Mr Nigam ENT Treatments - Meniere's Disease
In 1861, the French physician Prosper Ménière described a condition which now bears his name. Meniere's disease is a disorder of the inner ear that causes episodes of vertigo, ringing in the ears (tinnitus), a feeling of fullness or pressure in the ear, and fluctuating hearing loss.
Symptoms
A typical attack of Meniere's disease is preceded by fullness in one ear. Hearing fluctuation or changes in tinnitus may also precede an attack. A Meniere's episode generally involves severe vertigo (spinning), imbalance, nausea and vomiting. The average attack lasts two to four hours. Following a severe attack, most people find that they are exhausted and must sleep for several hours. There is a large amount of variability in the duration of symptoms. Some people experience brief "shocks," and others have constant unsteadiness. The majority of people with Meniere's disease are over 40 years of age, with equal distribution between males and females.
Meniere's episodes may occur in clusters; that is, several attacks may occur within a short period of time. However, years may pass between episodes. Between the acute attacks, most people are free of symptoms or note mild imbalance and tinnitus.
Meniere's disease usually starts confined to one ear but it often extends to involve both ears over time so that after 30 years, 50% of patients with Meniere's have bilateral disease . In most cases, a progressive hearing loss occurs in the affected ear(s). A low-frequency sensorineural pattern is commonly found initially, but as time goes on, it usually changes into either a flat loss or a peaked pattern . Although an acute attack can be incapacitating, the disease itself is not fatal.
Meniere's disease affects roughly 0.2% of the population. Interestingly, the Framingham study found that 2% of the population of the United States believe they have Meniere's disease, suggesting that there is considerable chance of misdiagnosis.
An acute attack of Meniere's disease is generally believed to result from fluctuating pressure of the fluid within the inner ear. A system of membranes, called the membranous labyrinth, contains a fluid called endolymph. The membranes can become dilated like a balloon when pressure increases. However, for the most part, the underlying cause of Meniere's disease is unknown. It is most often attributed to viral infections of the inner ear, head injury, a hereditary predisposition, and allergy.
Investigations
Diagnosis is based on a combination of the right set of symptoms (usually episodic dizziness and hearing disturbance); hearing tests, which document that hearing is reduced after an attack, and then gets better; and exclusion of alternative causes. The process of diagnosis usually includes hearing testing (audiometry), an ENG test, and an MRI scan of the head. Electrocochleography (ECOG) is helpful in difficult cases.
Hearing tests often begin with showing a fluctuating low-frequency sensorineural hearing loss. Over years, this gradually progresses to a "peaked" pattern with both low- and high-tone reduction, and finally a "flat" pattern, typically 50 db loss (110 db would be completely deaf).