Meniere's disease

Synonyms in a broader sense

Meniere's disease; Inner ear vertigo, sudden hearing loss, dizziness, balance organ

English: Menière’s disease

Definition of Meniere's disease

Menière's disease is an inner ear disease and was first described impressively by the French doctor Prosper Menière in 1861.
In Menière's disease, there is an increased accumulation of fluid (hydrops) in the membranous labyrinth of the inner ear (see anatomy ear). This results in a pathological increase in pressure in the inner ear. This increase in pressure leads to the typical signs of illness (symptoms / complaints): seizure-like, non-provocable vertigo, one-sided noises in the ears (tinnitus) and one-sided hearing loss or hearing loss. In addition, nausea and vomiting can occur.

Occurrence / frequency

The frequency (incidence) of this inner ear disease is estimated at 1: 1000 in the industrialized nations. Especially people between the ages of 40 and 60 are of the Meniere's disease affected.
One in five patients has a positive family history, i.e. a first-degree relative also has Menière's disease, which is why a genetic component is suspected.

Possibly, previous viral infections favor Smoke, Allergies, stress and alcohol consumption the occurrence of the disease.

Cause / origin

The origin of the disease (pathogenesis) is not fully understood. One goes from one disproportion between the production and removal of inner ear fluid and has the following explanatory approaches:

There is a defective production of endolymph (inner ear fluid), the fluid that is contained in the membranous labyrinth of the Inner ear is included.
This is either a quantitative, i.e. a quantitative, production disorder or a qualitative disorder in which there is a change in the composition of the inner ear fluid.

The uptake (resorption) of the endolymph in the endolymphatic sac, a sac (sacculus) of the inner ear filled with endolypm, which can also be referred to as the "endolymph reservoir", is disturbed.
There is an occlusion of the endolymphatic duct, which is in direct connection with the cochlea as well as with the semicircular canal system and leads the endolypm to the reservoir (endolymphatic sac).
The endolymohatic sac releases oncotically active substances, i.e. substances that have a water-drawing effect, into the endolymphatic space.

The resulting high pressure tears the endolymph tube and the endolymph penetrates Balance organ and leads to false reports of the sense of balance and the inner ear.
The mixing of endo- and perilymph leads to the menière - typical symptoms:

Dizziness
Tinnitus
Hearing loss.

A rupture of the endolymph tube or a permeability disorder in the boundary membrane between the bony and membranous labyrinth are possible reasons for the development of the symptoms in the patient.
It is suspected that when the potassium-rich (endolymph) and sodium-rich (perilymph) fluids are mixed, the auditory cells (hair cells) are damaged.

You can find out more causes under our topic: Dizziness that can be triggered by the inner ear

Figure of semicircular canals / organ of equilibrium

1. Semicircular canals
2. Saccule
3. utricle

Stress as a cause

Since the metabolism of the inner ear is a very complex process, it can also be disturbed by minor influences. In addition, the metabolism of the inner ear is influenced by the autonomic nervous system. The vegetative nervous system is in turn related to the state of mind of the person. For these reasons, it is assumed that psychologically stressful situations and increased stress can also be a trigger for Menière's disease.
It is also interesting that many sufferers have a similar personality. The frequently observed character traits of the patients include a tendency towards perfectionism and ambition. These characteristics often result in those affected putting themselves under great pressure. The seizures of Menière's disease are also often provoked by stressful situations, the seizures then trigger increased stress.
Thus, patients can quickly enter a vicious circle of stress and seizures. With relaxation exercises and psychotherapy, an improvement is evident in many patients.

Symptoms / complaints

The so-called Menière triad, the occurrence of three typical symptoms in this disease, is made up of:

sudden onset of vertigo, vomiting and nausea are also possible (see: vertigo caused by diseases of the ear).
a one-sided ringing in the ear (tinnitus) and a dull feeling ("as if you had cotton wool in your ears") and
a one-sided hearing loss for low tones (low frequency hearing loss).

These complaints improve after minutes to hours and occur repeatedly at irregular intervals. The patient does not know when and to what extent the next attack will occur, which can lead to uncertainty and fear.

