Meniere's Disease Research Paper

1. Introduction
Meniere’s disease is an inner ear disorder. People diagnosed with Meniere’s disease experience a variety of symptoms which include a fluctuating hearing loss which can turn permanent, tinnitus or a ringing sound in the ears, ear pressure, and spinning also known as vertigo. Most people with Meniere’s disease only have one ear affected by the disease. Meniere’s disease usually affects people between the ages of 20 and 50, but it can appear at any age. Meniere’s disease is chronic and there is no cure, but there are treatment options people can use to minimize some of the symptoms they might experience (1).
2. Definition
Meniere’s disease is a disorder of the membranous labyrinth of the inner ear that is determined by recurrent

attacks of dizziness, tinnitus, and hearing loss (2).
3. Characteristics of Meniere's Disease
Incidence and Prognosis: Attacks of vertigo can occur suddenly and often without any warning. The episode, or attack, is generally preceded by headache or, more commonly, aural fullness along with increased tinnitus and hearing loss. The hearing loss can last only a few minutes to several hours, is exacerbated by head movements and can be accompanied by nausea, vomiting, sweating, diarrhea, and in some cases, nystagmus, (an involuntary rhythmic movement of the eyes, usually from side to side, caused by some illnesses that affect the nerves and muscle behind the eyeball) (3).
Genetics: Meniere’s disease is genetic. There is a variety of genetic testing that can be done to determine each individual case (3).
Physical: Meniere’s disease causes episodes of vertigo, ringing in the ears, hearing loss, and a feeling of fullness in the ea.

These symptoms can last for short periods or even long periods of time. Intensity varies as well. Although there are many theories that exist about what causes Meniere’s disease, no definite answers have been proven. There are researchers who believe Meniere’s disease is the result of constrictions in blood vessels, like those that cause migraine headaches. Some researchers believe Meniere’s disease could be the result of viral infections, allergies, perhaps eve some autoimmune reactions. Meniere’s disease appears to run in some families. Genetic variations could be considered the cause of abnormalities in the volume or regulations of endolymph fluid

(3).
Cognitive: In Meniere’s disease, the endolymph fluid is compressed in response to sound vibrations, which stimulates sensory cells that send signals to the brain. The endolymph buildup in the labyrinth interferes with the normal balance and hearing signals between the inner ear and the brain. This abnormality results in vertigo and other symptoms of Meniere’s disease (3).
Speech and Language: Individuals may exhibit speech impairment or lose the ability to distinguish speech or location of sound (3).
Vision: Double vision or loss of vision may occur during the recurring attacks associated with Meniere’s disease (3).
Hearing: At first onset, hearing loss can be effected only during recurring attacks. In most cases, there is some degree of permanent hearing loss (3).
4. Differential Diagnosis
According to the National Institute on Deafness and Other Communication Disorders (NIDCD), there is no definitive test or single symptom that a otolaryngologist can use to make a diagnosis of Ménière’s disease, and must rely on the patient’s medical history and the presence of specific symptoms exhibited by the patient.

These symptoms include: two or more episodes of vertigo lasting approximately 20 minutes each, tinnitus (ringing or buzzing of the ear), temporary episodes of hearing loss, as well as a feeling of “fullness” in the ear. In terms of assessment, the NIDCD asserts that some physicians will implement the use of hearing tests to determine the extent of the hearing loss that has occurred due to Ménière’s disease

(4).
The use of magnetic resonance imaging (MRI) and computed tomography (CT) scans of the brain is also important in terms of ruling out other possible causes to the symptoms that the patient is experiencing. According to Vassiliou, A., Vlastarakos, P. V., Maragoudakis, P., Candiloros, D., & Nikolopoulos, T. P. (2011), “ENT specialists, audio-vestibular physicians and neurologists also need to often differentiate Meniere’s disease from other pathologies which can cause subjective tinnitus.” These different pathologies include otologic conditions, metabolic disorders, drugs, dental disorders, as well as psychological factors (5).
5. Relevant Assessments
The two main things that need to be tested and assessed are the conditions of one’s balance and hearing (6). To test a person’s hearing, an audiology assessment is administered (6). During this assessment, one is usually hooked up to various machines that will take record of what he/ she hears or prints out results onto a graph (7). Not being able to distinguish through closely sounding and related words is usually a huge indicator of a problem (6). To test for balance, an ENG test could be used (6). This is performed in a dark room where warm and cold puffs of air are administered into the ear canal (6). Other beneficial tests may include tests like, an ECOG or an MRI (6). An ECOG will measure the pressure in a person’s inner ear, which can affect one’s balance as it creates pressure and weight to your cochlea (6). A tube with a connected electrode is set near the eardrum in order to measure the pressure being exhibited (7). An MRI will produce images of the head and most importantly, the inner ear without any obstruction (6).
6. Possible Treatment/ Rehabilitation
Meniere’s disease has varying degrees of intensity and treatments are in proportion to individual intensities.
Short Term Therapies – Acute attacks of vertigo
- Valium/Motion Sickness Medications – Reduces spinning sensations and nausea/vomiting (8)(9)(10)(11).
- Steroids – anti-inflammatory properties help reduce endolymphatic sac pressure, also to possibly decelerate hearing loss (11).
- Low sodium diet combined with a diuretic – Reduces pressure by reducing fluid retention and volume of fluid in the inner ear, specifically the endolymphatic sac (9)(10)(11).
Non-Invasive Therapies
- Vestibular Rehabilitation Therapy (VRT) – specialized therapy to alleviate primary and secondary problems caused by vestibular disorders (12).
- Hearing Aids – benefits those suffering hearing loss from the disease (10).
- Meniett Devices – Intermittent air pressure pulses delivered to the middle ear via a surgically placed ventilation tube (8)(10)(11)(13). This treatment is believed to reduce the excess inner ear fluid and swelling by acting on the endolymph (13).
Middle Ear Injection Medications – Medication delivered to the middle ear, then absorbed into the inner ear (10). Used for patients unresponsive to Short Term or Non-Invasive treatments.
- Antibiotics such as Gentamicin – Toxic to the inner ear (10) and will damage hair cells critical for hearing (8). Hearing loss risk increases with use. The goal of the injection is to reduce balancing function in affected ear, and the opposite ear assumes responsibility for balance (10).
- Steroids such as Dexamethasone – Reduces pressure and inflammation. Not as effective as an antibiotic but less likely to cause hearing loss (10).
- Surgery – last resort when earlier treatments fail (3).
- Endolymphatic Sac decompression surgery/shunt placement – a portion of the overlying mastoid bone is removed which allows the enlarged endolymphatic sac to expand freely and conform to less pressure (10, 11). Sometimes a shunt will be placed to drain excess endolymph into surrounding mastoid space (10, 11). The long-term effectiveness of these surgeries is controversial (9, 11).
- Vestibular nerve section- a surgery that cuts the vestibular nerve and is intended to discontinue information transfer from affected ear to the brain (9, 10, 11). This surgical option aims to preserve hearing, while inhibiting vertigo (10) and shows high success rates of both (11).
- Labyrinthectomy- the removal of the balance portion of the ear (10, 11). This procedure will result in complete hearing loss on the affected side (10), but is a highly effective treatment for vertigo (14).