Meniere's disease is a condition characterized by tinnitus, episodic dizziness, imbalance, and progressive hearing impairment. Despite the high prevalence of the disease, its causes have not been reliably established. The existing methods of treatment can alleviate the patient's condition, but not completely eliminate the problem.

What is the Difference Between Disease and Meniere's Syndrome

Meniere's disease and the syndrome of the same name have much in common, but at the same time, they are completely different problems.

Meniere's disease is an independent disease, whereas syndrome (it occurs more often) can develop against the background of other pathologies of the inner ear (for example, with a sharp change in atmospheric pressure, with insufficient blood supply to the inner ear and brain, traumatic brain injury, overdose of certain drugs (Aspirin), certain diseases, etc.) ...

The main distinguishing features of the latter are the absence of tinnitus and progressive hearing loss.

Causes of occurrence

The exact causes of Meniere's disease continue to be studied by science. It has been proven that an attack is caused by an increase in the amount of endolymph (fluid in the inner ear system) and a corresponding increase in intra-labyrinth pressure.

It disrupts the adequacy of the regulation of spatial orientation by cellular structures. As a result, such an increase in the amount of endolymph occurs, has not yet been established.

Possible reasons:

The hearing impairment progresses with each attack, regardless of the intensity of the latter.

The most at risk of developing such a pathology are faces from 30 to 60 years old, moreover, more often women.

Provoking factors for the development of the disease:

• smoking;
• excessive use of salt and caffeine;
• alcohol abuse;
• reception of Aspirin.

Symptoms and signs

Meniere's disease is manifested by impaired vestibular and auditory functions:

You can also observe:

• forgetfulness;
• brief episodes of memory loss;
• fatigue;
• headaches;
• drowsiness;
• depression;
• visual impairment.

The order of occurrence of symptoms and their predominant nature are different in different patients.

The phases of exacerbation with increased frequency of attacks are replaced by phases of remission with the restoration of working capacity and all functions (with the exception of hearing loss).

The intensity of manifestations over time can both increase and persist, and sometimes even weaken.

Treatment methods

Since the causes and mechanism of the development of the disease are not precisely known, a wide variety of methods of both conservative and surgical therapy are used for its treatment. Unfortunately, there is currently no reliably effective approach.

Help with seizures

At the first signs of an attack, the patient goes to bed in a position that most relieves the condition. Bright light, harsh sounds are excluded, a heating pad can be applied to the legs, and a mustard plaster can be applied to the neck and back of the head.

Medication is carried out according to the doctor's prescription and may include:

• the introduction of Suprastin, Pipolphen intramuscularly, Atropine sulfate subcutaneously, Glucose solution or Novocaine intravenously;
• additional introduction of Promedol, Aminazine, Atropine, Caffeine;
• for elimination of acidosis with a dropper with sodium bicarbonate.

Conservative treatment

Eating a diet low in salt and elimination of caffeine has been shown to reduce the frequency and intensity of attacks.

You should also quit smoking, normalize the psycho-emotional state.

To improve vascular microcirculation of the inner ear, normalize endolymph pressure, drugs based on betahistine are used (Betaserc, etc.).

To reduce the accumulation of fluid, diuretics (Furosemide, etc.) are used, and to suppress the effect on the vestibular apparatus, sedatives (Valium, Relanium) and antihistamines (Suprastin, Diphenhydramine, Fenkarol, etc.) are used.

With nausea and vomiting, antiemetics are indicated (Cerucal, etc.).

Additionally, the doctor may prescribe:

Methods of physiotherapy exercises are effective (depending on the patient's condition, jumping on a home trampoline, turning and rotating the head, etc., may be allowed), vestibular rehabilitation measures on a stabilographic platform, etc.

Surgical intervention

With the complete ineffectiveness of conservative therapy, surgical intervention is performed:

• on the plexuses and nerves, indicated in the initial stages of the disease;
• to normalize the pressure of the fluid inside the labyrinth (drainage, endolymphatic shunting, etc.), are used to identify the hydrops of the labyrinth at the 2nd and 3rd stages;
• labyrinthinectomy - removal of the labyrinth, leading to complete hearing loss.

