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Meniere’s Disease

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Introduction

Meniere's disease is a condition that afflicts the ear & often results in loss of hearing, although, it usually affects only one ear and is also known as idiopathic endolymphatic hydrops, Meniere's disease is a disorder of the ear and  is a problem that is associated with the fluid balancing system in the inner ear.
The exact cause of this condition is not known, but it occurs when the amount of fluid in the inner ear rises up. However, what exactly causes this fluid level to rise is not known. The condition manifests as an abnormality of the inner ear indicating its existence through:

  • vertigo
  • severe dizziness
  • tinnitus (a roaring sound in the ears)
  • fluctuating hearing loss, & the sensation of pressure or pain in the affected ear known as aural fullness.

There are several factors like allergy, abnormal immune response, trauma, etc

Generally, it is defined as the symptom complex of episodic vertigo (sensation of whirling and spinning), tinnitus (ringing, roaring, and hissing that usually occurs in one ear), aural pressure (feeling of pressure in the concerned ear), and fluctuating hearing loss. There is a pattern involved here, which is usually a sensation of pressure building up in one ear with increasing tinnitus and a drop in hearing. After this happens, the vertigo comes quite suddenly, which may last for a few hours to several days. When the vertigo attack is over the hearing improves.

As mentioned above, there is no cure for this disease; but the different methods can help in alleviating the symptoms. Following a strict diet regularly is one of the methods.

Causes

There exists a portion in the inner ear known as the labyrinth, within which, fluid is contained. The labyrinth has two parts: the membranous labyrinth and the bony labyrinth. The membranous labyrinth, required for hearing and balance, is encased by bone, and filled with a fluid called endolymph. When we move our heads, the endolymph fluid moves, causing nerve receptors in the membranous labyrinth to send signals to the brain about the body's motion. An increase in endolymph, however, can cause the membranous labyrinth to balloon or dilate. This condition is known as endolymphatic hydrops.

Perilymph, is another fluid that occupies the space between the membranous labyrinth and the bony inner ear. It is the belief of many experts, that a rupture of the membranous labyrinth allows the endolymph to mix with perilymph. Accordingly, this results in the symptoms of Meniere's disease. Nonetheless, the exact cause of this condition remains unknown. In some cases, a connection exists between the onset of the illness and recently suffered head injury, middle ear infection, or syphilis. Other factors that increase the risk, include, allergies, alcoholism, fatigue, recent viral illness, respiratory infection, smoking, stress, and use of certain medications like aspirin. Genetics also play a role in acquiring this disease.

Symptoms

One of the most weakening symptoms is vertigo, which can lead to vomiting, severe nausea, and sweating. All of these symptoms can come with a little or no warning at all.

Apart from this, some individuals have attacks that begin with tinnitus, a loss of hearing or a feeling of fullness or pressure in the affected ear. All these symptoms are experienced at varying frequencies, intensities, and duration. Some other symptoms associated are, headache, abdominal discomfort, and diarrhea.

The symptoms of this disease occur suddenly. Its unpredictable symptoms can be experienced every day or as rarely as once a year. In some patients, symptoms start with tinnitus, which is a sensation of a ringing, roaring, or buzzing sound in the ears or head. Following this, they may experience diminished hearing or a buildup of pressure in the affected ear. One of the worst symptoms is vertigo, which is dizziness accompanied with a rotating feeling that forces the person to lie down. Vertigo attacks can lead to severe nausea, vomiting, and sweating, and often come with little or no warning.

The most commonly experienced attack of this disease lasts for several hours, and is characterized by a combination of vertigo, tinnitus, and hearing loss. The intensity, frequency, and duration of an attack differs from person to person. The lucky ones may experience vertigo only a few times a year, or be faced with intense tinnitus while sleeping. Others may suffer from hearing loss, and feel unsteady for an extended period. A person's hearing usually recovers between attacks, but over time can become worse. Occasional symptoms, include, headache, abdominal discomfort, and diarrhea.

Diagnosis

The physician will take a history of the duration, frequency, severity, and character of your attacks. He/she might also inquire about whether the hearing loss has been changing, and if you have had tinnitus or fullness on either of the ears. The physician would also like to know whether you have a history of mumps, syphilis, inflammation of the eyes, an autoimmune disorder or, allergy or ear surgery in the past. You might also be questioned about your general health, such as whether you have diabetes, high blood pressure, high blood cholesterol, and thyroid or any neurologic or emotional disorders. Once the physician has completed the questioning, he/she will conduct diagnostic tests to check your balance functions and hearing.

Tests

The tests may include:

  • Test for Balance
  • Test for Hearing
  • Other Tests

Test for Balance

To test balance the physician may perform Electronystagmography (ENG). In this procedure, recording electrodes are placed near the eyes in a darkened room. After they have been placed in the above manner, warm and cool air is gently introduced into each ear canal. Using this procedure, the eye movements can be used to test the balance system, since the eyes and ears work in coordination through the nervous system. Rotational testing or balance platform may also be used to evaluate the balance system.

