Ménière's disease: symptoms, diagnosis and treatment

Ménière's disease is a disease of the inner ear. Is manifested by attacks of dizziness, nausea, vomiting, noise in the ears and progressive hearing loss. For the diagnosis of this pathology, otoscopy (examination of the ear canal and drum membranes), the study of the function of the hearing and the vestibular analyzer by various methods, the MRI of the head the brain. Treatment of the disease is first carried out using conservative methods. If this is not enough, then surgical correction and hearing aid are performed. Let us consider in more detail what kind of disease it is, how it manifests itself, how it is diagnosed and treated.

Meniere's disease was first described by a French doctor in 1861. and bears his name. The disease is found among people of different ages from 17 to 70 years, children are practically not prone to Ménière's disease. People who are 30-50 years old suffer most often. Sexual differences in frequency of occurrence were not revealed. Usually, the disease affects the inner ear on the one hand, but at 10-15% the process can be initially bilateral. Sometimes, in the course of a patient's long existence, the unilateral process is transformed into a two-sided process.

Causes

There is no exact cause for the development of Ménière's disease. It is believed that the symptoms of the disease are caused by increased fluid pressure (endolymph) in the inner ear. The inner ear is located in the thickness of the pyramid of the temporal bone, consists of the semicircular canals, the cochlea and the vestibule. These formations are the organ of hearing and balance. Increase in pressure in the structures of the inner ear occurs due to an increase in the endolymph content (as a result of increased formation, impaired absorption and circulation). This leads to a violation of the perception of sound vibrations (and hearing impairment), coordination and balance (vestibular changes).

It is believed that various factors can serve as prerequisites for increasing the pressure of the endolymph. Among them are the following:

• viral diseases of the inner ear (especially herpes and cytomegalovirus): their role is not in direct damage structures of the inner ear, and in launching an autoimmune process, that is, the production of antibodies not only to the virus, but also to the cells of the internal ear. Then even after recovery from a viral infection, the process of damage to the inner ear continues;
• allergic reactions: apparently, the mechanism of development is similar to that in viral infections;
• head trauma with damage to the temporal bone;
• vascular disorders: changes in blood flow in the inner ear are directly related to the production of the endolymph;
• anomalies in the structure of the inner ear: the width of the semicircular canals plays a role, the volume of pathways that conduct fluid in the inner ear.

It is not always possible to trace the connection of Meniere's disease with one of the above factors, therefore each of them can be the cause of the development of the disease, but this is not necessary.

There are cases of hereditary predisposition to Meniere's disease, when the disease was detected in every generation. This indicates the existence of genetically dependent forms.

Symptoms

A characteristic sign of the disease are attacks of severe dizziness.

There are three forms of the disease, which depend on the patient's symptoms:

• cochlear: when among the clinical symptoms of hearing impairment prevails;
• vestibular: the main manifestations are disturbances in balance and coordination;
• Classical: combining both auditory and coordinating disorders.

In general, the disease has a paroxysmal course. If between the attacks the patient's condition is fully restored, then they say about the reversible stage of Meniere's disease. Even if there are violations of coordination and hearing in the interstitial period, although less pronounced than at the time of the attack, then this is an irreversible stage.

In addition, the frequency and duration of seizures are several forms of the disease. Let's call them:

• light: in this form the attacks are very short (several minutes - a couple of hours), repeated once every few months or even years;
• moderate: the duration of the attack is up to 5 hours, after an attack for several days the patient is disabled. Attacks are repeated no more than once a week;
• severe: an attack lasts more than 5 hours, occurs from once a day to once a week. The disability of the patient in this case is steadily lost.

What are the symptoms of an episode of Meniere's disease? It can be:

• sudden sharp dizziness. There is a sense of rotation of objects around the world, a sense of failure, pitching. "The world is turning around so patients describe their feelings at the moment of the attack. At any, even insignificant, movements of a head dizziness amplifies. Dizziness is almost always accompanied by nausea and indomitable vomiting. Patients can not sit or stand still. They lie with their eyes closed, trying not to move. If you ask the patient to touch the index finger of his nose in the supine position with his eyes closed, he will not be able to fulfill the request. Patients do not fall even into the face area, so sharp is the miss. Movement of the limbs can also increase nausea and vomiting. Thus, coordination at the time of the attack is severely impaired;
• change of hearing. Resistance to low frequency sounds arises. Loud sounds and noise cause unpleasant sensations in the head and pain. There is also noise and ringing in the ears without a direct source of sound;
• sensations in the ear. Zalozhennost, pressure, raspiranie, simply discomfort in the ear;
• vegetative symptoms. Nausea and vomiting, increased sweating, increased heart rate, lower blood pressure (very rarely may be an increase), blushing of the face, shortness of breath;
• nystagmus. Oscillatory involuntary movements of the eyeballs.