Chemical ablation (injection of Streptomycin and Gentamicin into the ear, toxic to the labyrinth system) can also be used.

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Intramuscular injection of streptomycin or steroid preparations in combination with hyaluronic acid into the inner ear.

Treatment with folk remedies

Traditional methods of treatment should be used only after the permission of the doctor and include:

• infusions of burdock, thyme, knotweed as a diuretic;
• tea made from ginger or with the addition of lemon balm, lemon, orange, rye coffee, infusion of chamomile flowers for nausea and vomiting;
• putting tampons soaked in onion juice into the ear or inhaling the vapors of a boiling mixture of water and grape vinegar for tinnitus, etc.

Medicines and their approximate cost

Medicines for the treatment of the disease can be purchased with or without a prescription at any pharmacy, including Yandex.Market and online stores.

The price of some drugs:

• Betaserk - 296 - 469 rubles;
• Furosemide - 10 - 16 rubles;
• Relanium - 30 - 198 rubles;
• Fenkarol - 112 - 288 rubles;
• Cerucal - 105 - 167 rubles.

Meniere's disease, despite its long history of discovery, is still a poorly understood pathology. The many conservative and surgical treatments available have a wide range of efficacy, depending on the individual patient.

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Meniere's disease (Meniere's syndrome). Causes, symptoms and diagnosis

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The site provides background information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

What is Meniere's disease and syndrome?

Meniere's diseaseAlso known as endolymphatic hydrops or endolymphatic dropsy, is a disease of the inner ear on its own. The problem lies in the excessive formation of a special fluid - endolymph, which normally fills the inner ear cavity. The increased formation of endolymph leads to an increase in internal pressure, disruption of the hearing organ and the vestibular apparatus.

Meniere's syndrome has all the same manifestations as Meniere's disease. However, if the disease is an independent pathology with unexplained causes, then the syndrome is a secondary manifestation of other diseases. In other words, some diseases (of the ear or of a systemic nature) cause increased endolymph formation and lead to the appearance of similar symptoms. In practice, patient complaints and symptoms are almost the same in Ménière's disease and syndrome.

This disease is considered to be relatively rare. Its prevalence varies from country to country and ranges from 8 to 155 people per 100,000 population. There is an assumption that the disease is more common in more northern countries. Perhaps this is due to the influence of climate on the body, but there is still no reliable data confirming this connection.

Meniere's disease occurs with equal frequency in men and women. Most often, the first signs begin to appear between 40 and 50 years, but there is no pronounced dependence on age. The disease can also occur in young children. Representatives of the Caucasian race are statistically more likely to get sick.

Causes of the disease and Meniere's syndrome

To understand the causes of Meniere's disease, it is necessary to understand the structure of the inner ear. In general, this is the name of the internal section of the human hearing aid. It is located in the thickness of the temporal bone. This department communicates with the middle ear through a special opening - the window of the vestibule. Its lumen is closed by a stapes - one of the bones of the middle ear.

The following parts are distinguished in the inner ear:

• The threshold. It is a small cavity located between the cochlea and the semicircular canals. The channels of both of these structures originate precisely on the eve. Sound waves are transformed into mechanical ones at the level of the middle ear and are transmitted in the vestibule through the stapes. From here, the vibrations propagate to the cochlea.

• Snail. This part of the inner ear is represented by a bony spiral canal resembling a cochlear shell. The canal is divided into two parts by a membrane, one of which is filled with endolymph. This fluid is necessary for the transformation of sound waves and their transmission in the form of a nerve impulse. The part of the ear filled with endolymph is called the endolymphatic space.
• Semicircular canals. Three semicircular canals are located at right angles to each other. They begin and end in the uterus connecting with the vestibule. These channels are filled with liquid. They serve to orient the head and body in space. The change in pressure in the channels is perceived by special receptors, transformed into a nerve impulse and decoded in the brain. This process underlies the work of the vestibular apparatus.

