Meniere's disease: symptoms and treatment of Ménière's syndrome

What is it - Ménière's disease, according to the author's description, is a consequence of the narrowing of the vessels of the ear maze, leading to a violation of his blood supply and, as a result of increased production of the endolymph with the development of edema, stretching the labyrinth.

In accordance with this symptomatology, the disease is also called endolymphatic hydrops or labyrinthine dropsy.

The function of the human's ears is to transmit and perceive vibrations by means of an elongated forward nerve. Pathological changes in the labyrinth cause processes in the form of impaired coordination, weakness in the legs, unsteadiness of the gait - all manifestations of dizziness accompanied by symptoms of vegetative disorders( nausea and vomiting) with the development of deafness.

One and a half hundred years ago, a disease with similar symptoms, and a scientific report on it, was presented to the French scientific council by a speech theologian P. Menier and was subsequently named after him. To date, it is considered one of the most mysterious diseases of the inner ear. It belongs to the category of incurable pathologies.

This fact was disputed for decades. Similar symptoms are present in a number of background diseases, in the treatment of which, the symptoms described by Meunier disappear. To put the "point" in the definition was helped by an international congress, held in Sweden, dedicated to this disease.

Based on the research of various authors, taking into account the dominant symptoms, Meniere's disease is considered to be:

1. 1) Manifestation of any vestibular dysfunction of central or peripheral pathogenesis.
   
2. 2) Clinical condition characterized by vestibular dysfunction, sudden hearing loss in one ear and subjective sensations in it( ringing, hum, noise, etc.)
   
3. 3) Hemorrhages in the inner ear.

If a similar symptom complex is caused by:

• labyrinth ischemia;
  
• diffuse hemorrhage of the labyrinth, or with his injuries;
  
• by inflammatory processes or intoxication;
  
• vertebrogenic labyrinthopathy;
  
• vascular craniocerebral diseases, dependent on the labyrinth;
  
• craniocerebral trauma.

These manifestations should be diagnosed with Meniere's syndrome..

Causes of Meniere's Syndrome

Why does the disease develop and what is it? Ménière's disease does not have a clearly defined etiological factor. There are only possible causes that contribute to its development. The main cause, to this day, is considered a dystrophic change in the Riderner membrane of the inner ear.

The cause of this pathology is idiopathic endolymphatic edema( hydrops), which is manifested by an increase in the amount of labyrinthine fluid entering the cavity of the membranous labyrinth and increasing the pressure inside it.

An increase in the volume of a viscous liquid( endolymph) can be caused by a violation of its absorption in the sac at the end of the endolymph's duct. Such disorders, in rare cases, can be congenital in the form of an inferior development - in the form of Mondini dysplasia.

Acquired labyrinthine dropsy is associated with:

• with congenital anomalies in the structure of the temporal bones;
  
• presence of vascular diseases;
  
• injuries and head and ear injuries;
  
• by inflammatory and infectious ENT diseases;
  
• inflammatory and infectious processes in the inner ear( see symptoms of otitis)
  
• autoimmune and endocrine diseases;
  
• hypersensitivity to allergens.

There are no more reliable facts on this score. The disease in general can be asymptomatic if there are no characteristic gaps in the vestibular membrane caused by the pressure of the endolymph, and the disease does not progress. It is the rupture of the membrane that causes vestibular disorders-a decrease in hearing and a manifestation of various noises inside the ear.

The rupture of the membrane leads to the mixing of the secretion of the endolymph, rich in potassium, and perelymph, the excess of which leads to the swelling of the labyrinth.

This process of mixing secretion, leads the vestibular nerve into a state of excitation and death of afferent auditory neurons in the nerve fibers of the spiral ganglion of the cochlea, which explains the hearing loss and possible causes of dizziness.

Pathomorphism of the disease

Pathomorphism of pathological changes is characterized by:

1. 1) Uneven expansions of the cavity of the ear maze due to the increase in the volume of the labyrinth fluid. In most cases, in the cochlear spiral canal, in the depressions of the bone vestibule, in the system of semicircular canals.
   
2. 2) Multiple point breaks in the vagina membrane, both fresh fractures, and healed.
   
3. 3) Expressed by degenerative changes in the cellular structure of the inner ear, the result is endolymphatic edema.

Classification of

The disease characterized as endolymphatic hydrops has several types:

1. 1) A typical or neurological species refers to the relatively favorable form of Ménière's disease. Symptoms of labyrinthine disorders are not typical. Occurs in the form of periodic attacks caused by endolymphatic edema. It manifests itself as signs of vestibular disorder and short-term hearing loss. Between attacks, deafness does not appear.
   
