Ménière's disease
Ménière's disease: Excerpt from Professional Guide to Diseases (Eighth Edition)
Ménière’s disease, a labyrinthine dysfunction also known as endolymphatic hydrops, produces severe vertigo, sensorineural hearing loss, and tinnitus. After multiple attacks over several years, this disorder leads to residual tinnitus and hearing loss. Usually, only one ear is involved.
Causes and incidence
The exact cause of Ménière’s disease is unknown. It may result from overproduction or decreased absorption of endolymph, which causes endolymphatic hydrops or endolymphatic hypertension, with consequent degeneration of the vestibular and cochlear hair cells. This condition may also stem from autonomic nervous system dysfunction that produces a temporary constriction of blood vessels supplying the inner ear. In some cases, Ménière’s disease may be related to otitis media, syphilis, or head injury. Risk factors include recent viral illness, respiratory infection, stress, fatigue, use of prescription or nonprescription drugs (such as aspirin), and a history of allergies, smoking, and alcohol use. There also may be genetic risk factors: In some women, premenstrual edema may precipitate attacks of Ménière’s disease.
In the United States, about 100,000 people per year develop Ménière’s disease.
Signs and symptoms
Ménière’s disease produces three characteristic effects: severe episodic vertigo, tinnitus, and sensorineural hearing loss. A feeling of fullness or blockage in the ear is also common. Violent paroxysmal attacks last from 10 minutes to several hours. During an acute attack, other symptoms include severe nausea, vomiting, sweating, giddiness, and nystagmus. Vertigo may cause loss of balance and falling to the affected side. Symptoms tend to wax and wane as the endolymphatic pressure rises and falls. To lessen these symptoms, the patient may assume a characteristic posture — lying on the side of the unaffected ear and looking in the direction of the affected ear.
Initially, the patient may be asymptomatic between attacks, except for residual tinnitus that worsens during an attack. Such attacks may occur several times a year, or remissions may last as long as several years. These attacks become less frequent as hearing loss progresses (usually unilaterally); they may cease when hearing loss is total. All symptoms are aggravated by motion.
Diagnosis
Presence of all three typical symptoms suggests Ménière’s disease. Audiometric studies indicate a sensorineural hearing loss and loss of discrimination and recruitment. Selected studies such as electronystagmography, electrocochleography, computed tomography scan, magnetic resonance imaging, or X-rays of the internal meatus may be necessary for differential diagnosis.
Laboratory studies, including thyroid and lipid studies, may be performed to rule out other conditions such as Treponema pallidum.
Caloric testing may reveal loss or impairment of thermally induced nystagmus on the involved side. However, it’s important not to overlook an acoustic tumor, which produces an identical clinical picture.
Treatment
Treatment with atropine may stop an attack in 20 to 30 minutes. Epinephrine or diphenhydramine may be necessary in a severe attack; dimenhydrinate, meclizine, diphenhydramine, or diazepam may be effective in a milder attack.
Long-term management includes use of a diuretic or vasodilator and restricted sodium intake (less than 2 g/day). A typical diuretic regime is hydrochlorothiazide 500 to 100 mg daily. Prophylactic antihistamines or mild sedatives (phenobarbital, diazepam) may also be helpful. If Ménière’s disease persists after 2 years of treatment, produces incapacitating vertigo, or resists medical management, surgery may be necessary. Destruction of the affected labyrinth permanently relieves symptoms but results in irreversible hearing loss. Systemic streptomycin is reserved for the patient with bilateral disease for whom no other treatment can be considered. If a patient fails medical therapy and remains disabled by his vertigo, surgical decompression of the endolymphatic sac may bring relief.
Special considerations
If the patient is in the hospital during an attack of Ménière’s disease:
❑ Advise him against reading and exposure to glaring lights, to reduce dizziness.
❑ Keep the side rails of the patient’s bed up to prevent falls. Tell him not to get out of bed or walk without assistance.
❑ Instruct the patient to avoid sudden position changes and any tasks that vertigo makes hazardous because an attack can begin quite rapidly. Hazardous activities, such as driving and climbing, should be avoided until one week after symptoms disappear.
❑ Before surgery, if the patient is vomiting, record fluid intake and output and characteristics of vomitus. Administer antiemetics as needed, and give small amounts of fluid frequently.
❑ After surgery, record intake and output carefully. Tell the patient to expect dizziness and nausea for 1 or 2 days after surgery. Give prophylactic antibiotics and antiemetics, as ordered.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Earache [Otalgia] (Professional Guide to Signs & Symptoms (Fifth Edition))
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