Some of the diseases of the ENT organs remain a mystery to specialists to this day. One of these ailments is Meniere’s disease.
For the first time, the French doctor Prosper Meniere suggested linking severe dizziness with a specific pathology back in the XIX century. But, despite the long history of studying the disease, no effective treatment has yet been found, and even the causes of the disease are not fully understood. However, medicine does not stand still, and today doctors manage to help patients with such a diagnosis to live a full life. This article will tell you about the methods of treatment and prevention.
Causes of Meniere’s disease
Meniere’s disease is a lesion of the inner ear that is not associated with the inflammatory process. Under the influence of various factors, endolymph fluid accumulates in the membrane labyrinth. This leads to an increase in intra—labirint pressure and causes severe symptoms, and over time – permanent hearing loss, poor coordination of movements, etc. It is characteristic that the initial process spreads most often to one ear and only affects both in 10-15%. However, with the course of the disease, complete deafness may occur.
What exactly the development of pathology is connected with is not fully established. Doctors most often tend to the following risk factors:
- Complications of viral infection (cytomegalovirus or herpes virus), which are expressed in the development of autoimmune reactions.
- Genetics. Often the disease occurs in people whose families have already had such a diagnosis. Therefore, it can be attributed to hereditary.
- Hormonal disorders. Dizziness can be caused by a change in the secretory activity of the labyrinth cells that produce adrenaline and serotonin.
In 2016, researchers from the University of Exeter Medical School conducted a large-scale study that helped establish the causes of the disease. After analyzing the data of 1,376 patients, scientists have identified a number of other risk factors. Among them:
- Female gender.
- Old age. Despite the fact that, like many other diseases, Meniere’s disease is “getting younger”, it does not occur in pediatrics. But among people over 50 years of age, the percentage of patients increases significantly.
- Autoimmune disorders, improper functioning of the immune system. Almost half of the patients with Meniere’s disease have allergic reactions.
Also, patients often have concomitant diseases — arthritis, irritable bowel syndrome, Crohn’s disease.
Earlier, researchers at the University of Colorado School of Medicine suggested that Meniere’s disease is associated with vascular problems of the brain. So, pathology often manifests itself in people suffering from headaches.
Symptoms and danger of dizziness attacks
Meniere’s disease can occur in mild and severe form — the number of attacks varies from several times a year to several times a day. Their duration is also very individual — from 2-3 minutes to 5 hours.
The main symptom of the disease is a sharp and severe dizziness. It is so pronounced that it is difficult for a person to stand or even sit, from any change in the position of the body it only intensifies. Accompanied by an attack and other signs:
- Loss of coordination.
- Noises or a feeling of bursting in the ear.
- Hearing impairment.
- Nausea and vomiting.
- Excessive sweating.
- Pallor.
- Palpitations, tachycardia.
- Dyspnea.
- Nystagmus is an involuntary very rapid eye movement (sometimes up to a hundred twitches per minute).
With a mild form of the disease, after the end of the attack, its clinical picture disappears completely. If the disease progresses, the symptoms do not go away — hearing loss, impaired coordination, heaviness in the head become permanent.
It is extremely rare for patients to notice an aura before dizziness — for example, tinnitus. In most cases, the attack occurs suddenly. And this is the main problem for patients. With such a diagnosis, it is impossible to drive vehicles. In addition, people often have to give up professional activity if the work involves risks and requires high concentration of attention.
To date, there is no single test for the diagnosis of Meniere’s disease. In fact, it is the characteristic symptoms that are the basis of the diagnosis. But at the same time, the doctor should exclude other causes of such dizziness. If they manifest themselves against the background of a traumatic brain injury, circulatory disorders in the brain or an inflammatory process, it is not the disease that is diagnosed, but Meniere’s syndrome. The syndrome can pass, the disease is incurable and prone to progression.
Medical treatment and injections in the ear
Drug treatment is the basis of therapy for Meniere’s disease. Some drugs are prescribed for life, others are used to relieve dizziness. During an attack, patients are recommended to take, in particular, the following medications:
- Chlorpromazine (aminazine).
- Diazepam.
- Preparations of scopolamine and atropine.
- Antihistamines (diphenhydramine).
Vomiting is often observed during an attack, so the drugs are injected, not inside.
Since Meniere’s disease is associated with the accumulation of fluid in the inner ear, patients are often prescribed diuretics — drugs that remove excess water from the body. Against the background of such therapy, the number of seizures really decreases, and their intensity becomes less pronounced. It is important to remember that uncontrolled intake of diuretics can result in a deficiency of minerals, in particular, potassium. Therefore, such drugs should be taken only under the supervision of a doctor.
One of the ways to treat Meniere’s disease are injections of drugs directly into the ear. Until recently, the use of the antibiotic gentamicin was considered the gold standard. It really reduces dizziness, but, unfortunately, it acts in such a way that it destroys cells and leads to irreversible hearing loss. In 2016, researchers from Imperial College London proposed an alternative option. In a report published in the Lancet magazine, they recommend replacing gentamicin with steroids. According to their research, the drugs are equally effective in combating dizziness, but steroids do not affect hearing and do not lead to hearing loss.
Surgical treatment
If drug therapy does not have an effect, doctors recommend surgery. Most often, operations are aimed at lowering the level of endolymph in the inner ear cavity. Partial removal of the inner ear or cutting of the vestibular nerve may also be performed.
Recently, scientists at the University of Washington in Seattle have proposed another method of treating Meniere’s disease — a vestibular electric prosthesis. The device affects the fluid inside the ear canals, from which a signal about the position of the body is transmitted to the brain. With proper stimulation, it is possible to save people from impaired coordination of movement and reduce dizziness. The prosthesis was tested on four patients and showed its effectiveness. However, people showed individual reactions to stimulation, in particular, with their eyes closed, patients were fixed in an inclined position, rather than standing straight. Therefore, at this stage, the prosthesis requires refinement, and in the future — individual customization for a specific patient.
Cochlear implantation is recommended for people with severe Meniere’s disease and complete hearing loss. According to a 2014 study conducted by scientists at Wake Forest University School of Medicine in Winston-Salem, such manipulation significantly improves the condition of patients. At the same time, the implant does not return attacks of dizziness, which most often disappear with complete hearing loss.
Lifestyle in Meniere’s disease
Today it has been proven that some habits can provoke an attack. Therefore, patients diagnosed with Meniere’s disease should change their lifestyle:
- Give up smoking. People who quit smoking note that the severity of seizures has decreased.
- Reduce alcohol and coffee consumption. These drinks affect blood pressure and can provoke severe dizziness.
- Avoid stress and get enough sleep.
- If the disease is at an early stage and the person’s condition is fully restored between attacks, it is very important to exercise. Exercises for training the vestibular apparatus will be especially useful.
- Eat right. It is important not to overeat, not to eat a lot of flour, sweet or fatty. It is also necessary to reduce the intake of salt, which helps to retain fluid in the body.