Background:
Ménière’s disease, also known as idiopathic endolymphatic hydrops, is a disorder of the inner ear. The term endolymphatic hydrops is believed to result from increased pressure within the endolymphatic system in the ear leading to hearing and balance difficulties. It can be seen at almost all ages with a typical onset beginning at early to middle adulthood. Recent studies show that Ménière’s tends to affect women more often than men with a prevalence increasing with age.
Pathophysiology and Causes:
Ménière’s disease is linked to an excess of fluid in the inner ear, mainly in the membranous labyrinth, a system of membranes in the ear that contains a fluid called endolymph. In Ménière’s disease, endolymph rushes from its normal channels in the ear to flow into other areas, causing various symptoms of hearing loss and vertigo (spinning sensation).
Other disorders that may give rise to elevated endolymphatic pressure include metabolic disturbances, hormonal imbalance, trauma, and various infections in the ear.
Signs and Symptoms:
The typical history must be suggestive of Ménière’s disease, it often begins with one symptom, and gradually progresses. It involves episodic attacks of vertigo, which usually are preceded by a variable sense of ear pressure and fullness, decreased hearing, and a low-tone ear ringing. The vertigo or dizziness attacks may last from few minutes to hours and often are associated with nausea and vomiting.
The timing and frequency of attacks are variable among people. Between episodes, some patients may be completely symptom free, but some people may notice a progressive deterioration of hearing and balance function with each successive attack throughout the years.
Diagnosis:
The diagnosis of a Ménière’s disease is based on signs and symptoms. Your clinical history provides a valuable information. Neuroimaging may be necessary to rule out other medical causes of your dizziness. The neurologist will examine you and perform different maneuvers of head movements in the clinic as part of the physical examination. An evaluation of hearing loss is also indicated as part of the evaluation.
Treatment:
Medical treatment of Ménière’s disease is directed toward vertigo relief. Typically, vestibular suppressants and anti-nausea medications are prescribed as needed. Some of these medication include meclizine (Antivert), prochlorperazine (Compazine), diazepam (Valium), lorazepam (Ativan) and alprazolam (Xanax).
Lifestyle and dietary changes are also recommended to reduce the frequency or severity of the symptoms. Avoiding trigger substances such as salt, chocolate or caffeine may be helpful. Smoking cessation is also recommended. Many studies suggest a diet high in salt can lead to an increase of fluid within the inner ear triggering and worsening the attacks, therefore reducing salt intake can be beneficial.
Resources
Vestibular Disorders Association (VEDA)
www.vestibular.org
Citation
Li, John C. “Meniere Disease (Idiopathic Endolymphatic Hydrops)”: Background, Anatomy, Pathophysiology. Medscape.
URL: emedicine.medscape.com/article/1159069
Updated December 12, 2014. Accessed October 13, 2015.