Before the attack, there may be a slight disruption of coordination, manifested in the patient's instability, noise or ringing in the ears, a sensation of something flowing to the ear (or filling it).

After an attack, which lasts from several minutes to several hours (usually 1-8 hours), the patients feel broken, tired, complain of a headache and heaviness in the head, drowsiness. For some time, there is a disruption in coordination and instability, a decrease in hearing, a staggering gait. As the disease develops, the period of existence of post-transient phenomena lengthens, and with time the interval of normal health is completely lost. In this case, the disease becomes irreversible.

If in the beginning of the disease the perception of only low-frequency sounds is broken, the entire range of sound vibrations is gradually lost. Each new attack leads to an even greater hearing impairment. In the end, deafness comes. Usually, with loss of hearing, dizziness attacks disappear.

There are factors that provoke seizures:

• stress;
• drinking alcohol;
• drinking coffee;
• smoking and inhaling tobacco smoke;
• increased body temperature;
• lack of sleep;
• excess salt in food.

Sometimes the attack develops suddenly without any precursors, which can cause the patient to fall and cause self-injury. Especially dangerous can be a fall in the street on the roadway, because patients can not get up and move as a result of vestibular disorders (even if the fall did not lead to injury).

Ménière's disease is characterized by an unpredictable course. The frequency of seizures, their duration and severity can both increase and decrease.

Principles of diagnostics

Before the appointment of a full examination of patients with suspected Meniere's disease, the doctor performs otoscopy.

To establish the diagnosis, a characteristic clinical picture of seizures is taken into account, otoscopy is performed, during which does not reveal any pathological changes (which is evidence in favor of confirmation diagnosis).

Further, the hearing function and the balance organ are examined.

Conduct samples with a tuning fork: Weber, Rinne. They make it possible to distinguish the defeat of the sound-receiving apparatus (inner ear) from the sound-conducting device (external auditory canal, middle ear).

Audiometry is compulsory. When conducting tone threshold audiometry in Meniere's disease, changes in perception of low frequencies are observed, hearing loss does not exceed I degree (at the beginning of the disease). With the progression of the disease, the audibility of all frequencies decreases, the depth of hearing impairment increases. When carrying out above-threshold audiometry, a positive phenomenon of accelerated growth of loudness is determined.

Vestibular disorders are confirmed by a number of techniques: vestibuleremia (with a series of samples of caloric, rotational, index, palcenosoic and others), stabilography (evaluation of the stability of the body), studies of spontaneous nystagmus and etc.

Also for the diagnosis of Ménière's disease, methods are used that confirm the increase in the amount of endolymph and increase its pressure: dehydration tests and electrochlearography.

The dehydration test consists in the use of a solution of glycerol in a dose of -2 g / kg of body weight with fruit (more often lemon) juice and water (which makes it possible to enhance the effect of glycerol). Examination of the hearing before the test and after, 3, 24 and 48 hours from the time of taking the drug. Glycerol causes a decrease in the pressure of the endolymph, and in the presence of Meniere's disease after its administration, a decrease in the perception threshold is observed in the range of frequencies studied (that is, the hearing improves slightly). There are certain digital criteria for changing hearing that can confirm the increase in pressure of the endolymph.

Electro-chlo- ography allows the recording of electrical impulses from the cochlea and auditory nerve after 1-10 ms from the reproducible stimulus. Changes in the amplitude of the detected action potentials and their duration make it possible to confirm the excess of the endolymph and increase of its pressure in the inner ear.

Diagnosis of the disease requires a computer tomography (CT) or magnetic resonance imaging (MRI) of the brain to exclude other causes the appearance of symptoms similar to Meniere's disease (for example, neurinoma of the auditory nerve, multiple sclerosis, circulatory disorders in the vertebrobasilar basin and others). For the purpose of differential diagnostics, echoencephalography, electroencephalography, rheoencephalography, ultrasound of the vessels of the head and neck, examination of auditory evoked potentials.

In most cases, such a comprehensive use of various diagnostic methods can correctly establish a diagnosis.

Treatment

It is believed that Meniere's disease is incurable. But it is possible to stop the progression of the process and reduce the symptoms to a minimum.

