will not remind himself of himself anymore. In this case, it is safe to talk about a complete cure for Meniere's syndrome.