The Meniere ‘s syndrome is a disorder of balance and hearing other characteristics associated clinical manifestations.
It is, without a doubt, the best known of all the pictures that produce vertigo of otorhino origin.
The inner ear is housed within a part of the temporal bone of the skull, the so-called temporal bone. It is called a labyrinth due to the complexity of its shape. In the labyrinth there are two zones: the bone labyrinth and the membranous labyrinth.
The bony labyrinth consists of many cavities located in the temporal rock, which are filled with a clear and watery fluid, which is the perilymph.
The membranous labyrinth is like a replica of the bony labyrinth, it is housed in it and it is a very delicate set of tubes and membranes that contain a viscous liquid, which is the endolymph. This complex tube system is surrounded by the bony labyrinth and the perilymph.
Causes of Meniere’s syndrome
The origin of this process is not known. Multiple causes have been attributed to it, such as vascular, vitamin deficiency, allergic, infectious, traumatic, hereditary factors, etc., but it is not clear nor has any responsible cause been proven.
There may be general causes that favor its appearance, such as arterial hypertension (HTN), blood diseases (leukemia), mental disorders, general vascular disorders, atherosclerosis …
What occurs in this disease is a dilation of the labyrinthine membranes, produced or associated with an increase in the volume of endolymph.
We can say that there is an alteration in the mechanisms that regulate the volume of endolymph, both in its production and in its elimination. This increase in volume produces an alteration in the nutrition of all the cells of the labyrinth and can lead to the rupture of the membranous labyrinth, originating a mixture of the liquids of both labyrinths – endolymph and perilymph – altering the cellular nutrition of both.
Symptoms of Meniere’s syndrome
The picture usually begins abruptly, without triggers, except sometimes, mental stress .
Symptoms usually appear in this order:
- severe tinnitus or ringing in the ear
- pronounced vertigo
- deafness or hearing loss
- the picture is accompanied by nausea and vomiting.
They are usually processes that affect only one ear (unilateral), although in 50% of cases there may be involvement of both ears. If the second ear has not been affected after 5 years of evolution, it is unlikely that it will already do so.
The symptoms appear episodically and we can say that in this disease there are two phases: the crisis phases and the periods between crises (intercritical periods) or remission.
They have a variable duration, ranging from an hour to almost a day. Its frequency of appearance is also variable, but the most frequent is that the next one appears between three months and a year later, although sometimes it appears after many years. This phase begins or is predicted by the appearance of tinnitus (ringing in the ear) or by their increase in intensity, if they already existed previously.
Vertigo is the most intense symptom. The patient presents a sensation of turning of objects, being unable to stand up and forcing him to lie down, having the intense impression that he is going to fall. The patient, in turn, presents a rhythmic horizontal and rotating eye movement, called nystagmus, which disappears after the crisis. Vertigo is accompanied by nausea, vomiting, sweating, and pale skin. After the intense vertigo, the patient recovers little by little, later leaving a feeling of instability.
There is never loss of consciousness.
Other times vertigo manifests itself in different ways: as a sensation of imbalance when walking, of falling to one side, that the ground is moving, and sometimes there are even attacks with falling to the ground. Deafness is the last thing to appear.
The condition resolves itself, spontaneously, without leaving any sequelae, but when repeated sporadically it can leave, in a residual way, a deafness for the low tones and if there are many outbreaks, the deafness can affect all tones, accompanied by constant tinnitus (ringing in the ears). The first thing that goes away is the vertigo and then the tinnitus.
In any case, there are many other clinical variations of the disease, although this is the most common form.
How is it diagnosed?
The clinical evolution is very important in the diagnosis.
On examination, the horizonto-rotatory nystagmus towards the side of the affected ear is characteristic, with alterations in balance tests.
In audiometries there is initially a fluctuating hearing loss and it is generally for low tones; in the second phase, deafness affects mid and high tones, and in the last phase and after years of evolution, hearing is affected in all tones.
In the intercritical period equilibrium tests are normal.
In any case, it should always be sought or discarded if there may be a treatable cause responsible for the process (such as infectious, vascular, etc.), through a good questioning of the patient, seeing their personal and family medical history, and making a complete physical examination.
Treatment of Meniere’s syndrome
Treatment during crises is to reassure the patient, bed rest in the dark, in silence and without sudden movements, which is the most effective; avoid tobacco, excessive food and drink, and reduce salt intake. If there is a known cause of the condition, it must be treated (eg treat the infection if it is of infectious origin).
Multiple drugs have been used such as vasodilators, antihistamines, diuretics, vitamin B, vestibular sedatives, antiemetics.
If the crisis persists, treatment with intravenous medication with antivertiginous and antiemetic drugs will be required.
The inter-crisis treatment is to avoid eating excesses and psychic tension, administering anxiolytics to reduce anxiety, and labyrinthine sedatives.
Surgical treatment is indicated when there is significant disability due to the frequency and intensity of the seizures and there is no response to medical treatment. There are different surgical procedures, such as surgery on the endolymphatic sac, in order to increase the reabsorption of endolymphatic fluid (it will be carried out in the initial stages, since it reduces crises and prevents the evolution to deafness).
Other surgeries are: the vestibular nerve section or neurectomy, which is used when crises are frequent and disabling, but it does not act on hearing; and lastly, if the patient already has manifest deafness and sustained buzzing, the complete destruction of the labyrinth or labyrinthectomy will be performed.
Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.