Ménière's Disease

Cause

Ménière's disease is also known as endolymphatic hydrops. It is a disorder resulting from the distention of an endolymph-filled compartment in the inner ear. It is thought that the symptoms of Ménière's disease are due to the increase of endolymph volume. Although most cases of Ménière's disease are sporadic, some genetic components related to mutation in the cochlin gene on chromosome 14q12–q13 have resulted in earlier onsets and familial occurrence. Typically, Mé-nière's disease inflicts both men and women equally between the ages of 20 and 50.

Symptoms and Risks

Patients’ chief complaints consist of episodic vertigo (lasting from one to eight hours), tinnitus, and sensorineural hearing loss. These comprises the four symptoms of the “classic Ménière's disease”: (1) abnormal sensation of movement and dizziness, (2) perception of ringing noise in the ears in the absence of a sound source, (3) fluctuating loss of hearing in the lower frequency range in one or both ears, and (4) the sensation of pressure or fullness in the ears. The symptoms of Ménière's disease can be debilitating as they involve the sense of balance and orientation to the outside world. The disease can be accompanied by nausea and vomiting. Acute attacks occur in intervals of weeks to years. These attacks are characterized by vertigo, nausea, and vomiting. Hearing loss is progressive and with or without bilateral involvement. As hearing loss deteriorates, vertigo tends to become less severe.

The actual pathogenesis of endolymph swelling is unknown; however, it is thought that certain medical conditions such as otitis media (middle ear infection) and injuries to the head can lead to Ménière's disease. Additionally, environment factors such as the use of aspirin, alcohol, and cigarettes can influence the pathogenesis. It has been found that excessive consumption of caffeine and salt may exacerbate the condition in some patients.

The first line of treatment for Ménière's disease is with diuretics, such as hydrochlorothiazide and triamterene, to relieve fluid volume. Antivertigo medications, such as meclizine, and antinausea medication can also be prescribed to give temporary relief. Apart from medical treatments, a change of lifestyle habits such as maintaining a low-salt diet, getting regular sleep, and maintaining a physically active and stress-free lifestyle are also suggested. The patient should also take precautions when driving or climbing ladders if episodes of vertigo occur without warning. If Ménière's disease is persistent, debilitating, and becomes drug resistant, surgical options are considered to relief fluid buildup in the ear and/or resect the eighth cranial nerve to alleviate symptoms.

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