2. 2) Neuritic appearance is characterized by frequent or continuous attacks, the manifestation of complete deafness in one ear. Enlightenment and gaps between them do not happen.
   
3. 3) Hemorrhagic appearance is characterized by increased symptoms - in the ear maze there is complete total, one-sided disabling of vestibular and auditory functions.
   
4. 4) Bilateral appearance is due to the development of edema in one ear and simultaneous perceptive hearing loss in the second. With the subsequent manifestation of the totality of all Mejnier's symptoms in the opposite ear.

Symptoms of Meniere's disease

Symptoms of Meniere's syndrome are manifested by a triad of already known symptoms. The clinical picture varies depending on the severity of the course and the stage of the disease.

The initial, first stage of Ménière's disease is manifested by such signs:

• by the appearance of periodic noises inside one ear( see causes of tinnitus);
  
• with an unpleasant feeling of stuffiness and a feeling of pressure in the ear;
  
• with hearing-impaired hearing loss;
  
• dizziness, which are periodic in nature, with different intervals of manifestation accompanied by vegetative disorders;
  
• increase in noise inside the ear, congestion and pressure in it indicate the approach of a fit;
  
• approaching a fit of dizziness causes hearing impairment, then it improves;
  
• manifestation of nystagmus - directed to the affected side during a seizure, and in moments of inhibition, in the opposite direction.

The second stage of clinical symptoms manifests itself more intensively:

• is characterized by daily, or frequent intense attacks of dizziness with an entire bouquet of intoxication;
  
• noise and the manifestation of discomfort in the ear are of a permanent nature, amplified by seizures;
  
• by the audiometry method of deafness is determined by the second and third degree
  
• vestibulometric studies of the ear maze indicate signs of hyporeflexia - a decrease in reflexes, and an increase in reflexes - hyperreflexia at the time of attacks

. In the third stage, characteristic pronounced deafness is characteristic, no oscillations are observed. Fits of vertigo go to recession, but there are otolith symptoms( crises), manifested by unexpected loss of orientation, leading to falls without revealing obvious causes - the result of hyporeflexia, or areflexia of the inner ear.

Diagnosis of Ménière syndrome

A number of studies are being conducted to diagnose and confirm the "discovery" of Meniere's disease. The first step is aimed at elucidating the connection of Mechnier's symptoms, differentiating them with the pathologies of the inner ear or craniocerebral diseases.

Neurological and otorhinolaryngological examinations are carried out including:

1. 1) Electronstagmography method records involuntary movements of the eyeball that determine the nature of nystagmus. Characteristic movements indicate the cause of dizziness in the pathology of the inner ear, or certain movements due to CNS damage.
   
2. 2) MRI and CT are performed to visualize craniocerebral pathologies.
   
3. 3) Audiometric method, which determines the degree of deafness development.
   
4. 4) Dehydration test, improving hearing, which is typical for Ménière's disease.
   
5. 5) The method of transtimpanal electrochlearography, which determines the difference in the muscular potentials involved in the passage and transmission of sounds.
   
6. 6) Method of vestibulometry, determining deviations in the vestibular apparatus.
   
7. 7) Application of caloritic irrigation test. As a result of direct stimulation, data are obtained on the frequency of strokes and the determination of the slow phase of nystagmus.

Treatment of Ménière's disease

Since complete recovery from Ménière syndrome is not possible, the treatment is directed:

• to reduce and reduce the frequency of seizures;
  
• for the prevention of exacerbation of the disease

1. 1) To prevent excessive accumulation of lymph, prescribe diuretics - diuretics.
   
2. 2) Antihistamines and sedatives, improving the functions of the vestibular apparatus.
   
3. 3) Correction of a diet aimed at reducing the consumption of salt, conducive to the accumulation of fluid.

Unfortunately, to prevent a decrease in hearing medication is not able to. In the most extreme case, when drug use does not produce results, and the disease proceeds in severe form, surgical treatment is used:

1. 1) The method of labyrinthectomy consists in the destruction of the vestibular apparatus.
   
2. 2) The method of chemical ablation - the introduction of antibiotics into the vestibular apparatus.

These techniques are used in emergency cases, as in most cases they lead to complete deafness. The effectiveness of maintenance treatment is due to early diagnosis and timely treatment.

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