ABOUT THE DISEASE
Ménière’s disease is a chronic, vestibular (inner ear) disorder defined in 1995 by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery as “the idiopathic syndrome of endolymphatic hydrops.”. In plain language, this means that Ménière’s disease results from increased inner ear pressure causing recurrent episodes of hearing loss, vertigo, tinnitus and fullness in the affected ear. Ménière’s disease can develop at any age, but it is more likely to occur in people under the age group of 30 – 60 years.
SIGNS AND SYMPTOMS
Signs and symptoms of Meniere’s disease include:
The person suffering from Meniere’s disease experiences recurring episodes of vertigo. A spinning sensation that starts spontaneously without warning. These vertigo episodes last for about 20 minutes to a couple of hours. In general, a vertigo spell does not prolong for 24 hours or more. Acute vertigo bouts induce vomiting and nausea.
Loss of Hearing Ability
Hearing loss may intermittentlyrecurin the earliest stages of Meniere’s disease. As the disease progresses with the time and left unattended, the temporary hearing loss may become a permanent disability.
Tinnitus (Or ringing in the ear)
Tinnitus is a perceived sound of ringing, buzzing, roaring, whistling or hissing sound in your ear. These sounds are initially fluctuating but may become perpetual as the disease progresses.
Feeling of Fullness in the ear
Patients suffering from Meniere’s disease often feel pressure in the affected ear (aural fullness) or on the side of their heads before the spell of vertigo starts, and this decreases after vertigo spell subsides.
After the episodes of vertigo, the symptoms improve and might even disappear entirely. Vertigo bouts often appear in intervals; may be in-between days, weeks or years.
To diagnose Meniere’s disease, the patient has to have had two vertigo episodes for 20 or more minutes in length, but not more than 24 hours. A hearing test is conducted to check the absence or reduction of the ability to hear. A trained medical practitioner checks for a feeling of fullness in the ear or ringing sensation (tinnitus).
There can be other symptoms of Meniere’s disease too. In any case, a thorough assessment alone can confirm Meniere’s disease.
The treatment for Meniere’s disease focuses on relieving the symptoms of the disease.
Patients are advised to take a diet which is low in salt and caffeine.
Vestibular suppressants medications, such as meclizine/prochlorperazine or diazepam, may reduce the spinning sensation.
Anti-nausea medications may be advised to control nausea and vomiting
Diuretics may be recommended to reduce inner ear pressure.
NONINVASIVE THERAPIES AND PROCEDURES
Vestibular Rehabilitation Therapy
The patient can be assisted with customised vestibular rehabilitation treatments to resolve disequilibrium issues arising due to vertigo.
Hearing aids are proven devices to improve the hearing ability of the patient affected by the Meniere’s disease.
Meniette Device generates pulsations to put pressure on the inner ear canals via ventilation tube. This way, the fluid movement improves, thus reducing pressure built up in the middle ear.
This non-invasive treatment of Meniere’s disease has shown tremendous improvements in the conditions of vertigo, tinnitus and reducing aural pressure. Although the long-term effects of this therapy are still studied, the immediate results are quite impressive.
You can use this device at home for about 5 minutes, thrice a day.
If the non-invasive therapies don’t much help with the condition, the doctor may prefer to put you on more aggressive means of treatment for Meniere’s disease.
MIDDLE EAR INJECTIONS
The doctor injects the medicine into the middle ear which then seeps into the inner ear, providing relief from vertigo symptoms.
Gentamicin is injected in the middle ear boosting chemical labyrinthectomy( meaning, it affects the dark cells in the labyrinth that produce endolymph – inner ear fluid)
Gentamicin decreases the inner ear pressure by reducing production of endolymph. The doctors perform this procedure under local anaesthesia. The results are that of reduced frequency and severity of vertigo episodes.
The risk factor of the procedure is likely hearing loss in the patient. If the patient already has decreased hearing ability, the procedure may not affect much.
Steroids, such as dexamethasone and methylprednisolone, also may help control vertigo attacks in some people. This procedure is also performed under local anaesthesia. Although steroids may be slightly less effective than gentamicin, they do not reduce the ability of the patient to hear.
Surgery remains the last option of the doctors to treat Meniere’s disease when the vertigo episodes are severe and frequent, and no other treatments could help ease the condition.
Endolymphatic sac procedure
The endolymphatic sac plays a significant role in controlling fluid level in the inner ear. The surgical procedure may effectively lessen vertigo by reducing the fluid production in the inner ear and simultaneously increasing the absorption of lymphatic fluids in the inner ear.
The procedure, endolymphatic sac decompression consists of removing a small fragment of bone from the endolymphatic sac. Sometimes, a tube is placed in the inner ear to drain the excess fluid, to help relieve the pressure from the ear canals.
Vestibular nerve section
This procedure involves cutting the vestibular nerve in the inner ear, which is responsible for maintaining balance. This medical procedure relieves issues associated with vertigo spells while attempting to preserve hearing ability in the affected ear. The procedure requires administering of general anaesthesia and an overnight hospitalisation of the patient.
This procedure best suits the patients who have almost lost the hearing ability in entirety. The surgeon removes a section from the affected inner ear that governs balance and hearing ability.