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Meniere's disease

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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.

Incidence

- 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).

Symptoms

- Disease progression takes place in three stages.

- In the early stage vertigo may be accompanied by:

- Nausea;

- Dizziness;

- Vomiting;

- 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.

Possible clauses

- Viral infection.

- Injury to the inner ear.

- Arterial disease.

- Thyroid hormone deficiency.

- Oestrogen deficiency.

- Pituitary or adrenal gland malfunction.

- History of migraine.

- Food allergy.

Diagnosis

- 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.

Effects

- 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

- 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.

Websites

Ménière’s Society: www.menieres.org.uk

NHS Direct: www.nhsdirect.nhs.uk

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