20-11-24
What is Menière's disease and what causes it?
This condition was first described by the Frenchman Prosper Menière in 1861. It is characterized by a triad of symptoms: episodes of positional vertigo, tinnitus and hearing loss. It usually affects one ear. Despite numerous studies, the etiology of this disease still remains unknown.
What are the symptoms of the disease?
As mentioned above, this disease is characterized by episodes of positional vertigo, tinnitus and hearing loss. The episodes of vertigo last from 1 to 24 hours and are often accompanied by nausea and a tendency to vomit. Body movement aggravates these symptoms. For this reason, the patient usually remains lying down and motionless until the vertigo gradually subsides. During the episode, the intensity of the tinnitus in the ear also increases. The patient may also feel a feeling of fullness in the affected ear.
How does this disease develop?
Usually, over a long period of time (10 years), the episodes of vertigo are significantly reduced or completely eliminated in more than 75% of patients, regardless of the type of treatment. Unfortunately, however, hearing is ultimately significantly reduced in the affected ear.
What tests should be performed to diagnose Menière's disease?
The patient's history initially raises the suspicion of Menière's disease. The audiogram is very important for the diagnosis of this condition. Hearing loss is usually revealed, especially at low frequencies. This hearing loss may be intermittent in the early stages of the disease, meaning that hearing returns to normal levels between episodes of vertigo and is only worsened during the episodes. Over time, the hearing loss becomes permanent. The labyrinthine irrigation test usually shows damage to the balance function (vestibular function) in the affected ear. The glycerol dehydration test helps in the diagnosis, but is not often performed because it can cause nausea and headache. In some cases, an MRI scan is required (to rule out acoustic neuroma).
Is there a cure for Menière's disease?
Because the etiology of the disease is unknown, there is no exact cure. The therapeutic approach can be either pharmaceutical or surgical. Initially, the simplest treatment regimens are used, gradually choosing more invasive methods. It is always recommended to reduce the patient's daily salt and water consumption. Psychological support is also important. The most commonly administered pharmaceutical preparations are vasodilators. The use of diuretics is also sometimes recommended. Vestibular depressants are administered only in the acute phase. Lately, intratympanic injections of pharmaceutical substances have begun to gain ground.
What are intratympanic infusions?
Intratympanic infusion means the injection/administration of a pharmaceutical preparation behind the eardrum. This is achieved by administering the drug in liquid form. The eardrum is pierced with the help of a very fine needle so that the injection of the drug is as close as possible to the target organ (inner ear). The drugs injected are either cortisone (dexamethasone) or antibiotics (aminoglycoside), depending on the case.
Is there a surgical treatment for the disease?
Surgical treatment of the disease is increasingly being removed as an option. Recommended procedures are decompression of the endolymphatic sac with or without placement of a ventilation tube (grommet) and destruction of the labyrinth (labyrinthectomy). In general, there is much disagreement about the effectiveness of any surgical intervention for Menière's disease.