The main cause of Meniere's disease is an increase in endolymph pressure. This deforms the membrane in the inner ear, interfering with the functioning of the auditory and vestibular apparatus. If normally at rest the receptors in the inner ear are not irritated, then during an attack of the disease they actively send nerve impulses to the brain. Irritation occurs due to abnormally high blood pressure. The brain decodes impulses and disorientation occurs. The organ of balance sends signals that the body is moving in space, but the eyes do not confirm this information. There is a feeling of dizziness, lack of coordination. At the same time, the transmission of sound waves in the inner ear deteriorates, due to which hearing acuity decreases.

Meniere's disease is considered a disease with an unexplained etiology. In other words, modern medicine cannot give an answer what exactly leads to the increased formation of endolymph and the development of the pathological process. There are several theories, but none of them has been conclusively confirmed at the moment.

The following disorders are considered possible causes of the development of Meniere's disease:

• Vascular disorders. Endolymph is normally partially formed from the blood. More precisely, a part of the fluid leaves the vascular bed. This process is regulated by cells in the walls of blood vessels and in the vestibule of the inner ear. With increasing pressure in the vessel (labyrinth artery), more fluid passes through the wall, and the volume of the endolymph increases.
• Innervation disorders. The vascular tone (expansion and narrowing of their lumen) is regulated by smooth muscle cells, and they, in turn, by nerve fibers. With violations of innervation, the tone of the vessels changes, the pressure in them can increase or decrease, which will affect the formation of endolymph. Long-term stress can play a role in these disorders.
• Eating disorders. In this case, we mean the nutrition of the cells in the vestibule area. Extremely sensitive receptors are located here. Lack of nutrients leads to impaired filtration of endolymph and regulation of its formation.
• Infectious processes. Inflammatory processes in the middle ear, in the absence of qualified treatment, can spread to the inner ear. Then the receptors are damaged, the vascular tone is disturbed, the pressure in the inner ear cavities increases. This process can seriously disrupt the anatomical structure of tissues. After the infection and inflammation itself are eliminated, the mechanisms responsible for the production of endolymph are damaged and the patient suffers from Meniere's disease.
• Allergic processes. Part of allergic reactions occurs with the formation of special antibodies that circulate in the blood. These antibodies enter all organs and tissues, but only attack some cells (depending on the structure of the antigen that caused the production of antibodies). If, during an allergic reaction, the area of \u200b\u200bthe inner ear is affected, special substances begin to be released that dilate the vessels and increase the permeability of their walls. As a result, more endolymph is formed.
• Hereditary factors. It has been noticed that Meniere's disease is more common in blood relatives. This suggests that the individual features of the structure of vessels or receptors in the inner ear are responsible for the enhanced production of endolymph.
• Professional factors. A number of occupational hazards (some toxins, ultrasound, vibration, etc.) can damage the inner ear and enhance endolymph production. Moreover, violations do not always go away on their own, even after the elimination of the external factor that caused them.

Thus, Meniere's disease can have many different causes. It is most likely that each patient with this pathology has one or another combination of reasons (for example, hereditary predisposition and occupational factors). There are several other reasons for Meniere's syndrome. In this case, all of the above factors can also take place. But other pathologies come to the fore. It is they who trigger all the same mechanisms of regulation of endolymph formation. The result is an increase in pressure in the inner ear with the development of similar symptoms.

Meniere's syndrome can develop against the background of the following diseases:

• Autoimmune diseases. In a number of autoimmune diseases, connective tissue and blood vessels are damaged (vasculitis). As a consequence, the production of endolymph in the inner ear may increase.
• Traumatic brain injury. With traumatic brain injuries in the temporal bone (less often in other areas of the skull), the outflow of lymph may be impaired. This is a liquid that normally removes the products of their vital activity from the tissues of the body. Overgrowth of lymphatic vessels after trauma or surgery leads to overflow of veins and increased pressure. Because of this, fluid stagnation occurs, and the amount of endolymph increases.
• Increased intracranial pressure (ICP). In some cases, increased intracranial pressure can also lead to disturbances in the inner ear. The pressure inside the skull increases due to the increased volume of cerebrospinal fluid. Since the cavities of the skull and ear are connected with each other (albeit through cellular barriers), the hydrostatic pressure in the endolymphatic space also increases.
• Endocrine Disorders. Various hormones are involved in the regulation of vascular tone and blood pressure. In some endocrine diseases, hormonal imbalance leads to the release of fluid from the lumen of the vessels. In rare cases, local edema of the inner ear region occurs with the development of Meniere's syndrome.
• Water-salt balance disorders. The water-salt balance of the blood is maintained due to the normal concentration of various ions, proteins, salts and other chemical compounds in the blood. Its violation leads to a change in blood properties (oncotic and osmotic pressure). The result can be a facilitated exit of fluid through the walls of blood vessels. The water-salt balance is often disturbed in case of poisoning, kidney and liver diseases.
• Ear neoplasms. One of the rare causes is gradually growing benign or malignant tumors in the middle or inner ear. The growth of the neoplasm squeezes blood and lymph vessels, which can lead to impaired outflow of fluid and swelling.

