Meniere’s disease : symptoms, syndrome & treatment

Definition of menere’s disease : 

Synonyms : Endolymphatic hydrops.

Definition :  Menere’s disease  is a disorder inner ear where the endolymphatic system is distended with endolymph & characterized by episodic vertigo, sensorineural hearing loss, tinnitus & aural fullness. Meniere’s disease is the commonest cause of orogenic vertigo.

Symptoms of Menere’s disease :

 1) Incidence : 

• Age: Between 35-60 years.
• More common in male.
• Unilateral in 90% cases.

 2) Cardinal symptoms :

 a). Episodic vertigo:

• It comes in attacks.
• The onset is sudden.
• Rotational
• There is feeling of “to and fro” or “up and down” movement
• Attacks come in clusters, with periods of spontaneous remission lasting for weeks, months or years.

b) Fluctuating hearing loss :

• Distortion of sound.
• Intolerance to loud sounds.

C).Tinnitus :

• Low-pitched roaring type.
• It is aggravated during acute attacks.

d) Sense of fullness or pressure in the involved ear.

3) Other features : Signs of emotional upset

Signs of Menere’s disease :

1) Otoscopy : No abnormality is seen in the tympanic membrane.

2) Nystagmus :

• It is seen only during acute attack.
• The quick component of nystagmus is towards the unaffected ear.

3) Tuning fork tests :

• They indicate sensorineural hearing loss.
• Rinne test is positive.
• Absolute bone conduction is reduced in the affected ear.
• Weber is lateralized to the better ear.

Meniere’s syndrome of Menere’s disease :

Ménière’s disease is an idiopathic condition while Ménière’s syndrome, though resembling Ménière’s disease clinically (episodic vertigo, fluctuating hearing loss, tinnitus and ear fullness) results from a variety of conditions such as trauma (head injury or ear surgery), viral infections (following measles or mumps), syphilis (congenital or late acquired), Cogan’s syndrome, otosclerosis or autoimmune disorders. It is also called secondary Ménière’s disease

Investigations of Menere’s disease :

1) .Pure-tone audiometry : Sensori-neural hearing loss.

2) Speech audiometry.

3) Special audiometry tests :

• Recruitment test is positive.
• SISI (short increment sensitivity index) test. SISI score is better of the patients (normal 15%).
• Tone decay test: Normally, there is decay of less than 20 dB.

4)Electrocochleography.

5) Caloric test.

6) Glycerol test.

Treatment of Menere’s disease :

General measures :

• Reassurances.
• Cessation of smoking.
• Low salt diet.
• Avoid excessive intake of water.
• Avoid over-indulgence in coffee, tea and alcohol.
• Avoid stress and bring a change in lifestyle.
• Avoid activities requiring good body balance.

Management of acute attack :

1. Reassurance and psychological support to allay worry and anxiety.
2. Bed rest with head supported on pillows to prevent excessive movements.
3. Intravenous fluids and electrolyte administration.
4. Vestibular sedatives to relieve vertigo.
5. Vasodilators : Carbogen (5% CO2 with 95% 02) is a good cerebral vasodilator.

Management of chronic phase :

• Vestibular sedatives: Prochlorperazine (stemetil).
• Vasodilators: Betahistine (Vertin).
• Diuretics: Furosemide.
• Propantheline bromide (Probanthine).
• Elimination of allergen.
• Hormones.

Intervention : Chemical labyrinthectomy by intratympanic injection of Gentamycin.

Surgical treatment of Menere’s disease :

Conservative procedures :

1. Decompression of endolymphatic sac.
2. Endolymphatic shunt operation.
3. Sacculotomy (Fick’s operation).
4. Section of vestibular nerve.
5. Ultrasonic destruction of vestibular labyrinth.

• Destructive procedures : Labyrinthectomy.
• Intermittent low-pressure pulse therapy (Meniett Device Therapy).

Meniere’s tried :

The following three symptoms of Meniere’s disease are called Meniere’s triad

1. Episodic vertigo.
2. Progressive bearing loss
3. Tinnitus

Variants of Meniere’s disease :

1. Cochlear hydrops.
2. Vestibular hydrops.
3. Drop attacks (Tumarkin’s Otolithic Crisis)
4. Lermoyez syndrome.

Pathology of Menere’s disease :

• The main pathology is distension of endolymphatic system, mainly affecting the cochlear duct (scala media) and the saccule, and to a lesser extent the utricle and semicircular canals.
• The dilatation of cochlear duct is such that it may completely fill the scals vestibuli; there is marked bulging of Reissner’s membrane, which may even herniate through the helicotrema into the apical part of scala tympani.
• The distended saccule may come to lie against the stapes footplate.
• The utricle and saccule may show outpouchings into the semicircular canals.

Aetiology of Menere’s disease:

1. Exact aetiology is unknown. But there are some factors –
2. Defective absorption by endolymphatic sac.
3. Vasomotor disturbance.
4. Allergy
5. Sodium & water retention.
6. Hypothyroidism.
7. Autoimmune and viral aetiologies.