Meniere's disease - what is it? Symptoms, diagnosis and treatment of the disease

What is it - Meniere's disease? This is a disease of the inner ear. It manifests itself as quite frequent bouts of dizziness. Symptoms such as nausea, tinnitus, vomiting, and progressive hearing loss are also possible. To diagnose this pathology, it is necessary to carry out otoscopy (examination of the eardrum), a study of the functions of the hearing and vestibular analyzers using various methods.

Treatment is initially carried out by conservative methods. But in the event that this is not enough, surgical correction and hearing replacement are performed. Next, we consider in more detail what kind of disease it is, how it manifests itself and how it is diagnosed and treated.

General pathology information

Consider what it is - Meniere's disease, in more detail. Pathology was first described by a French doctor 150 years ago. Therefore, the name of the disease carries his last name. The disease can occur among people of different ages - from 17 to 70 years old, children are almost not affected by this ailment.

More often, people aged 30 to 50 years suffer from it. No gender differences have been identified. Usually, the disease can affect the inner ear only on one side, but in 10% of cases, the pathological process may be initially bilateral. Sometimes, during a long existence, the disease transforms into a bilateral form.

Causes

There is no specific reason for the development of Meniere's disease. It is believed that its symptoms are due to an increase in endolymph pressure in the inner ear, which is located in the thickness of the temporal bone. It consists of semicircular canals and the vestibule, as well as the cochlea. This formation is an organ of balance and hearing.

An increase in pressure in the structure of the inner ear occurs due to an increase in the amount of endolymph. This leads to impaired perception of sound vibrations, and therefore to impaired hearing, balance and coordination, that is, vestibular changes occur. Various factors can serve as prerequisites for increasing endolymph pressure, among which the following stand out:

• The appearance of viral diseases of the inner ear (especially herpes and cytomegalovirus). The role of these viruses is not to damage the structure of the inner ear, but to trigger autoimmune processes. Thus, antibodies are produced not only against viruses, but also against the cells of the inner ear. In this case, even after complete recovery and cure of the virus, the damage process continues.
• The appearance of an allergic reaction. In this case, the mechanism of the development of the disease is similar to that of viral infections.
• Getting head injuries in which the temporal bone is damaged.
• The development of vascular disorders, against which the blood flow in the inner ear changes.
• The presence of anomalies in the structure of the inner ear. In this case, the width of the channels plays a role along with the volume of the paths that conduct fluid in the ear.

It is far from always possible to trace the relationship of Meniere's disease with the above factors. There are cases of a hereditary predisposition to this disease, when it was detected in each generation, which indicates the existence of genetic dependence.

Forms of pathology

In total, three forms of the disease are distinguished, depending on the patient's symptoms:

• Cochlear form, against which among the clinical symptoms, hearing impairment predominates.
• Vestibular form. In this case, the main manifestation is an imbalance and coordination.
• The classic form that combines auditory and coordinating disorders.

In general, Meniere's disease is characterized by a paroxysmal course. In the event that immediately between the attacks the patient's condition is completely restored, they talk about the reversible stage of the disease. But, even when hearing impairment is present even in the interictal period, then they speak of an irreversible stage. In terms of frequency and duration of attacks, several more forms of the disease are distinguished, namely:

• The development of a light form. Against the background of this form, seizures are very short: from a few minutes to a couple of hours. They can be repeated every few months or years.
• The form of moderate severity. In this case, the attack lasts up to five hours. And after him, the patient is incapacitated for several days. Such attacks can be repeated no more than once a week.
• In severe cases, seizures last more than five hours. Such an attack can occur once a day. The patient's ability to work is lost.

The following are symptoms of Meniere's disease.

Symptoms of the disease

What are the symptoms of pathological attacks? As a rule, the following symptoms are observed in patients:

• The appearance of sudden and sharp dizziness. The emergence of a sense of rotation of objects in the world around him, as if he were turning over. With any movements, dizziness intensifies and is almost always accompanied by nausea with vomiting. Patients at the same time can neither sit nor stand. They try to lie with their eyes closed and not move. In that case, if you ask the patient to touch the nose with his eyes closed while lying down, he will not be able to do this. At the same time, patients cannot even get into the area of ​​the face. Any movement of the limbs can increase nausea and vomiting. Thus, the coordination itself at the time of the attack is sharply violated. What other signs of Meniere's disease are possible?
• Auditory changes. Patients may experience immunity to low frequency sounds. And loud sounds with noise cause an extremely unpleasant sensation with pain in the head. Tinnitus may also occur without the actual sound source.
• The appearance of sensations in the ear. Presence of congestion, pressure, bursting and simply discomfort in the ear.
• The appearance of autonomic symptoms. The patient has nausea along with vomiting, excessive sweating, an increase in the frequency of contractions of the heart, a decrease in pressure, a pale face and shortness of breath.
• The appearance of oscillatory involuntary movements of the eyeballs.

