Microsoft word - meniere's disease.doc
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Ménière’s disease (MD) is a disease of the inner ear. The inner ear is composed of the organ of balance (semicircular canals) and the organ of
How to Help Yourself
hearing (the cochlea). Ménière’s disease is a long-term, progressive
Most people with MD cope well with their symptoms and the problems it
disease which damages both the balance and hearing parts of the inner
produces. Understanding the disease and discussing treatment options with
ear. The main symptoms of the disease are vertigo, tinnitus and hearing
your doctor is valuable. Counselling, relaxation and stress management play
an important part in maintaining a good quality of life. Contact with other people with MD via local groups and the Ménière’s Society can improve confidence
It mainly affects white people. Its incidence is between 1 per 2,000 and 1
and provide valuable support and information. The Society can also support the
per 20,000 of the population. It affects both sexes equally. It can occur at all
ages, and most frequently starts between the ages of 20 and 50 years. About 7-10 percent of people with MD have a family history of the disease.
The Ménière’s Society has many more information sheets on all aspects ofMénière’s disease, its treatment and management. Information sheets and
Initially, the disease usually affects one ear, but both ears are affected in
SPIN, the Society’s quarterly magazine for members, is available on joining the
15% of people at the onset of the symptoms. As the disease progresses,
up to 50% of people will develop the disease in both ears.
The Causes of Ménière’s Disease
The cause is unknown. Many factors are probably involved in the
development of the disease. The relationship between these factors and
the progression of the disease remain unclear. The factors that may be
x Increased pressure of the fluid in the endolymphatic sac in the inner ear
x A familial predisposition to develop the disease x Allergic factors damaging the inner ear
x Vascular factors. There is an association between migraine and Ménière’s disease
x Metabolic disturbances involving the balance of sodium (Na+) and
potassium (K+) in the fluid of the inner ear x Unknown factors
x Adaptation of lifestyle
Reducing stress and regular relaxation helps with coping with the
anxiety MD can produce. Some complementary therapies are
During severe attacks of vertigo, many people also suffer from diarrhoea,
MD can severely affect the quality of life of a person. It can affect the ability
MD affects all aspects of a person’s life. Change of employment,
to work and travel. Families and relationships may suffer. Periods of
financial problems, as well as personal and relationship difficulties
can occur. Counselling can help with these and improve the quality of life.
Necessary Investigations to Make a Diagnosis
In four out of five people these measures are sufficient to control the
There is no specific test that, on its own, is reliable in diagnosing MD. Your
symptoms. However if vertigo remains a problem there are several further
general practitioner and Ear Nose and Throat specialist will arrange
procedures that can help to control vertigo. These are:
appropriate investigations. The history and progression of the illness together with simple hearing (audiogram) and balance tests (caloric test)
x Gentamicin treatment
will be sufficient in many cases. However, the three main symptoms of
Controlled use of gentamicin given locally to the ear can reduce and
vertigo, hearing loss and tinnitus occur in many other illnesses, and these
may need to be excluded by tests (blood tests and MRI scan) before a final diagnosis can be made. Other investigations may help with the
x Saccus decompression
management and assessment of symptoms (postulography,
This is a surgical operation on the endolymphatic sac of the inner
electronystagmography, speech audiogram).
ear. There are several variations. They aim to reduce the pressure of the fluid in the sac.
How it affects you
x Vestibular nerve section
MD is a fluctuating progressive illness and the symptoms vary between
This is a neurosurgical operation. The nerve from the balance organ
people, and over time in the individual person. It is useful to divide the
in the inner ear is cut, stopping the abnormal messages reaching
course of the illness into three stages.
the brain and therefore stopping the vertigo.
Stage 1: Early
The main feature is intermittent attacks of vertigo (giddiness) associated
This operation destroys the inner ear and stops any vertigo arising
with nausea and vomiting. These attacks can last from a few minutes to 24
from that ear. However, it also destroys the hearing in that ear.
hours. During the attack, there is a variable amount of hearing loss, and a sensation of fullness and discomfort in the affected ear. There may be tinnitus (noises in the ear) or an increase in existing tinnitus in the ear. The
fullness in the ear and the tinnitus may precede the attacks of vertigo, but
often the attacks occur without warning. Between attacks, the hearing and
Treatment is aimed at reducing, controlling and alleviating the symptoms. It
sensation in the ear return to normal. The attacks vary in severity and
is symptomatic treatment and will vary with the needs of each patient at
There can be giddiness lasting a few minutes to severe rotational vertigo with vomiting. The person may need to lie completely still for several hours. There are periods of remission between the attacks, and these can vary from days to months or even years. The periods of remission vary in each person and over time, making MD an unpredictable and distressing illness.
x Treatments aimed at controlling the attacks of vertigo
Drugs such as betahistine (Serc) and a low dose of a diuretic on a
Main problem: Unpredictable attacks of vertigo.
regular basis can reduce the frequency of attacks of vertigo. Vestibular sedatives (cinnarizine-Stugeron) and anti-sickness drugs
Stage 2: Intermediate
(prochlorperazine-Stemetil) help to control the vertigo and vomiting
The attacks of vertigo continue, with variable remissions. They may be less
severe. The attacks may be preceded or be followed by a period of imbalance and movement-induced giddiness, adding to the distress.
x Specific exercises
Permanent hearing loss develops and continues to fluctuate with the
Vestibular rehabilitation exercises can be helpful between the
vertigo attacks. Tinnitus becomes more prominent; it also fluctuates,
attacks of vertigo to help compensate for difficulties with balance.
The exercises can be especially useful in later stages of the disease. These specific exercise programmes need to be done only
Main problems: Attacks of vertigo, tinnitus, hearing loss.
under the supervision of a physiotherapist or hearing therapist
Stage 3: Late
x Low salt diet
In the later stages, the hearing loss increases and often the attacks of
This can reduce the frequency and severity of attacks of vertigo in
vertigo diminish or stop. The disease affects both ears in up to 50% of
people. Hearing loss can be severe and distortion, loudness discomfort and recruitment can be a problem. There is permanent damage to the balance
x Treatment to help tinnitus
organ in the ear and significant general balance problems are common,
Various white noise generators, which help mask the tinnitus, as
well as retraining and counselling, are available.
Main problems: Hearing loss, balance difficulties, tinnitus.
x Treatment to help hearing loss
Hearing aids are important for all people with hearing loss, whether it is in one ear (unilateral) or both ears (bilateral). There are specific hearing problems for people with MD but most can be helped by the range of aids available.
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