It should be noted that Meniere's syndrome develops quite rarely with the above pathologies. This is a special case, a complication of the course of this or that disease, which is not found in all patients. That is why it is assumed that the inner ear is affected only with an existing hereditary predisposition, that is, with a combination of various factors.

Labyrinthopathies with Meniere's syndrome

Labyrinthopathies are a group of diseases of the inner ear in which there is no pronounced inflammatory process, but the functions of the organ are still impaired. Usually labyrinthopathies develop in case of poisoning with certain toxins or pharmacological drugs (quinine, streptomycin). Infectious diseases (through allergic and autoimmune processes) can also play a role. Some labyrinthopathies can lead to the development of Meniere's syndrome, but this outcome is not at all necessary.

Signs and symptoms of Meniere's disease

The disease usually has a chronic recurrent course (with periods of remission and exacerbation of symptoms). During the period of remission, no manifestations are usually observed. The patient can normally tolerate even rapid changes in body position and not suffer from motion sickness in transport. However, such loads on the vestibular apparatus can lead to an exacerbation of the disease. An exacerbation or attack of the disease manifests itself differently in all patients. Nevertheless, there are a number of classic symptoms (triad) that are observed in almost all patients.

The main symptoms of Meniere's disease are:

• dizziness;
• hearing loss;

Dizziness with Meniere's disease

Dizziness in this case is called labyrinthine. It is explained by squeezing the receptors of the vestibular apparatus. Because of this, the brain cannot clearly define its position in space. Dizziness is usually the first symptom of an attack. It appears suddenly (sometimes it can be triggered by external factors) and lasts from several seconds to several minutes. The attack is accompanied by severe disorientation in space, nausea. In this case, an attack of nausea and a gag reflex will have nothing to do with recently eaten foods, it can also occur on an empty stomach. After the first sudden attack, the dizziness usually subsides slightly, but continues to get worse periodically. This condition can last for several hours or even days.

Another important symptom associated with labyrinth vertigo is nystagmus. These are involuntary quick movements of the eyeballs. During an attack, they appear against the background of disorientation in space. The nerves that control eye movements are reflexively irritated. Usually, with an attack of Meniere's disease, the pupils move horizontally (left and right). Much less often patients have vertical nystagmus (up and down) or circular movements. Fixing the gaze on some object can temporarily stop movement. However, in a relaxed state, the frequency sometimes reaches 150-200 movements per minute.

Often, dizziness during an attack has the following features:

• sudden onset;
• the patient falls or tries to immediately take a horizontal position;
• usually patients close their eyes (this eliminates the dissonance between visual information and sensations from the vestibular apparatus);
• an attack can be triggered by physical or emotional stress (they cause changes in vascular tone);
• changing body position (for example, trying to stand up) during an attack increases dizziness and nausea;
• sometimes there is vomiting;
• harsh and loud sounds also worsen the patient's condition;
• most often, attacks begin at night (if the patient is awake) or in the morning, immediately after waking up, but there is no strict dependence on the time of day;
• dizziness is less pronounced in older people than in younger people.

Hearing loss in Meniere's disease

Typically, hearing in Meniere's disease decreases progressively. At the very beginning of the disease, during the period of remission, hearing acuity is normal. However, during an attack, severe hearing loss appears. The patient complains that the ear is suddenly blocked. Sometimes a moderate decrease in hearing acuity precedes dizziness and the onset of an attack in general.

