Meniere disease is thought to arise from abnormal fluid balance in the inner ear, which is the centre of hearing and balance. During an attack, the person experiences vertigo- a sensation that they or the world around them is moving. They feel dizzy and sick, their hearing is dominated by a hissing or roaring sound (tinnitus) and one or both ears feel full.
The inner ear contains a series of canals filled with fluid. These canals are at different angles. When your head is moved, the rolling of the fluid inside these canals tells your brain exactly how far, how fast and in what direction your head is moving. Information from these canals is passed along to the brain via the vestibular (balance) nerve. If your brain knows the position of the head, it can work out the position of the rest of your body.
The cochlea is the snail-shaped hearing organ in your inner ear, which is also filled with fluid. This fluid moves in response to sounds. Messages are passed along the hearing nerve to the brain to tell you what you are hearing.
Meniere disease is diagnosed only if the patient complain of both episodic vertigo and sensorineural hearing loss. Vertigo may be associated with nausea and vomiting, and persists from 20 minutes to 24 hour duration. Sensorineural hearing loss is usually fluctuating and often initially affects lower frequencies. Hearing loss progresses over time and often results in permanent hearing loss at all frequencies in the affected ear over an 8 to 10 year period.
There is no specific diagnostic test for Meniere disease.
- Hearing tests (audiometry) - should be performed in all suspected patients. The most common audiometric pattern is a low frequency or combined low and high frequencies sensory loss with normal hearing in the mid frequencies
- Vestibular test - measures involuntary eye movement while your balance is put under stress. It involves rotatory chair testing and computerized dynamic posturography.
- MRI - can identify features that support the diagnosis but the findings cannot confirmed the condition. It is usually indicated to rule out other disorders
There is no cure for Meniere disease. Treatment is aimed at relieving the symptoms
Medical management include:
- Medications such as prochorperazeine, diuretics and betahistidine to control vertigo, nausea and vomiting and reduce fluid retention
- Avoid trigger factors such as high salt intake, caffiene, alcohol, nicotine, stress, monosodium glutamate (MSG) and allergies. Salt should be restricted to 2 to 3g of sodium per day
Interventation treatment only recommended in those who have intractable or progressive, unremitting symptoms that significantly impair their quality of life, despite medical therapy.
- Intratympanic gentamicin - Gentamicin is delivered into the middle ear space by injection to destroy the hair cells in the semicircular canals. Therefore, destroying the labyrinthine function. Study showed it control vertiginous symptoms in 80 to 90 percents of patients. Side effect of this treatment can cause moderate sensorineural hearing loss which is irreversible
- Labyrinthectomy - Surgical destruction of the bony and membranous labyrinth which relieves vertigo in all patients but cause irreversible hearing loss