Neurological Disorders: Menieres Disease

Introduction

Menieres Disease can be considered as a neurological as well as an ear problem, and usually both neurologists & ENT physicians are involved in the care of these patients.

It is primarily an inner ear problem however presents with both ear & neurological type of manifestations and this is because inner ear contains both primarily ear and neurological structures.

Who gets this disease?

Middle aged individuals are the victims usually. Women are affected more than men. It can affect any race or ethnicity.

What Causes It?

The primary problem is with excessive fluid in the inner ear called as endolymph. This excessive fluid associated with its excessive-pressure causes damage to the inner ear structures related with maintaining the balance/positioning of the head and body as well as hearing.

What triggers this excessive endoymph formation is still unknown.

There are some speculations that it may be due to certain infections like herpes viral infection, head-injuries etc. Caffeine, smoking etc are thought to ether trigger and/or exacerbate this condition. Allergy may play part in some individuals.

Clinical Picture

Initially the symptoms are usually intermittent and later they may become more constant, although there are various grades of severity and patterns of presentation seen.

The following manifestations are common;

• Spinning sensation of the self and/or the surrounding (Vertigo sensation)
• Nausea and vomiting with vertigo feeling
• Hearing loss
• A feeling of fullness in the affected ear

The disease starts in one ear but may spread to the other ear too, but not in all patients.

Diagnosis

The diagnosis is mainly clinical one since there are no confirmatory tests for this condition. However several investigations are ordered; to help with supporting the diagnosis as well ruling out the mimickers.

These are the usual set of investigations accomplished;

• An MRI of the brain (less often CT brain) helps in ruling out any intracranial problem mimicking this disease (e.g. cerebllo pontine area tumors, 8th cranial nerve pathologies etc)

• A Nystagmography test to look for characteristic peripheral type abnormal eye movements called as nystagmus

• An audiogram (to assess the hearing loss)

• Certain blood tests like RPR to rule out neurosyphilis, ESR/CRP, ANA etc to rule out connective issue/autoimmune disorders.

Treatment

The treatments are focused on patient’s symptoms; treating & preventing them as much as possible. Such measures include;

• Patients are advised to avoid or reduce the intake of caffeine containing beverages, and smoking etc
• Anti vertigo medications like meclizine, betahistine etc
• Diuretics like hydrochlorthiazide
• Allergy-desensitization
• A course of acyclovir for presumed herpes infection is a consideration too

In severe cases of Menieres Disease where the above measures fail to help then we may need to try more aggressive approaches which are basically destroying the vestibular structure in the inner ear. There are different types of surgical options including labrynthectomy, sectioning the vestibular branch of 8th cranial nerve etc. With some of these surgeries there is a risk of losing the hearing.

A chemical-labrynthectomy with an antibiotic called gentamicin may be an option too for the management of severe menieres disease.

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