Treatment of Ménière's disease is complex. Only the simultaneous use of a number of ways makes it possible to alleviate the suffering of the patient.

The first step is to follow the diet. Certain nutritional recommendations can affect the metabolic processes, including in the inner ear. Restricting the use of salt, refusal from alcohol and coffee, spicy condiments contribute to reducing the pressure of the endolymph, which means a more rare occurrence of seizures.

It is desirable to stop smoking (including passive), maintain a healthy lifestyle with enough sleep, reduce the number of stressful situations.

To increase the stability of the vestibular apparatus, the patient is shown special exercises that allow him to train, raise the threshold of his excitation, which contribute to improving the coordination of the body.

Medication

Drug treatment is the use of various drugs at the time of an attack to eliminate it and during the inter-rush period.

An arrest of an attack is carried out with the help of:

• antichilinergics: Atropine, Platifillin, Scopolamine;
• adrenoblockers: pyrroxane;
• antihistamines: Meklosin, Fenkarol, Suprastin, Dimedrol;
• antiemetic drugs: Cerucal (Metoclopramide), Osetron;
• sedatives: Diazepam (Sibazon);
• preparations of the beta-histidine group: Betaserk, Vestibo, Vestinorm, Betagis;
• vasodilators: Nicotinic acid, No-shpa.

If possible, the drugs are used in the injection form.

In the interictal period, treatment is conducted to prevent new seizures and reduce the manifestations of Meniere's disease between attacks. To do this, use:

• preparations betagistina (for example, Betaserk 24 mg twice a day, 1 month course, with repetitions of courses);
• diuretics (Triamteren, Veroshpiron, Hydrochlorothiazide, Diacarb), which contribute to the reduction of endolymph pressure. Their use requires a correction of the diet, as the drugs remove potassium from the body. It is necessary to include in the diet products such as apricots (dried apricots), bananas, potatoes. If necessary, additionally prescribe potassium preparations (Asparcum, Panangin);
• venotonics (Escuzan, Troxevasin, Detralex, Fleobodia);
• drugs that normalize microcirculation (Pentoxifylline, Trental).

Surgical treatment

This type of treatment is used in case of ineffectiveness of conservative methods. The goal of surgical treatment is to improve the outflow of the endolymph, reduce the excitability of the vestibular receptors, preserve and improve hearing.

All surgical interventions for Meniere's disease are divided into several types (according to the mechanism of the operation):

• draining (decompression): aimed at improving the outflow of the endolymph (drainage of the labyrinth through the middle ear, fenestration of the semicircular canal and others);
• Destructive (destructive): allow interrupting the transmission of impulses (removal or destruction of the labyrinth, crossing the branch of the VIII craniocerebral nerves, destruction of the cells of the labyrinth by ultrasound);
• operations on the autonomic nervous system (removal of the cervical sympathetic nodes, resection of the drum string).

Unfortunately, some of the operations performed on the structures of the inner ear lead to hearing loss on the side of the operation. This circumstance has stimulated the search for alternative ways to fight the disease. These include chemical labyrinectomy (ablation): the introduction of small doses of gentamicin into the tympanum (middle ear). Gentamicin is an antibiotic that causes the death of the cells of the vestibular apparatus. In this way, a break of impulses from the affected side is achieved, and a healthy ear takes on the function of equilibrium. For the same purpose, alcohol, streptomycin can be used.

Bilateral disease Meniere gradually leads to a complete hearing loss. In this case, the hearing aid is shown.

Prognosis for Meniere's disease

The disease does not carry a threat to life and does not shorten its duration.

Ménière's disease is unpredictable. It can be characterized by steady progression, undulating course, and in some cases, by improving the condition in the form of a decrease in the frequency of seizures (sometimes even without treatment).

Such a diagnosis presupposes limitations in professional activity (work at a height, on a lathe and a milling machine, with any rotating elements of construction, in conditions of noise and vibration, driving professions).

Sharp coordination disorders and hearing loss can lead to disability.

Thus, it becomes clear that Meniere's disease is not a fatal but insidious disease, It can cause a lot of inconvenience in everyday life and cause loss ability to work. In connection with the symptoms present in this disease, many patients have limitations in working life, and sometimes they lose their jobs. Meniere's disease is treated in various ways, trying to slow progression and keep hearing, to eliminate vestibular disorders. In most cases, with timely diagnosis and comprehensive treatment is possible.

The first channel, the program "Live Healthily" with Elena Malysheva on "Meniere's Disease. What to do when the head is spinning "