Ménière’s disease is a pathology of the inner ear in which the patient presents hearing loss and, above all, balance problems.
This medical condition usually affects only one ear, and can occur in adulthood and middle age.
Although there is no known cure for Ménière’s disease, there are some treatments that help reduce its symptoms and the frequency of vertigo attacks. Let’s discover in more depth what the particularities of this hearing disorder are.
Ménière’s disease is an otorhinolaryngological disorder in which the inner ear is affected. The patient who suffers from this disease suffers from episodes of dizziness and vertigo, as well as partial hearing loss
In most cases, only one ear is affected. It can manifest at any age, but usually appears in early adulthood and middle age between 20 and 50 years. It is considered a chronic disease, although there are treatments to reduce the symptoms and long-term impact.
Symptoms of this pathology
Among the symptoms of Ménière’s disease we find the following.
1. Recurrent episodes of vertigo
Patients with Ménière’s disease have the sensation of spinning with recurrent episodes of vertigo that begin and end spontaneously These occur without prior notice, lasting between about 20 minutes and several hours. In some severe cases they last 24 hours, but no longer. As a result of intense vertigo, the patient may feel nauseated.
These episodes of vertigo can cause the patient to lose balance suddenly, which increases the risk of falls and accidents. As they are unpredictable, the affected person can suffer a lot of anxiety and stress, greatly affecting their quality of life.
2. Hearing loss
Hearing loss from this disease is a symptom that can come and go, especially at first. Over time, most patients with Ménière’s end up losing part of their hearing permanently
3. Tinnitus
Tinnitus is a kind of ringing that is heard inside the ear, at different volumes and sonic frequencies They may also manifest in the form of ringing, roaring or whistling in the ear, not produced by apparent external auditory stimulation.
4. Hearing congestion
Patients with Ménière’s disease often feel pressure in the affected ear
After having suffered an episode associated with the disease, the signs and symptoms may improve and even disappear completely temporarily. There are many cases of patients in whom the frequency of episodes of hearing loss and dizziness decreases.
Causes
It is not well known what causes Ménière’s disease, although Your symptoms have been associated with an abnormal amount of fluid in the ear, called endolymph (endolymphatic dropsy). This fluid is kept in a bag-shaped structure called the endolymphatic sac that is continually secreted and reabsorbed, maintaining a constant amount in the ear of healthy people.
Both an increase in the production of this fluid and a decrease in its reabsorption will result in an excess of endolymph. Although this phenomenon has been associated with Ménière’s disease, it is not known why this pathological production and reabsorption of this fluid occurs.
Possible causes include inadequate fluid drainage due to an obstruction or anatomical abnormality, as well as an abnormal immune response and viral infection.
Diagnosis
There are several diagnostic procedures to see if a patient has Ménière’s disease or not. The person in charge of this diagnosis must be a medical professional specialized in otorhinolaryngology or who has knowledge of Ménière’s disease and other ear disorders. The diagnosis of this disease requires that the following requirements be met
1. Balance assessment
In the period between episodes of vertigo, the sense of balance returns to normal in most cases. However, the patient may have ongoing problems with balance, which is why Different tests are applied to check the degree of affectation and if there is a possibility of recovery
Among the balance and hearing evaluation tests we have the following.
2. Audiometry
In audiometry It is evaluated whether the patient is able to detect sounds of different pitches and volumes, in addition to checking if you are able to distinguish between words that sound similar. Patients with Ménière’s disease often have problems hearing at low frequencies or combinations of high and low frequencies. Your hearing is normal for midrange frequencies.
3. Videonystagmography
Videonystagmography examines balance function by evaluating eye movement In the inner ear there are sensors that are related to balance and connect with the muscles that control eye movement. This connection is what allows us to move our head while keeping our eyes fixed on one point.
4. Rotating chair tests
Rotating chair testing, as the name suggests, involves having the patient sit in a computer-controlled rotating chair that will stimulate the inner ear. This test measures the function of the inner ear according to eye movement just like the previous test does.