Test for Hearing

To test hearing, an audiometric examination is used. This test typically indicates a sensory type of hearing loss in the affected ear. If the ear is affected, speech discrimination is often diminished.

Other Tests

  • Computer Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
  • Electrocochleography (ECoG), which is used to indicate increased inner ear fluid pressure in a few cases of Meniere's disease
  • Auditory brain response (ABR), which is a computerized test used to test the hearing nerves and brain pathway

Treatment

Unfortunately, there is no cure, however, the symptoms can be controlled successfully by reducing the body's retention of fluids through dietary changes (which include low-salt or salt-free food and no caffeine or alcohol) or medication. Eliminating tobacco and reducing stress levels also help lessen the severity of the symptoms. The goal of the treatment is to reduce pressure in the inner ear, & relieve symptoms. This can be achieved through:

  • dietary changes (such as a low-salt or salt-free diet, and no caffeine or alcohol)
  • Medication to control allergies, or improve blood circulation in the inner ear may help. Water pills (diuretics) that can relieve fluid pressure in the ear could also help.
  • Lifestyle changes such as reducing stress levels, and stopping the intake of tobacco have also proved effective in managing the symptoms.
  • Certain surgical procedures are also recommended for patients with persistent, debilitating vertigo. A procedure of removal of the inner ear sense organ, called Labyrinthectomy can effectively control vertigo. However, this procedure sacrifices hearing, and is reserved for patients with non-functional hearing in the affected ear. Another option, Vestibular neurectomy involves selectively severing a nerve from the affected inner ear organ, and controlling vertigo while preserving hearing. However, it carries certain surgical risks.
  • In recent times, an option that is gaining popularity, is the administration of the ototoxic antibiotic - gentamicin directly into the middle ear space, which helps control vertigo.

There is no known prevention, but prompt treatment of ear infections and other related disorders may be the best way to avoid this disease.

Apart from the treatment options mentioned above, there are various surgical procedures that have been advocated for patients, who have persistent, debilitating vertigo from Meniere's disease. One such surgical treatment is Labyrinthectomy, in which the inner ear sense organ is removed. This procedure can control vertigo, but is reserved for patients, who have nonfunctional hearing in the affected ear. Vestibular neurectomy is another such treatment, in which, a nerve from the affected ear is selectively severed. This procedure usually controls vertigo while preserving the hearing, however, it also carries certain surgical risks.

First Aid

During an attack, it is advisable to lie flat on a surface keeping your eyes aimed at an object that is stationary. Do not eat or drink anything. When you feel that the symptoms have gone away, get up slowly. At this time you may want to sleep for several hours. Remember to call your doctor, if you keep vomiting for more than 24 hours, and are not able to keep down any liquids.

Meniere's Disease Diet

Following a diet can also help in bringing the symptoms of the condition under control.
The aim of the Meniere's disease diet is to limit the intake of foods that affect the fluid level in the ear. There are certain foods like those containing large amounts of salt and sugar, which affect the fluid level in the ear. Studies have proven that having a salt free diet helps in reducing the severity of the symptoms to a great extent. The following is a list of foods that you need to avoid if suffering from this disease:

  • Salt containing foods like chips, crisps, etc.
  • Processed foods, preserved foods, canned foods
  • Pickles, soy sauce, MSG containing foods
  • Preserved meats
  • Foods containing high amounts of sugar like desserts, ice cream, chocolates, etc.
  • Caffeine containing foods and chocolate

As always, it is essential to consult the doctor before making changes in your daily diet. You should also reduce smoking and drinking in order to get the condition treated fast.

Dietary Recommendations include:

  • Your diet should consist of fresh fruits and vegetables, whole grains and other healthy and fresh foods.
  • You should read the labels before buying any food.
  • Avoid foods that are high in salts and sugar. You should add very little salt while cooking and avoid using salad dressings and sauces as they contain salts which are used as preservatives or in the form of MSG.
  • Ask the chef to make your food low in salt and sugar, when eating out.
  • Coffee and other caffeine containing foods trigger off the symptoms of this condition and can even induce migraine. Therefore, it is wise to avoid it completely.
  • You can have herbal tea, green tea, fresh fruit juices, etc.
  • You should have adequate amounts of water, i.e., 8-9 glasses every day.

When following the diet for Meniere's disease, you should remember that it is very essential to have same amount of food and at same time every day. Along with the diet, the doctor will also prescribe medications to treat symptoms like vertigo and nausea. At the same time, you should also avoid stress and try to prevent the conditions that can trigger off the symptoms. Lastly, remember that the condition can be treated if one follows the diet, medication and lifestyle changes properly.

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