Meniere's disease (endolymphatic hydrops)


Meniere's disease is a disease of the inner ear, manifested by severe attacks of vertigo, progressive sensorineural hearing loss, tinnitus and a feeling of fullness in the ear. After many years of disease a profound sensorineural hearing loss in the affected ear is diagnosed. Although Meniere's disease is not life threatening, it is its unpredictable nature, especially recurrent severe attacks of vertigo with nausea and vomiting, resulting in a significant reduction in social, family and professional life of the patient. The natural course of the disease includes periods of exacerbation with frequent attacks of vertigo and rapidly progressing hearing loss and natural periods of remission, which can last even two years.

 

The disease usually starts in one ear, but in about 45 % of the cases, after the long-term course of the disease, the symptoms also are found in the other ear. The time until onset of symptoms in the second ear is unpredictable, from several months to several years. Knowledge about the possibility of developing the disease in the other ear is important in the decision making process of treatment. Meniere's disease begins at different ages, but most of it starts at the age of 30-50 years and applies equally for men and women.

 

The essence of Meniere's disease is the accumulation of fluid in the membranous labyrinth, which in medical language is called endolymphatic hydrops. Endolymphatic hydrops may develop as a result of :

 

  • genetic factors ( intrinsic Meniere's disease)
  • late effects of infectious agents, metabolic, traumatic, drug-induced, allergic, rheumatic, vascular factors, in the course of certain diseases of the temporal bone (otosclerosis ), and other (extrinsic Meniere's disease)

 

Diagnostics

 

The diagnostic process in patients with Meniere's disease comprise:

 

  • hearing tests (pure tone audiometry,speech audiometry, Tympanometry, audiometry of evoked response from brainstem)
  • balance examination (otoneurologic examination, videonystagmografy, dynamic visual acuity test vestibular evoked myogenic potentials test, computerized dynamic posturography )
  • imaging studies (computed tomography, magnetic resonance imaging)
  • consultation (neurological, ophthalmologic)

 

Treatment

 

In the treatment of Meniere's disease conservative treatment is used,  intratympanic  corticosteroids or gentamicin and surgery .

 

Due to the nature of the disease (endolymphatic hydrops) pharmacological treatment involves drugs that "drain" vessels of the inner ear and diuretic drugs. It is also recommended to avoid excessive use of salt and fluids, and coffee, alcohol, tobacco and avoiding stress.

 

Intratympanic treatment (transtympanal) involves injecting a drug directly into the tympanic cavity, so it penetrates by diffusion into the labyrinth. The procedure is performed in the outpatient clinic under local anesthesia, using a very fine needle. In the Maniere disease corticosteroidsand gentamicin are used:

 

  • intratympanic corticosteroids are used in the early stages of the disease, during its exacerbation for "silencing" symptoms, improve hearing, decrease tinnitus severity and feelings of fullness in the ear; treatment with intratympanic corticosteroids is a safe method for the hearing, but its efficacy does not exceed 50 %, due to practically no complications after treatment, it may be used at any stage of the disease, even after surgery
  • intratympanic gentamicin therapy is used in cases of acute illness in patients whose hearing is socially inefficient (profound hearing); assumption of treatment with intratympanic gentamicin is to destroy the labyrinth; this method effectively frees patients from the attacks of vertigo, but risk of further hearing loss is about 30 % it is also worth noting that after the treatment, some patients report long-term imbalance (up to 3 months).

 

The most effective method of releasing patients from the attacks of vertigo, is surgery. Among the different surgery methods for the treatment of Meniere's disease, the most effective is  vestibular nerve section, which is a section of "cable" that carry on information about  vertigo from labirynth to the brain. This operation in the Department of Otolaryngology, Medical University of Warsaw is done routinely since 2004.

 

The vestibular nerve section is the only vestibular nerve surgery, which at 100% efficiency of releasing form vertigo attacks, can preserve hearing. The section of vestibular nerve is symptomatic treatment, which means that even after cutting the vestibular nerve, disease in the labyrinth goes on. Numerous researches and personal experience indicate that hearing loss in patients who have undergone surgical treatment progresses more slowly than in those treated conservatively.

 

Katarzyna Pierchala MD