Especially at the beginning of the disease, symptoms can appear alone and not in the typical threefold structure, so that the diagnosis of Menière's disease as a cause of Vertigo is difficult and may not occur until the further course of the disease.

Read more on the topic:

Meniere's disease symptoms
Dizziness and vomiting

Menière diagnosis

A thorough investigation of the medical history (anamnesis) and description of the symptoms (symptoms) is the most important basis in the diagnosis of Menière's disease.
The exact diagnosis and a comprehensible explanation of the disease for the patient are important so that the person concerned is sufficiently informed about the disease and knows how to deal with the symptoms that arise.

The symptoms of Menière's disease are as follows:

In acute attacks that are limited in time, patients report vertigo and describe it in a variety of ways, e.g. with a feeling "As if the ground were shaking" or "The environment revolve". You are therefore very unsteady on your feet and vomit frequently.
Furthermore, there is a hearing loss / hearing impairment, which mainly relates to low frequency ranges (low frequency or bass hearing impairment). Both ears are rarely affected by these symptoms.
The patient also reports a ringing in the ear (tinnitus) and a feeling of pressure in the affected ear.
An accompanying symptom in the patient is trembling of the eyes (nystagmus), which the doctor can detect when looking through special diagnostic glasses (Frenzel glasses). Due to this trembling of the eyes, the patient cannot fix his gaze on a solid object, which increases his unsteadiness.
You may experience vegetative symptoms such as palpitations (tachycardia) or sweating.

In the so-called interval, the time between Meniere's attacks, the patient does not suffer from vertigo. Symptoms of tinnitus, pressure, and low-pitched hearing loss can be chronic and persist beyond the attack.
With regard to the hearing impairment, a deterioration in the course of the disease can often be determined: While the hearing ability initially recovers and returns completely after the seizures, it is possible that if the illness persists, the hearing ability will also be reduced in the symptom-free period or even become deaf.

The diagnostic guidelines state that the diagnosis of Menière's disease can only be made if at least two spontaneous attacks with vertigo of at least 20 minutes have occurred, a ringing in the ear (tinnitus) with or without a feeling of pressure in the ear and hearing loss audiometric tests (hearing test) can be determined.
You can also find more information on this topic at: Hörprüfung
With the help of these criteria, the majority of disturbances in the equilibrium system can be excluded.
It is also important to inform the patient about e.g. examine a herniated disc of the cervical spine or infections of the auditory tract (differential diagnosis = alternative causes); these are diseases that can cause similar symptoms.

The following diagnostic methods are used to determine Ménière's disease:

The glycerol test, also known as the Klockhoff test, is used to detect a hydrops (fluid build-up) in the inner ear:
The patient drinks a solution of glycerol (1.5 g of glycerol per kg of patient's body weight), water in the same amount and lemon juice.
Glyerol (synonyms are: propanetriol or propane-1,2,3-triol) is a trihydric alcohol and causes a temporary flushing out of the fluid build-up in the inner ear with an improvement of hearing in Menière's disease.
As part of the test, three audiograms (hearing curves / hearing test) are recorded:
The patient's hearing is tested 15 minutes before taking the glycerol-water mixture and 15 minutes and 120 minutes afterwards.

The test result is positive if the hearing ability improves due to the osmotic glycerol solution: The hearing threshold must decrease in at least three adjacent frequency ranges, which means that the patient can (better) perceive low tones again.
Understanding monosyllabic words must improve by 10% for the test to be positive.

Positive means that there is a high probability that the patient's symptoms are due to Menièr's disease.

Electrocochleography is an apparatus-based examination that is used to determine whether Menière's disease is present. This examination tests how functional the hair cells of the hearing organ and the auditory nerve are.
The hair cells are the auditory cells in the inner ear and are surrounded by endolymph. The sound waves, which reach the middle ear through the auditory canal, set the eardrum and subsequently the ossicles (hammer = malleus, anvil = incus and stapes = stirrup) in vibration. These vibrations set the inner ear fluid in a wave-like movement and the hair cells are activated. The activated auditory cells convert the mechanical stimulus into electrical impulses, which are passed on to the brain via the auditory nerves.

