Meniere’s disease, Inner ear, Endolymph, Hearing loss, Spinning, Tinnitus, Vertigo

Description :   Meniere’s disease also known as idiopathic endolymphatic hydrops is a disorder of the inner ear.

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What is Meniere’s disease?

Meniere’s disease also known as idiopathic endolymphatic hydrops is a disorder of the inner ear. It occurs when there is an excess pressure in the part of the inner ear that contains a fluid called endolymph. This can lead to several symptoms including hearing loss, spinning sensation and ringing sound in the ear.

In the United States, approximately 1000 people per 100,000 population has Meniere’s disease. It can occur at any age but is most commonly seen among people aged between 40 to 60 years. It appears to be more common in women compared to men.

Meniere’s disease is a chronic condition which can significantly impair your daily life due to the unpredictable nature of the spinning episodes. However, various treatment options are available to improve your quality of life.

Causes of Meniere’s disease

The cause of Meniere’s disease is unknown. If a cause is identified, the condition is no longer referred to as Meniere’s disease. Therefore, it is important to rule out other diseases that can cause an increased pressure in the inner ear.

Some other causes of elevated inner ear pressure include metabolic disturbances, hormonal imbalance, trauma and infections. Autoimmune diseases, such as lupus and rheumatoid arthritis, can also lead to an increased inner ear pressure due to inflammation of the structures containing endolymph.

Risk factors

Despite having an unknown cause, some factors can contribute or put your more at risk of having the disease, including:

• Family history of Meniere’s disease: If you have a close family member with the disease, you may also be at risk of having it at some point in your life.
• Pre-existing autoimmune diseases: Some studies have shown that your body’s own immune response may contribute to the development of Meniere’s disease.
• Allergies: Certain allergies to food products, dust or pollen can trigger the episodes or aggravate them.
• Trauma to the head or ear: This may cause injury or inflammation in the inner ear structures that can result in a disturbance in the fluid pressure in the ear. 
• Infections: Infections, such as syphilis, can trigger Meniere’s disease attacks.

Sign and symptoms of Meniere’s disease

Meniere’s disease manifests as attacks of impairing symptoms which can occur at any time and recurs. In between episodes, you will be completely symptom free. The attacks may be linked to specific food triggers, stresses or the menstrual cycle. The signs and symptoms include:

• Vertigo – Spinning sensation that may last for several minutes
• Unsteadiness
• Nausea
• Vomiting
• Falls without loss of consciousness
• Hearing loss which may deteriorate with time
• Tinnitus which is a ringing or whistling sound in the ear. It can be continuous or intermittent.
• Nystagmus which is an abnormal movement of the eye

The above symptoms can cause significant distress and functional impairment. If you experience the above symptoms, you should seek medical help for further evaluation.

Making a diagnosis

After taking a detailed history from you, your doctor will examine you. What he/she will find on examination will depend on the phase of the disease. If it is done in between episodes, the examination may be without any abnormalities. If it is performed during an acute attack, your doctor will find you in significant distress which may be accompanied by pallor and sweating a lot. You may also have an elevated blood pressure and breathing rate.

Your doctor will also examine your ear using a special instrument called an otoscope. He/she will also ask you to perform specific manoeuvres to check for your level of stability. Further examination may be required to rule out the other medical conditions that can mimic Meniere’s disease.

Your doctor may also perform special tests such as the Dix-Hallpike positional test to look for any other coexisting conditions that may lead to vertigo such as benign paroxysmal positional vertigo.

Other tests may be performed to aid in the diagnosis including:

• Laboratory tests: There are no specific blood test to diagnose Meniere’s disease. However, some blood tests may be done to rule out any metabolic disorders, infections or hormonal imbalance that may be the root of the symptoms. These tests include: thyroid function tests, blood sugar levels, inflammatory markers, urine tests, blood electrolytes and allergy tests.
• Magnetic resonance imaging (MRI) or computed tomography (CT) scan: These imaging modalities are not usually required in the classic presentation of Meniere’s disease. However, they may be useful in looking for anatomical abnormalities or lesions that may be mimicking the condition.
• Audiometry: This is a test used to assess hearing. It is specifically used to check for any changes in hearing for particular sound intensities and pitch. During this test, you will be wearing headphones or earplugs that will be connected to a special apparatus that will be sending different volumes    Read more