VOL: 100, ISSUE: 40, PAGE NO: 31
What is it?
- Ménière’s disease is a rare progressive disorder of the hearing and balancing mechanisms in the ear labyrinth.
- It usually starts in one ear but progresses to both ears in up to 50 per cent of those affected.
- Fifteen per cent of people are affected in both ears from the onset of the disease.
- The cause is unknown.
- Between one in 2,000 and one in 20,000 of the population are affected.
- Onset can be at any age, but is most frequently between the ages of 20 and 50 years.
- Caucasian people are most commonly affected.
- Seven to ten per cent of those affected have a family history of the disease (Osbourne, 2004).
- Disease progression takes place in three stages.
- In the early stage vertigo may be accompanied by:
- Temporary hearing loss;
- A feeling of pressure, ‘fullness’ and discomfort in the ear;
- Palpitations and sweating;
- Tinnitus, which can vary in severity.
- Acute episodes of vertigo usually last 20 minutes to 24 hours.
- They tend to occur in clusters, with a mean frequency of 6-11 per year.
- Remission can last from a few days to months or years.
- In the middle stage, vertigo may be less severe, but tinnitus and hearing may worsen.
- In the later stage, attacks become less frequent, but hearing worsens.
- Hearing loss may eventually be permanent; vertigo may then decrease, but balance problems will remain, especially in the dark.
- Other symptoms are depression, anxiety, headaches and migraines.
- Viral infection.
- Injury to the inner ear.
- Arterial disease.
- Thyroid hormone deficiency.
- Oestrogen deficiency.
- Pituitary or adrenal gland malfunction.
- History of migraine.
- Food allergy.
- Audiogram to assess hearing loss.
- Vestibulometric tests to assess the patient’s balance.
- Blood test, magnetic resonance imaging (MRI) or computerised tomography (CT) scan to rule out other causes such as hypothyroidism, anaemia, diabetes or head injury.
- A firm diagnosis requires at least two spontaneous episodes of vertigo lasting at least 20 minutes, hearing loss confirmed by audiometry and tinnitus and/or perception of aural fullness.
- The unpredictable and progressive nature of Ménière’s disease can severely restrict daily life.
- It can lead to psychological distress, anxiety and depression.
- Sudden and disabling symptoms can lead to loss of driving licence.
- Treatment focuses on the control of symptoms.
- Prochlorperazine and cinnarizine can be used to treat acute attacks of vertigo and nausea.
- Betahistine and diuretics can reduce the frequency of attacks.
- A range of drugs may be used prophylactically, different ones work for different people, so trial and error is usually necessary.
- Grommet insertion to drain fluid from the ear may be helpful.
- Vestibular nerve section can reduce vertigo by cutting the nerve from the balance organ.
- In severe cases, labyrinthectomy may be performed, but normally if only one ear is affected and hearing loss is serious, as the procedure results in total deafness.
- Physiotherapy may help to improve balance.
Ménière’s Society: www.menieres.org.uk
NHS Direct: www.nhsdirect.nhs.uk