In most cases (approximately 80% of patients), hearing loss is unilateral. This is due to the fact that the pathological processes in Meniere's disease are usually local, and there is no direct connection between the vestibular apparatus of the right and left ears. Bilateral hearing loss is more common in Meniere's syndrome. Then any disease or external cause (usually vibration disease, high intracranial pressure or poisoning) affects both ears approximately equally.

The patient may present various complaints and describe his condition in different ways. Sometimes it is a feeling of pressure or fullness in the ear, sometimes it is a feeling of stuffiness. During remission, hearing acuity may return to normal levels. However, over time (after years of periodic attacks), hearing still deteriorates irreversibly. This is due to the gradual degeneration of the nervous tissue.

Tinnitus in Meniere's disease

Tinnitus is heard by patients due to squeezing of the canal in the labyrinth by the fluid. Normally, sound waves pass from the middle ear here, but when squeezed with an excess of liquid, these waves are generated randomly and decoded by the brain as noise. The noise is almost always one-sided, in the same ear that begins to hear poorly.

Other possible symptoms and complaints in Meniere's disease are:

• feeling of rotation;
• ear pain (optional symptom);
• increased sweating (due to activation of the autonomic nervous system);
• sudden redness or blanching of the skin - mainly of the face and neck;
• increased blood pressure and headaches (these symptoms are observed more often in Meniere's syndrome and are associated with the underlying pathology that caused this syndrome).

In general, an attack usually lasts from several hours to several days. A gradually increasing hearing loss sometimes appears several days before a full-fledged attack, and some symptoms persist for some time after its end. The period of remission between two attacks of Meniere's disease can last for weeks, months, or even years. It depends on many factors. In Meniere's syndrome, the frequency of attacks depends on the intensity of the underlying disease. If, for example, you regularly take drugs to lower blood and intracranial pressure (provided that they were the root cause of the syndrome), then the frequency of attacks will significantly decrease.

Many experts distinguish the following stages during Meniere's disease:

• First (initial) stage. The disease appears for the first time, and its manifestations can be of varying degrees of intensity. Sometimes an attack is manifested by goosebumps, darkening in the eyes. The dizziness usually does not last very long (several hours), but it can be very severe. In the period between attacks, no dizziness, no coordination disorders, or hearing loss are noted. When examining a patient, signs of edema (hydrops) of the inner ear can only be detected during seizures. It is practically impossible to diagnose the disease during the period of remission.
• Second stage. At this stage, the disease takes on a classic course. There is almost always a major triad of symptoms during an attack. During the period of remission, spontaneous hearing loss, a feeling of stuffiness in the ear can sometimes appear. To one degree or another, the hydrops of the inner ear is constantly present and can be detected during remission. The attack is only an even more severe increase in pressure than usual.
• Stage Three. At this stage, the dizziness attacks may not be as intense. More often, there is a constant, rather than periodic, impaired coordination of movements, the gait changes, becoming more shaky and uncertain. At the same time, complaints of dizziness are less common. This is due to irreversible changes at the receptor level of the vestibular apparatus. In other words, the receptors are partially destroyed and no longer send nerve impulses to the brain.

In Meniere's syndrome, such a division into stages is usually impossible, since the manifestations of the disease, the intensity of the attacks and the general condition of the patient depend not so much on the pathological process in the inner ear as on the severity of the underlying disease.

Diagnosis of Meniere's disease

It can be difficult to diagnose Meniere's disease because of the nonspecific symptoms that are observed with this disease. However, recurrent unexplained bouts of dizziness and tinnitus, combined with temporary hearing loss, should already suggest an inner ear problem.

The diagnostic process usually occurs during the onset of the disease in a hospital setting. The patient is admitted to the hospital so that doctors have more opportunities to find out the causes of the attack. Clinical examination methods and a number of special, instrumental methods are used. Taken together, they provide insight into the structural integrity and functionality of the inner ear.

Clinical aspects of Meniere's syndrome

Clinical aspects are understood as information obtained by a doctor without the use of laboratory and instrumental methods. The first step is to take a thorough history. This is a routine conversation with a patient, during which many important details are revealed. Since Meniere's disease and syndrome are very difficult to detect, taking anamnesis is of great importance.