Before the onset of Meniere's disease, patients may experience minor disturbances in coordination, manifested in the instability of the patient. Immediately after the attack, lasting from a couple of minutes to several hours, the patient may feel overwhelmed and tired. In this case, patients complain of headaches and drowsiness.

For some time, a disturbance in coordination may persist along with instability, hearing loss and a staggering gait. As the disease develops, the periods of post-attack phenomena lengthen, and over time, the intervals of normal well-being are completely lost. In a similar situation, the disease gradually becomes irreversible.

It should be noted that at the beginning of this disease in patients only the perception of low-frequency sounds is disturbed, but the ability to hear the entire range of sound vibrations is gradually lost. Each new attack can lead to even greater hearing impairment. As a result, deafness occurs in a person.

As a rule, with hearing loss, dizziness attacks disappear. The following factors that trigger seizures are identified: stress along with drinking alcohol, drinking coffee, smoking and inhaling tobacco smoke, fever, lack of sleep and excess salt in food.

Sometimes attacks develop suddenly, which can cause a person to fall and cause injury to himself. A fall on the carriageway on the street can become especially dangerous, since patients will not be able to stand up and move as a result of vestibular disorder even if the fall does not lead to injury.

The disease is characterized by an unpredictable character. The frequency of seizures, with their duration and severity, may increase or decrease. What is it - Meniere's disease, now it’s clear. But how to identify the pathology?

Diagnostic Principles

Immediately before the appointment of the examination, patients with suspected this disease undergo otoscopy. As part of the diagnosis, the characteristic clinical picture of the attacks is taken into account. A hearing test is also being conducted. Tests are carried out with a tuning fork, which make it possible to determine all the nuances associated with damage to the inner ear.

It is mandatory to carry out audiometry. Against the background of tonal audiometry as a diagnosis of Meniere's disease, patients observe changes in the perception of low frequencies. Against the background of disease progression, the general audibility of any frequencies decreases, and the depth of hearing impairment, in turn, increases. In the framework of suprathreshold audiometry, a positive phenomenon of accelerated volume increase is determined.

Vestibular disorders are confirmed by a number of different methods, for example, vestibulometry, stabilography, analysis of spontaneous nystagmus and the like are used. In addition, methods are used to diagnose the disease, which confirm an increase in endolymph and an increase in its pressure. For this, dehydration tests are carried out along with electrocochleography.

Electrocochleography makes it possible to register electrical impulses. Changes in the amplitude of the recorded action potential along with their duration make it possible to determine whether there is an excess of endolymph with an increase in its pressure within the inner ear.

Diagnosis of this disease requires compulsory computed tomography of the brain. This is done in order to exclude other causes of symptoms that are similar to Meniere's disease. Similar symptoms have, for example, auditory nerve neuroma along with multiple sclerosis, circulatory disorders, and so on.

For the purpose of differential diagnosis, echoencephalography, electroencephalography, rheoencephalography, ultrasound examination of the vessels of the head, and, in addition, the analysis of auditory potentials are performed. In most cases, such a comprehensive application of various diagnostic techniques makes it possible to correctly establish a diagnosis. Now we know the symptoms. The treatment of Meniere's disease is discussed below.

Therapy

It is generally accepted that the disease is incurable. But you can stop its progression and minimize symptoms. Treatment for this disease should be comprehensive. Only the simultaneous use of a number of methods makes it possible to alleviate the suffering of the patient.

The first step in treating Meniere's disease should be a diet. Some nutritional recommendations make it possible to influence the metabolic processes in the region of the inner ear. The restriction of salt intake along with the rejection of alcohol and coffee contribute to a decrease in endolymph pressure, which means that the appearance of seizures will be more rare. Quitting smoking and maintaining a healthy lifestyle, in which a person should have enough sleep, is very important. It is important to eliminate or at least minimize the number of stressful situations.

In order to improve the stability of the vestibular apparatus, patients are prescribed special exercises that allow it to be trained, increasing the threshold of its excitation and contributing to an overall improvement in coordination of the whole body. Reviews of the treatment of Meniere's disease are presented at the end of the article.

