Meniere’s Disease was first described by Prosper Meniere in 1800s. It is characterized by episodes of giddiness, tinnitus and hearing loss or fullness in the ears. It may be preceded by an aura of twinkling in front of eyes, heaviness in head etc. Each episode typically lasts for few minutes to hours. The symptoms are likely to be worse as the episode progress. The hearing loss slowly becomes permanent. There is never a loss of consciousness. Rarely the giddiness is so sudden that patient may fall down.
Causes
The exact cause of Meniere’s Disease is not known. It is hypothesized that there is an increased fluid collection in the inner ear called Endolymphatic Hydrops. Till the pressure in inner ear is high, patient is symptomatic. Once the pressure reduces, patient improves. All efforts at treatment are made to prevent and treat the increase in inner ear pressure.
Evaluation
During the episodes of giddiness, tinnitus and hearing loss or fullness in the ears, Audiometry shows a low frequency sensorineural hearing loss, VNG and ECoG will be positive for vertigo due to Meniere’s Disease. Between the episodes the results may be normal. MRI Brain and ECG may be advised to rule out brain stroke and heart attack respectively.
Treatments
Commonly prescribed drugs include Betahistidine (VertinTM) and Prochlorperazine (StemtilTM) to control the giddiness. Diamox TM may be prescribed to reduce the collection of fluid in the body. A salt restricted diet is advised. If any other specific trigger is identified, the same is avoided. Low doses of medicines are continued to prevent further episodes. Regular walks and exercise are recommended. Normal day to day activity need not be restricted. Driving, climbing heights or carrying firearms are to be avoided.
Surgery is recommended to people who receive little or no benefit from medicines. Injection of steroid into the middle ear space allows it to slowly seep into inner ear and has shown beneficial effect in many patients. Other surgeries aim to control the production and outflow of inner ear fluid. Patients with severe hearing loss may be advised more radical surgeries.
While Meniere’s Disease is a common cause of giddiness. Every vertigo is not due to Meniere’s Disease. A combination of clinical examination and testing helps in accurate diagnosis. Most episodes can be easily controlled and prevented. Surgery is the last resort in resistant cases.
The author is a the Director ENT and Cochlear Implant, BLK-Max Super Speciality Hospital.