Definition

Meniere's disease is a condition that primarily affects the inner ear, typically impacting only one ear. Its prevalence ranges from 3.5 to 513 cases per 100,000 people. Most individuals with this condition experience progressively worsening symptoms, significantly affecting their social interactions.

Causes

The precise etiology of Meniere's disease remains unclear. Nonetheless, studies indicate an accumulation of fluid within the inner ear, though the exact mechanism of this fluid buildup is still unknown. Potential contributing factors of the fluid buildup include:

• Inefficient fluid drainage, potentially due to blockages or structural abnormalities
• An atypical immune response
• Viral infections
• Genetic predispositions

Consequently, Meniere's disease is believed to occur from a complex interaction of genetic and environmental factors.

Risk factor

Meniere's disease can manifest at any age but is most commonly observed in older adults. This disease is also particularly common among white women. Several conditions may elevate the risk of developing Meniere's disease, such as:

• Migraines. This symptom frequently occurs in patients with Meniere's disease and may sometimes be misdiagnosed as such.
• Autoimmune diseases. where the immune system erroneously attacks the body's own cells as foreign agents and consequently damages the cells. Conditions like rheumatoid arthritis (an autoimmune disease that causes joint inflammation), systemic lupus erythematosus (this condition could affect many organs in the body), and ankylosing spondylitis (an autoimmune disease that causes inflammation of the spine) have been linked to Meniere's disease.
• Genetic factors. About 10% of patients of European ancestry have family members who also suffer from Meniere's disease. The exact hereditary patterns, however, remain undetermined.

Symptoms

The signs and symptoms of Meniere's disease include:

• Recurring vertigo episodes, characterized by sudden, unprovoked spinning sensations due to issues of balance system in the body. In Meniere’s disease, these episodes of vertigo typically last from 20 minutes to several hours, but not exceeding 24 hours, and severe cases can cause nausea and vomiting.
• Hearing loss can fluctuate initially in Meniere’s disease but may become permanent over time in some patients.
• Tinnitus, experienced as persistent ringing or buzzing sounds.
• A sensation of fullness or pressure in the affected ear is often felt by patients.

Meniere's disease often occurs in episodic bouts, with symptoms appearing intermittently. These episodes may decrease in frequency over time.

Diagnosis

To diagnose Meniere's disease, a doctor will take a detailed history of your hearing and conduct tests to assess balance and hearing. Hearing tests may involve the use of a tuning fork. Additionally, the doctor may inspect the ear using a specialized device called an otoscope to get a clear view of the ear's interior. Caloric testing might also be performed, which involves introducing warm and cold water to induce balance-related eye movements (nystagmus).

A pure-tone audiometry test, which involves listening to pure-tone sounds, can also be recommended. It could be performed to determine the type of hearing loss and determine which sound frequencies the patients have trouble hearing.

Furthermore, a magnetic resonance imaging (MRI) scan can examine body tissues and detect abnormalities in the head and brain that might mimic symptoms of Meniere's disease.

Management

Although Meniere's disease is incurable, various medications can help manage its symptoms, particularly vertigo. Doctors may also recommend counseling and relaxation therapy to help patients cope with the unpredictability of the disease. In some places, support groups specifically for individuals with Meniere's disease are also available.

During a vertigo episode caused by Meniere's disease, here are the following steps that can be taken:

• Take prescribed vertigo medication if available.
• Sit or lie down to stabilize yourself.
• Close your eyes or focus on a single point or object before you.
• Avoid turning your head quickly or rapid head movements.
• Move slowly and carefully if movement is necessary.

In severe cases, a doctor may provide intravenous medication to treat symptoms. Rarely, patients might be required to be hospitalized to receive fluids intravenously to maintain hydration.

After the vertigo attack subsides, walking around can aid in the recovery of vision and other sensory functions.

Surgical intervention may be considered if other treatments are ineffective, though it is infrequently performed due to its variable effectiveness.

Complications

Meniere's disease can lead to sudden loss of balance, increasing the risk of falls and accidents. In advanced cases, individuals might experience falls without losing consciousness, known as Tumarkin drop attacks.

Meniere's disease can also affect both ears around 20 years after the initial episode. This condition significantly disrupts daily activities, leading to a lower quality of life than those without the disease. Individuals with Meniere's disease also often experience higher levels of fatigue and stress.

Prevention

Preventing Meniere's disease is challenging. However, if you experience an initial attack of this condition, your doctor may prescribe medication to reduce the frequency and severity of episodes. These medications aim to alleviate ear pressure, treat hearing loss, and reduce tinnitus and vertigo.

For those already diagnosed with Meniere's disease, predicting when future episodes will occur is difficult. It is advisable to take precautions before engaging in activities such as driving, swimming, climbing stairs, or operating heavy machinery. For your safety, consider having someone accompany you during these activities.

If you anticipate a vertigo attack, it is highly recommended that you avoid driving until your symptoms are fully managed.

Anxiety about a potential attack is expected if you need to travel by plane. To alleviate this, consider the following:

• Choose a seat near the aisle for better access to the restroom and distance from the window.
• Sit away from the aircraft engine to minimize exposure to noise and vibration if the noise bothers you.
• Stay hydrated by drinking water regularly and avoid alcoholic beverages.
• Check with the airline for special meal options that cater to your needs, such as low-salt meals, alcohol-free food, or decaffeinated beverages.

When to see a doctor?

It is important to consult a doctor if you experience symptoms like dizziness, tinnitus, and hearing loss. These symptoms may indicate other conditions, necessitating a prompt and accurate diagnosis to initiate appropriate therapy and minimize complications.

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