Medical treatment

Medication, as a rule, consists in the use of various drugs directly at the time of seizures to eliminate them. Also, medications should be used in the interictal period. Relief of attacks is carried out using the following medications:

• The use of anticholinergics in the form of “Atropine”, “Platifillin” and “Scopolamine”.
• Among adrenergic blockers, Pirroxan is most often preferred.
• Reception of antihistamines, for example, Meklosin along with Fenkarol, Suprastin and Diphenhydramine.
• Reception of antiemetic drugs in the form of "Tserukal" or "Sturgeon".
• Treatment with sedatives, for example, Diazepam.
• The use of drugs from the betahistine group, for example, Betaserk along with Vestibo, Vestinorm or Betagis.
• The use of vasodilators, for example, "No-shpy" or nicotinic acid.

If possible, medications should be used in injectable form. In the interictal periods, treatment is carried out with the aim of preventing subsequent attacks and reducing the symptoms of the disease. For these purposes, the following drugs are used:

• The use of betahistine, for example, Betaserk, 24 milligrams twice a day for a month.
• The use of diuretics in the form of "Triamteren", "Veroshpiron", "Hydrochlorothiazide" and "Diacarba", which lead to a decrease in endolymph pressure. Their use requires dietary correction, since such drugs remove potassium from the body. In this regard, foods such as apricots, potatoes and bananas need to be additionally included in the diet. If necessary, potassium medications are additionally prescribed, for example, Asparkam or Panangin.
• Venotonic treatment, for example, “Eskuzan” along with “Troxevasin”, “Detralex” and “Phlebodia”.
• The use of drugs that normalize microcirculation, for example, Pentoxifylline or Trental.
  

Surgical treatment

Doctors resort to this type of treatment if the conservative technique is ineffective. The goal of surgical therapy is to improve the outflow of endolymph along with a decrease in the excitability of the vestibular receptors and with the preservation, and, in addition, with improved hearing. All operational methods of exposure for this disease are divided into several of the following types:

• The draining type of surgical intervention is aimed at improving endolymphal outflow.
• The destructive type of surgical intervention allows you to interrupt the transmission of impulses.
• During operations on the autonomic nervous system, the cervical sympathetic nodes are removed by resecting the drum string.

Unfortunately, a certain proportion of operations that are performed on the structure of the inner ear leads to hearing loss. This circumstance serves as an incentive for finding alternative options for combating the disease.

Such methods include a chemical labyrinthectomy, which involves the introduction of small doses of gentamicin into the tympanic cavity. Gentamicin is an antibiotic that can cause the process of death of the vestibular apparatus cells. Due to this, interruption of impulses from the affected side is achieved, the healthy ear takes on the direct function of balance.

For the same purpose, alcohol with streptomycin is used. A bilateral form of Meniere's disease gradually leads the patient to complete hearing loss. In this case, a hearing replacement is prescribed.

We also consider the treatment of the symptoms of Meniere's disease with folk remedies.

It can be prescribed in combination with medications:

• Nettle, bearberry, St. John's wort, plantain, and dogrose - all this must be mixed in equal proportions. Raw materials are poured with boiling water, infused for about an hour, filtered and taken half a glass three times a day for 2 weeks.
• Licorice, juniper, lovage - mix, pour boiling water and insist. The course of taking half a cup 2 times a day - 10 days. Treatment of Meniere's disease with folk remedies should be under the supervision of a physician.
• Parsley, celery, carrots, potatoes, flax seed and wheat bran. Vegetables are boiled for 15 minutes, then the water is drained, seed and bran are added to it, placed in a thermos and infused for 8 hours. A broth is taken on an empty stomach in the morning.
• Combine camphor and menthol oils with tinctures of hawthorn and valerian, add sugar, take between breakfast, lunch and dinner.
• Horsetail and birch leaves pour boiling water, insist, take on an empty stomach for 2 weeks.
• To make sunflower roots as usual tea. Take within a month.

Alternative treatment of Meniere's disease can be very effective.

Disease prognosis

This disease does not threaten life and does not shorten its overall duration. But pathology is unpredictable. It is characterized by steady progression, and, in addition, a wavy course. Such a diagnosis implies certain limitations in the framework of professional activity. For example, such patients are contraindicated working at height, in noise, as well as driving professions and so on. A sharp violation of coordination with hearing loss can cause disability in Meniere's disease. What is it, we explained. Now consider the opinions of those who are faced with this ailment.

Reviews of Meniere's Disease

Reviews about this disease are abundant. Patients are very tormented by unpleasant symptoms. This disease is not fatal, but an insidious disease that can cause a lot of inconvenience and trouble in everyday life, often causing a person to lose his ability to work.

This disease is treated in many ways, slowing its progression and preserving hearing whenever possible. According to reviews, therapy will be effective if medications and alternative methods are combined. We examined the symptoms, treatment of Meniere's disease and reviews of this pathology.