Patient information / i / Otorhinolaryngology
What is Ménière’s disease?
Ménière’s disease is an ear disease, which includes tinnitus, impaired hearing and vertigo. The population-based prevalence of the disease is on average 1:2000. Its frequency is as its highest among 40-50 year-olds, roughly to same degree among both women and men. In rare cases the disease may also occur already during childhood.
Reasons for Ménière’s disease
Although Prosper Ménière described the syndrome, which nowadays carries his name, as early as in 1861, the cause of the disease is still not known for certain. Metabolic diseases, such as e.g. diabetes, functional disorders of the thyroid gland, cranial injuries, viral infections, noise, allergies and even heredity have been brought forward as causes, but none of these factors are more frequent among people suffering from Ménière’s disease than with the average for the rest of the population. Stress appears to aggravate the ear-related symptoms in some cases.
Onset mechanism of Ménière’s disease
The onset mechanism of the disease is considered to be a pressure rise of fluid inside the inner ear, i.e. the cochlea. In all probability various different causes may induce pressure rise of the cochlear fluid and trigger ear symptoms similar to the aforementioned: tinnitus, impaired hearing and vertigo. Ménière’s disease is usually active on only one side, especially at the beginning of the disease. Only about 10 % of the patients suffer from the disease in both ears during the initial stage. If the disease is manifested in one ear only, it will become double-sided at the latest within two years, seldom later than that.
Diagnosing Ménière’s disease is easy in the classic form of the disease with impaired hearing and vertigo. In some cases the syndrome begins with only tinnitus and impaired hearing or with episodes of vertigo, and in these cases diagnosing is difficult. However, as the disease is prolonged, the syndrome usually changes in such a way that vertigo also occurs in conjunction with the impaired hearing or the hearing of a vertigo patient begins to be impaired.
Progress of Ménière’s disease
Varying hearing is typical for Ménière’s disease. A disease episode is often preceded by tinnitus, impaired hearing and loud noises sound displeasing; they become cracked. The tinnitus and sound alteration make sound discrimination more difficult. Initially the hearing impairment manifests at the low frequencies, but as the disease becomes prolonged, the hearing also becomes impaired in other frequency zones. When the disease episode has passed, the hearing tends to regain the earlier level. Ménière’s syndrome only seldomly leads to deafness, but it may impair the hearing to such an extent that a hearing aid is required at least in cases where the disease is manifested in both ears. However, in the majority of cases the hearing impairment is slight, and rehabilitation of the hearing is not necessary.
The vertigo occurs in episodes and its frequency may vary from a few times per day to being rarely occurring, for instance only once per month. Some of the patients may have years between episodes. The vertigo normally begins with prodromal symptoms (aurae), there is tinnitus in the ear, the ear locks and there may occur a sensation of pressure around the ear. Thus for instance cancellation of driver’s licenses of patients suffering from Ménière’s disease has not been deemed prudent, as they can drive to the side of the road and rest upon onset of the prodromal symptoms. Driving should naturally be avoided if the disease is at a very active stage.
Therapeutic lines and prognosis for Ménière’s disease
Usually the disease is so mild that the symptoms are short-term and pass without permanent changes in hearing. The therapy is begun by emphasizing a healthy lifestyle. As the onset mechanism of the disease episode is considered to be a pressure rise of fluid inside the inner ear, i.e. the cochlea, the accumulation of fluid is attempted to be controlled with a low-salt diet. Coffee, alcohol and tobacco should be avoided.
Ménière’s disease is also often connected with stress-related symptoms and psychological symptoms may trigger an episode of Ménière’s disease. It is important that family and friends are aware of the nature of the disease and that they offer their support. If it appears that stress-related symptoms are connected with the Ménière’s disease, either as the cause of the disease or as a result thereof, then psychiatric help may ease or even cure Ménière’s disease.
Some of the patients are cured spontaneously without care. Approximately 75 % of the cases can be calmed medicinally, although the acute stage of the disease despite the treatment lasts from several weeks to a year. The remaining 25 % of the patients are candidates for surgery. One has to bear in mind that in excess of one fourth of the treated patients undergo a relapse of the active stage of the disease. Even after the vertigo has ended the hearing may become worse. Long-term follow-ups show that all in all 25 – 35 % of patients acquire double-sided Ménière’s disease.
Medicinal treatment
As the cause of Ménière’s disease is usually unknown, therapeutic trials with several pharmaceuticals of different type, or combinations of them, have to be conducted. Circulatory medicines and diuretics are central among the orally taken medicines. In addition to orally taken medicines Ménière’s disease can also be treated with medicines inserted behind the tympanic membrane, nowadays the most frequently used is an anaesthetic. Its primary function is to calm the function of the vestibular apparatus and to abolish or at least reduce the number of vertigo episodes. Symptom-free episodes of often months or even years can be achieved with anaesthetics. Ear-toxic antibiotics placed in the middle ear can also be used in treating the vertigo. They may induce deafness and can thus only be used in ears with very poor hearing.
Surgical treatment
Surgical treatment is resorted to when medicinal treatment is insufficient. Primarily surgical treatment is aimed at such patients whose work ability and quality of life are affected by the vertigo. The most certain way of finally ending the disease is by surgically destroying the inner ear. Loss of hearing is also, in addition to ending the vertigo, a consequence of the destruction of the inner ear. Thus operations such as this are not performed on ears which in practice are already deaf.
Extant hearing is attempted to be preserved with the currently used surgical methods. Operations where the fluid circulation of the inner ear is improved by inserting a small valve mechanism inside the inner ear are the most frequent. Two thirds of the operated patients are entirely cured of the vertigo or the vertigo is eased.
Another more reliable type of operation is severing the vestibular nerve. The erroneous sensation from the vestibular apparatus is not transmitted to the brain and the vertigo ends. Recovery from a severed vestibular nerve may be slow among elderly patients, but the balance can be exercised through active rehabilitation.
The vertigo can be cured by means of current therapeutic methods, but the treatment of the hearing and the tinnitus are still very problematic. However, in most cases Ménière’s disease is mild, and even in the worst cases it is not life threatening. With sensitive care and a correct approach one can well come to terms with Ménière’s disease.
Loimaa Regional Hospital tel. 02-3143261 Mon-Fri / Salo Outpatient Ward of Otorhinolaryngology tel.02-3144536 and Otorhinolaryngological Ward 02-3144325 / Turunmaa Hospital 02-314 6000 / Turku University Hospital Outpatient Ward of Otorhinolaryngology tel. 02-3131525 / Vakka-Suomi Hospital Outpatient Ward of Otorhinolaryngology tel. 02-3141005, Emergency Department tel. 02-3141111.
Ward 525 of the Turku University Hospital is responsible for the content, content revised in 2 / 2011
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