Meniere's Disease - Symptoms, Causes, and Treatment - DrSpectra Clinic

Meniere's Disease

What is Meniere’s Disease?

Meniere’s disease is an inner ear disorder that affects hearing and balance.

Symptoms of Meniere’s Disease?

Individual with miniere’s disease presents with

1. Episodic Vertigo

2. Fluctuating, progressive hearing loss 

3. Tinnitus

4. Aural Pressure in affected ear.

Causes of Meniere’s Disease?

Meniere’s disease is a multifactorial disorder. It could be because of genetic or bioenvironmental factors. The exact cause of Meniere’s disease is unknown.

There are 3 main theories which explains cochleovestibular dysfunction and acute attacks related to endolymphatic hydrops.

i. The membrane rupture theory.

Excessive buildup of endolymph causes membranous labyrinth bloating, distention, and subsequent rupture. This results in mixing of sodium and potassium fluids and ionic disturbances of inner ear hair cells and afferent neurons. This disrupts the resting membrane potential which governs neural spontaneous and dynamic electrical activity. 

ii. Endolymphatic hydraulic pressure theory.

The cochleovestibular dysfunction is caused by endolymphatic pressure changes or hydraulic pressure modulation within the membranous labyrinth of the inner ear. This is likely triggered by an abrupt increase in endolymph volume & pressure due to altered endolymph homeostasis, such as increased production or reduced absorption of endolymph. The theory suggests that the accumulation of endolymph bloats the membranous labyrinth & displaces the sensory structures within the labyrinth, leading to altered auditory and vestibular sensitivity and function. 

 iii. Ischemic theory 

The inner ear, with its terminal type vascular supply and stable metabolic requirements, is a potential target for hemodynamic instability, leading to modulations in inner ear sensitivity following local labyrinthine ischemia, which may then result in vertigo attack.

iv.  Inflammatory theory 

This theory explains that the acute inflammatory response which result in changes to the labyrinthine blood supply results in acute attacks and inner ear dysfunction. This may be caused by an infection, such as viral labyrinthitis. An inflammatory event may be associated with abrupt changes in labyrinthine blood flow, resulting in small fluctuations in inner ear temperature, affecting hair cell and nerve function leading to a spontaneous vertigo attack.

Risk Factors of Meniere’s Disease

1. Age: Most common in adults between 40-60 years but can occur at any age. 

2. Family History: Increases the risk, suggesting a genetic component.

3. Head trauma: Example A car accident or a severe blow, can increase the risk of developing Meniere’s disease.

4. Medical conditions such as migraines, allergies, autoimmune and disorders may increase the risk. 

5. Viral infections such as human cytomegalovirus increase risk of Meniere’s disease.

6. Alcohol and Caffeine can trigger vertigo attacks.

7. Autoimmune disorders such as rheumatoid arthritis & lupus may increase the risk. 

8. Stress may trigger episodes of Meniere’s disease. 

Complications of Meniere’s Disease

Meniere’s disease can significantly affect quality of life and lead to various complications such as:

1. Falls & injuries due to vertigo.

2. Hearing loss permanently.

3. Nausea & vomiting.

4. Tinnitus can be exacerbated by Meniere’s disease.

5. Anxiety issues.

6. Depression.

7. Social isolation.

8. Imbalance.

9. Fatigue.

10. Disability due to the unpredictable nature of vertigo.

Diagnosis of Meniere’s Disease

There is no single definitive test for Meniere’s disease. A thorough medical history, physical examination & hearing test are essential for diagnosis. The diagnosis is often made by an ENT. 

Tests: 

1. Detailed case history 

2. Otoscopic examination 

3. Audiological evaluation- Pure tone audiometry, Impedence audiometry, Auditory brainstem response, Vestibular assessments and Ecochg. 

4. Magnetic resonance imaging- To rule out tumors and other neurological issues. 

      Diagnostic Criteria:

• Two or more episodes of vertigo (2 min to 24 hours). 

• Hearing loss- Low to medium frequency.

• Aural symptoms including tinnitus, fullness or pressure in affected ear.

Treatment for Meniere’s Disease

The Pathophysiology of Meniere’s Disease remains unknown. Current treatments focus on the reduction and management of symptoms in the acute or intermittent phase of the disease rather than targeting the root cause of inner ear dysfunction.

• The acute phase treatment: 

Acute phase involves spontaneous vertigo of sudden onset, lasting 2 minutes to 24 hours. 

• Standard pharmacological treatments are anti-vertigo drugs or vestibular suppressants which include antihistamines, anticholinergics and benzodiazepines. 

• Antiemetic drugs, such as metoclopramides, which antagonizes dopamine D2 receptors in chemoreceptor trigger zone of the medulla oblongata, thereby suppressing nausea and vomiting at the level of central nervous system.

• Intermittent Phase treatment:

This phase focuses on reduction/Prevention of symptoms. 

• Conservative approaches include lifestyle changes, non-destructive pharmacologic interventions such as corticosteroid steroid use and non-ablative surgery such as ventilation tubes.

• Destructive techniques can be pharmacological or surgical and include administering ototoxic agents such as gentamicin or ablative surgery such as labyrinthectomy.

• Adjuvant treatments, such as vestibular rehabilitation and psychotherapy. 

• Changes in lifestyle:

• Stress and Meniere’s Disease attacks are related. The individual should engage in moderate exercise, avoid overworking and reduce strenuous activities.

• Low sodium diet. (1500-2300 mg/day) 

• Suitable water intake can assist in stable vasopressin levels and inner ear/endolymph homeostasis. 

• Restricted intake of caffeine, alcohol, tobacco, due to their vasoconstrictive and diuretic properties which may exacerbate hydrops.

• There is a direct association between chronic hyperglycemia/hyperinsulinemia and the dysfunction of peripheral vestibular organ.

Conclusion

Meniere’s disease is a chronic inner ear disorder characterized by recurrent episodes of vertigo, fluctuating hearing loss, tinnitus, and aural pressure. While there’s no Meniere’s disease cure, it can be managed through lifestyle changes, medications & in some cases surgery, with many patients experiencing improved quality of life. Early diagnosis and a multidisciplinary approach are crucial for treating Meniere’s disease.