A 38-year-old homemaker came to the otolaryngology clinic with a melancholy face. She sighed that in the past two years, she had been suffering from dizzy spells, feeling like the world is spinning, which lasted for 20 to 30 minutes or even 1 to 2 hours each time. The condition was often accompanied by nausea, vomiting or cold sweat all over her body. After the attack, the dizziness lasted for several days.

Her left ear also experienced tinnitus and a fullness in the ear. When she went out for shopping, once she heard louder sounds, such as bus noise or department store spoken announcements via a public address system, her left ear would be very uncomfortable. Moreover, over the past few years, her left ear hearing was getting worse, and she listened to the phone with her right ear instead, which made life a mess. She had seen many doctors and was diagnosed with Meniere's disease.

What is Meniere's Disease

The condition is named after the French physician Prosper Ménière, who was the first to identify the disorder in 1861. It is a disorder of the inner ear that is characterized by episodes of feeling like the world is spinning, ringing in the ears, hearing loss, and a fullness in the ear.

Most people with Meniere's disease have problems with only one ear. In addition, although Meniere's disease can occur at all ages, including in children, it is most common in people in their 40s and 50s.

Symptoms

• Paroxysmal vertigo lasts longer than 20 minutes: from a few hours to a full day. Vertigo occurs without warning and in severe cases can cause nausea and vomiting.
• Tinnitus or a feeling of fullness in the ears: tinnitus is the sensation of ringing, rumbling, honking or hissing in the ears. Tinnitus in Meniere's disease is usually a low-frequency sound.
• Fluctuating sensorineural hearing loss: the hearing loss is caused by lack of sensory cells (hairy cells) in the cochlea or damage to the cells. Later, most patients suffer from permanent hearing loss to varying degrees.

In the early stages of the disease, only one or two of the symptoms may occur. According to the 1995 diagnostic criterion for Meniere’s disease proposed by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), patients with three typical symptoms are referred to as "definite Meniere's disease," “probable Meniere's disease” for only the episodes of vertigo combined with tinnitus or hearing loss, and “possible Meniere's disease” for the episodes of vertigo.

Causes

The etiology of Meniere's disease has not been fully understood, but the primary pathological mechanism is endolymphatic edema. In recent years, some academics have proposed that there is a so-called "water channel" in the inner ear. Once the water channel is damaged, it may cause endolymphatic edema. Endolymph edema may be caused by excessive endolymphatic fluid, slow absorption or obstruction of endolymphatic circulation.

When to See a Doctor

If you have any of the above symptoms, it is advised to see a doctor for diagnosis, because even if it is not Meniere's disease, it may be caused by other disorders. For example, although rare, vertigo may be a symptom of stroke, brain tumors, and cardiovascular diseases.

At present, there is no clear method to determine the diagnosis of Meniere's disease, which depends on the patient's medical history and symptom description, as well as the record and observation of clinical medical history.

Auxiliary examinations included pure tone and voice audiometry, auditory brainstem response, inner ear temperature difference test, glycerin test, electrocochleography and vestibular evoked myogenic potential. According to the study, about half of Meniere's patients do not have vestibular evoked myogenic potential response.

Meniere's disease in in the early days was easily misdiagnosed as other diseases, such as the Dutch Impressionist Van Gogh, who suffered from severe vertigo and tinnitus in his right ear in his later years, which made him emotionally unstable for the last few years of his life. Diagnosed with epilepsy and mental disorders, he was admitted to a sanatorium for medication or even electric shock therapy, and finally committed suicide on the evening of May 21, 1890. In 1990, Dr. Arenberg sorted out his 796 personal letters from 1884 to 1890 describing all his symptoms from onset to suicide. In medical journals, he pointed out that Van Gogh was likely to suffer from Meniere's disease, rather than epilepsy.

Therapy

The course of Meniere's disease varies widely, with about 70 % of patients getting less vertigo with or without treatment, making it difficult to assess the effectiveness of treatment for the disorder. There are some cases of hearing loss, but they are mild to moderate. Another 30 % will experience severe vertigo and a significant increase in hearing loss.

There is no cure for Meniere's disease, but there are many ways to treat and control the symptoms, including drugs and surgery.

Drug therapy can be divided into preventive drugs (diuretics, vasodilators) and control drugs for acute vertigo attacks. In acute episodes, the use of anti-vertigo drugs and tranquilizers can control vertigo and vomiting. If patients need to be on medication for a long period of time, the purpose is to prevent vertigo recurrence. Approximately 90 % of patients can keep vertigo under control if proper medication is available.

Only a small number of patients who do not respond to drugs should consider surgery. Currently reported surgical procedures include endolymphatic sac surgery, labyrinthectomy and vestibular neurectomy:

• Endolymphatic sac surgery: The endolymphatic sac is responsible for the management of lymphatic secretion in the inner ear. Through surgery, vertigo symptoms can be alleviated by reducing lymph secretion or enhancing lymph absorption.
• Labyrinthectomy: Transection of the labyrinth (8th pair of cranial nerves), which removes the balance and hearing ability of the ear with Meniere's disease, is therefore recommended only if the patient has a near or complete loss of hearing in the affected ear.
• Vestibular neurectomy: The vestibulocochlear nerve is the main system that maintains the balance function of the body. The procedure usually improves vertigo while preserving hearing in the affected ear.

Over the past 20 years, with the development of medicine for the inner ear, glycosylamine-containing antibiotics with ototoxicity can be injected to the ear to selectively destroy vestibular black cells to achieve the effect of chemical labyrinthectomy. This is a less invasive treatment, which has more than 90% effect on vertigo and 70% hearing preservation after operation, but still has 30% chance of hearing loss, so it is generally not recommended for patients with Meniere's disease whose hearing is still normal.

In addition, over the past decade, based on the basic pathological mechanism of endolymphatic hydrops in Meniere's disease, some people have made a low-pressure pulse generator, that is, a pressure tube is placed in the outer ear, through which the low-pressure pulse wave is transmitted to the middle ear and then to the inner ear, which produces a massage-like effect of the inner ear, so that the pressure in the inner ear can be released, thus alleviating lymphedema and Meniere's disease symptoms.

Reminders

It is suggested that patients with Meniere's disease should get enough sleep and avoid staying up late and overwork. Keep your diet light and avoid salty foods. As some patients with Meniere's disease often have migraine, they should refrain from eating cold, sweetened, caffeinated or spicy and irritating foods and avoid smoking or drinking alcohol.