In order to determine the stage of the disease in which the patient with Menière's disease is, they are usually admitted to a clinic so that the diagnosis and treatment are precisely tailored to the patient.

Technical examinations such as an audiometric hearing test do not necessarily serve to diagnose Menier's disease in the early stages of the disease, but help to rule out diseases that show similar symptoms (differential diagnosis).

therapy

The treatment of Menière's disease is still heavily debated at the current point of view. The reason for this is that the exact cause that led to the development of the disease is largely unknown.
The pathomechanism, i.e. the mode of action of the disease, is understood and can be treated, so that the suffering of the patient is alleviated. In some cases, Meniere's disease can even be treated so well that the attacks stop completely.
An improvement in symptoms can also be achieved through surgical procedures. For example, a tympanic tube can be placed through the eardrum, which acts as a connector between the external auditory canal and the middle ear. As a result, the pressure fluctuations in the middle ear, which are particularly strong in Menière's disease, are no longer as pronounced. The pressure fluctuations in the middle ear are related in a complicated way to the pressure conditions in the inner ear, which in turn can influence the attacks of Menière's disease.
Alternatively, an improvement can be achieved through a change in lifestyle. Above all, relaxation and balance exercises, but also psychotherapy, can often help those affected.
In addition, the diet should be considered. It is advisable to consume a lot of potassium and little salt. In addition, stress, alcohol, smoking and loud noise levels should be avoided as much as possible.

Read more on the topic: Therapy of Meniere's disease

Medicines used to treat Meniere's disease

For acute Menière's disease, treatment is limited to symptoms only. Especially dizziness and vomiting can be treated with medication. Antiemetics (anti-vomiting drugs) such as Dimenhydrinate (Vomex®) or metoclopramide (MCP drops) can be used.
The endolymphatic hydrops, i.e. the direct cause of the Menière symptoms, is treated with betahistine. Betahistine works against nausea, vomiting and dizziness by promoting blood flow to the inner ear and improving balance regulation.
However, it is controversial whether the drug is really effective, as various studies have questioned the effectiveness of the betahistine. Potassium-sparing diuretics are used as alternative drugs. Diuretics are drugs that block certain transporters in the kidney so that more water is excreted. By taking the diuretics for Menière's disease, the fluid accumulation in the inner ear should be flushed out, which in turn improves the symptoms

Read more on the topic: Drugs used to treat Meniere's disease

Exercise for Meniere's disease

As severe dizziness occurs during acute attacks of Menière's disease, it will hardly be possible to do sports during an attack.
But in stable phases, sporting activities should no longer be a problem. Exercise and physical activity are recommended even with long-term treatment. This can have a positive effect on balance, metabolism and general well-being.
The function of muscles and the sense of touch can also be strengthened through sport, which can be helpful for those who are ill.
The leg muscles in particular should be built up, as sick people often tend to lunge and fall during dizzy spells. These falls and lunges can be better absorbed by stable muscles in the legs.
The increased well-being and the reduction of stress through sport also help to avoid stressful situations, which in turn can trigger attacks. The neurotransmitter (messenger substance) serotonin is released here, which leads to a feeling of happiness and reduces tension and stress. Overall, it can be said that exercise is certainly helpful in Menière's disease as long as it is compatible with the disease. Swimming or cycling involve certain dangers, as an acute attack can be fatal. For this reason, it is better to carry out the aforementioned sports with company.

Driving with Menière's disease?

Menière's disease sufferers are only suitable for driving to a limited extent due to imbalance.
The big problem here is that the dizzy spells sometimes occur unsigned. They are therefore also unpredictable and can therefore surprise the driver while driving. For this reason, those affected should refrain from driving a motor vehicle in order not to pose a risk to road traffic. Your own health is of course also of interest.
On the other hand, there are cases in which an attack is heralded by omens (decreased hearing, tinnitus, feeling of pressure in the ear). The prerequisite for suitability in road traffic is that only Menière seizures with signs occurred over a longer observation period, so that the road users concerned can withdraw from road traffic in case of doubt. However, a specialist medical report is required here and it is a case-by-case decision.