Meniere

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Meniere's Disease
Definition
Meniere's disease is a disorder of the labyrinth in the inner ear. The labyrinth is a system of cavities and canals in the inner ear that affects hearing, balance, and eye movement.
The Inner Ear

Causes
An increase in the volume or pressure of fluid in the labyrinth can result in Meniere's disease. The cause of these fluid changes is unknown. Possible causes may include:
• Part of the labyrinth ruptures, allowing fluid in different compartments to mix
• Scar tissue causes a blockage in the labyrinth
• Inner ear injury due to:
o Viral infection
o Syphilis, a type of sexually transmitted disease
o Autoimmune disorders
o Blood vessel problems
o High cholesterol or other fats in the blood
o Hormonal disorders
o Medications, such as antibiotics and chemotheraypy agents
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for Meniere's disease include:
• Age: 20-60
• Race: Caucasian
• Stress
• Allergies
• Excess salt in the diet
• Excess noise
Symptoms
The intensity of symptoms can vary from one person to another. Symptoms usually come on suddenly. They typically involve only one ear, but may involve both.
Symptoms may include:
• Episodes of vertigo (spinning sensation), often accompanied by:
o Nausea or vomiting
o Sweating
o Paleness of the skin
o Weakness or falling
o In some cases, headache or diarrhea
• Hearing loss may worsen during attacks of vertigo
• Tinnitus (ringing in the ears)
• Feeling of fullness or pressure in the ear
• Poor sense of balance
• A tendency for symptoms to worsen with movement
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. This will include an examination of your ears.
Tests may include:
• Blood tests–to check for an underlying cause
• Hearing test–this is also called an audiometry
• Electronystagmogram–a type of eye movement test
• Auditory Brainstem Response–measures electrical activity in the hearing nerve and brain stem
• Electrocochleogram–measures electrical response of the inner ear to sound
• MRI Scan–a test that uses magnetic waves to make pictures of structures inside the ear
Treatment
Treatment may include:
Dietary and Lifestyle Changes
These may help limit symptoms:
• Bed rest during acute attacks of vertigo.
• Avoid foods that are high in salt and high in sugar.
• Drink adequate fluids.
• Promptly begin replacing fluids lost to heat or exercise.
• Avoid caffeine, aspirin, and smoking.
• Minimize stress.
• Avoid medications that seem to bring on or worsen symptoms.
• Consider a hearing aid, if necessary.
• Consider masking devices (white noise) to limit the effects of tinnitus.
• Take safety measures to avoid falling.
• Consider getting exercise therapy to rehabilitate the inner ear.
• Chocolate restriction.
• Reduce alcohol intake.
Medications
Medications include:
• Drugs to treat vertigo, such as meclizine or scopolamine
• Antiemetics–medications to help control nausea
• Other medications that may improve hearing, control inner ear swelling, or limit overall symptoms, including:
o Antihistamines
o Cortisone drugs for a short time
o Antidepressants or antianxiety medications
o Diuretics
• Aminoglycoside therapy (such as streptomycin or gentamycin) to permanently destroy the part of the inner ear that deals with balance
Surgery
Surgical procedures include:
• Endolymphatic sac decompression–removal of a portion of inner ear bone and placing a tube in the inner ear to drain excess fluid
• Labyrinthectomy–destruction or removal of the entire inner ear, which controls balance and hearing
• Vestibular nerve section
Prevention
There are no specific guidelines for preventing Meniere's disease. However, to help reduce your risk, avoid the following risk factors:
• High-salt diet
• High-sugar diet
• Excess noise
• Excess alcohol
• Stress
• Smoking
• Use of drugs that can be toxic to the ear such aminoglycosides, aspirin, and quinine