Section 19. Ear, Nose, and Throat Disorders

Chapter 220. Middle and Inner Ear Disorders

Topics: Introduction | Perforation of the Eardrum | Barotrauma | Infectious Myringitis | Acute Otitis Media | Serous Otitis Media | Chronic Otitis Media | Mastoiditis | Meniere's Disease | Vestibular Neuronitis | Temporal Bone Fracture | Auditory Nerve Tumors | Tinnitus

Meniere's Disease

Meniere's disease is a disorder characterized by recurring attacks of disabling vertigo (a whirling sensation), hearing loss, and tinnitus.

Meniere's disease is thought to be caused by an imbalance in the fluid that is normally present in the inner ear. This fluid is continually being secreted and reabsorbed, maintaining a constant amount. Either an increase in production of inner ear fluid or a decrease in its reabsorption results in an imbalance of fluid. Why either happens is not known.

Symptoms include sudden, unprovoked attacks of severe, disabling vertigo, nausea, and vomiting; these symptoms usually last for 2 to 3 hours but can rarely last up to 24 hours. Periodically, a person may feel a fullness or pressure in the affected ear. Hearing tends to fluctuate but progressively worsens over the years. Tinnitus, which may be constant or intermittent, may be worse before, during, or after an attack of vertigo. Both hearing loss and tinnitus usually affect only one ear.

In one form of Meniere's disease, hearing loss and tinnitus precede the first attack of vertigo by months or years. After the attacks of vertigo begin, hearing may improve.

Diagnosis and Treatment

A doctor suspects Meniere's disease because of the typical symptoms of vertigo with tinnitus and hearing loss in one ear. Doctors usually perform hearing tests and sometimes magnetic resonance imaging (MRI) to look for other causes. A low-salt diet and a diuretic lower the frequency of attacks in some people. When attacks do occur, vertigo may be relieved temporarily with drugs given by mouth, such as meclizine, lorazepam, or scopolamine. Scopolamine is also available in skin patches. Nausea and vomiting may be relieved by suppositories containing the drug prochlorperazine.

Several procedures are available for people who are disabled by frequent attacks of vertigo despite drug treatment. The procedures aim either to reduce fluid pressure in the inner ear or to destroy inner ear balance function. The endolymphatic shunt procedure, in which a thin sheet of flexible plastic material is placed in the inner ear, is the least destructive of these procedures. To destroy inner ear balance function, a solution of gentamicin can be injected through the eardrum into the middle ear. Several injections over time provide the best result. However, severe hearing loss or chronic imbalance can result from this treatment. Cutting the vestibular nerve permanently destroys inner ear balance, while preserving hearing, and is successful 99% of the time in controlling vertigo. This procedure is usually performed on people who do not improve after an endolymphatic shunt or those who never want to experience another spell of vertigo. Finally, when vertigo is disabling and hearing has deteriorated in the involved ear, the entire semicircular canals can be drilled away in a procedure called a labyrinthectomy. The hearing loss that often accompanies Meniere's disease does not improve with any of the procedures to treat the severe vertigo.