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The sense of human balance not only depends on our inner ear, but also on vision, the sensations of the skin, muscles, tendons and joints and, if any of them fails, it can explain the patient’s vertigo and dizziness.
Posturography is a computerized test in which It is observed which part of the balance system the patient depends on most and which parts may be behind the problem In this test, the patient is asked to put on a safety harness, walk barefoot on a platform, and maintain balance under various conditions.
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6. Head impulse test with video
The head impulse test consists of measuring eye reactions to abrupt movements
The patient will have to concentrate on one point, looking at a target through which their eye behavior will be recorded. While the test is being performed, you will be made to turn your head quickly and unpredictably. If you take your eyes off the target while your head is turned, it means you have abnormal reflexes.
7. Electrocochleography
Electrocochleography allows us to observe the response of the inner ear to sounds. This technique can be helpful in determining if there is any endolymph buildup in the inner ear although it should be said that it is not specific for Ménière’s disease.
Treatments
Ménière’s disease does not have a complete cure for now, although treatments are available that can help reduce the severity of the symptoms and the frequency of vertigo episodes. However, there are no treatments for the hearing loss associated with this medical condition. Below we present the set of therapeutic options for this disease.
1. Medications for vertigo
The doctor can prescribe drugs for vertigo episodes and reduce their severity while an attack occurs. Among them we can highlight meclizine or diazepam, which may reduce the sensation of spinning and help control nausea and vomiting Additionally, anti-nausea drugs such as promethazine are also prescribed.
In anticipation of the possible long-term effects of the disease, the doctor may prescribe drugs for fluid retention such as diuretics, in addition to suggesting limiting salt consumption. For some patients, this combination helps control the severity and frequency of Ménière’s disease symptoms.
Some people with this disease may benefit from non-invasive therapies and procedures. The two main ones are rehabilitation and hearing aid implantation
Vestibular rehabilitation therapy could significantly improve the balance of people suffering from vertigo episodes.
Hearing aids for the ear affected by Ménière’s disease can improve the patient’s hearing. It is essential that the doctor refer to an audiologist to see what the best hearing aid options are for the patient in their case.
3. Middle ear injections
More invasive interventions, including middle ear injections, are necessary in some patients. Drugs are injected into the middle ear and then absorbed into the inner ear, improving the symptoms associated with vertigo. The drugs used in these techniques are the following.
3.1. Gentamicin
Gentamicin is an antibiotic toxic to the inner ear. This substance reduces the balance function of the ear, causing the unaffected ear to take responsibility for balance It is considered a risky treatment since there is a risk of worsening hearing loss.
3.2. Steroids
Steroids such as dexamethasone may help control vertigo attacks in some patients In the specific case of this drug, this substance is less effective than gentamicin but is less likely to aggravate hearing loss.
4. Surgical interventions
Surgery is a resource used when Ménière’s disease is severe and debilitating and other treatments have been proven not to help. Among the surgical procedures to treat this disease we have the following.
4.1. Endolymphatic sac procedure
As we have seen before, the endolymphatic sac is responsible for regulating endolymph levels. In Ménière’s disease, this structure is altered, which is why a therapeutic procedure consists of decompressing this structure which can reduce excess fluid In some cases, this surgical intervention is combined with the placement of a tube that drains excess fluid from the inner ear.
4.2. Labyrinthectomy
In labyrinthectomy The balance portion of the inner ear is removed, consisting of a very aggressive treatment since both the hearing function and the sense of balance of the affected ear are lost. This procedure is only carried out when there is already total loss in that ear.
4.3. Vestibular nerve section
Finally, one of the surgical treatments to correct Ménière’s disease is the section of the vestibular nerve. Basically, involves cutting the nerve that connects balance and motion sensors in the inner ear to the brain It is applied with the intention of preserving hearing in the affected ear, but eliminating the affected ear’s sense of balance.