The most important details when interviewing a patient are:

• previous head injuries;
• previous ear infections;
• the presence of concomitant diseases;
• whether the patient regularly takes any medications (the effect of some affects the hearing organ);
• the frequency and duration of attacks;
• the conditions in which the attack occurs;
• the patient's place of work (are there any harmful factors that contribute to the onset of the disease);
• dependence of seizures and symptoms on the weather (in particular, changes in atmospheric pressure);
• having an allergy to anything.

If a patient seeks help during remission in the early stages of Meniere's disease, it is almost impossible to confirm the diagnosis. In this case, he is regularly observed and the next attack is expected.

Laboratory examination for Meniere's syndrome

All research methods (in addition to clinical) can be divided into two large groups - instrumental and laboratory. Laboratory methods are primarily aimed at studying fluids and other biological materials taken from a patient. In most patients with Meniere's syndrome, these methods do not reveal any major changes. However, they are a must when visiting a doctor.

From laboratory methods for Meniere's syndrome, the following tests may be useful:

• General blood analysis. It can reveal signs of inflammatory (increase in ESR - erythrocyte sedimentation rate, increase in the number of leukocytes) or allergic (increase in the number of eosinophils) processes. In both cases, one should suspect not a disease, but Meniere's syndrome and look for its causes.
• Blood chemistry. A glucose tolerance test is mandatory for these patients. It was found that the disease is more often manifested in people with high blood sugar levels.
• Thyroid hormone test. One of the possible causes of Meniere's syndrome is a malfunction of the thyroid gland. A test for thyroid-stimulating hormone, triiodothyronine (T3) and tetraiodothyronine (T4) is prescribed.
• Serological methods. If you suspect an autoimmune cause of Meniere's syndrome, serological tests (tests) are prescribed. Autoimmune diseases are characterized by the presence of antibodies (autoantibodies) in the blood that damage the own structures of various organs and tissues (including the hearing organ). Serological tests can not only detect, but also determine the level of autoantibodies in the blood. Also, serological tests are prescribed if you suspect some infectious diseases (for example, with neurosyphilis).

Thus, laboratory research methods help mainly in the diagnosis of Meniere's syndrome, revealing the underlying pathology. With Meniere's disease, any changes may be absent altogether or they are caused by diseases not directly related to the pathology of the inner ear.

MRI for Meniere's syndrome

Quite often, if there is a history of mechanical head injuries, magnetic resonance imaging (MRI) is prescribed. It is prescribed to detect damage to both bone and brain tissue. In addition, MRI allows you to analyze the brain structures for the presence or absence of other pathologies (oncological, anatomical, infectious), which may be the root cause of Meniere's syndrome.

MRI rarely recognizes inner ear edema itself and endolymph congestion. For this, it is necessary that the study be carried out precisely in the acute period (during an attack). During the period of remission of the disease, this study is inappropriate, since it will not reveal any structural changes, and its implementation is quite expensive.

Audiogram for Meniere's syndrome

An audiogram is the result of an instrumental audiometry method. It focuses on the functional study of hearing in patients. The audiogram allows you to register in which particular frequency range the hearing acuity decreases. In addition, there are a number of functional tests that send signals of a given frequency and assess the hearing acuity thereafter. As a result, the ENT doctor has a complete picture of how the hearing organ functions. This study can last from 15 - 20 minutes to several hours, it can be unpleasant, but it always remains painless. It is carried out in a hospital, as it can sometimes provoke an attack of the disease.

An audiogram is mandatory for fitting a hearing aid or cochlear implant. It is also important to conduct this research before passing the commission for obtaining a disability group. Considering that functional problems (hearing loss) are one of the earliest symptoms, it should be carried out immediately at the first suspicion of Meniere's disease or syndrome. According to the results of the audiogram, unfortunately, it is impossible to judge whether there is a primary (Meniere's disease) or secondary (Meniere's syndrome) process.

Doppler ultrasonography for Meniere's disease

For Meniere's disease, Doppler ultrasound is often recommended. It allows you to assess the blood flow in the vessels of the brain. Transcranial Doppler ultrasonography often detects increased pressure in the arteries that feed the hearing organ, as well as increased intracranial pressure. This test is completely safe and painless. The frequencies at which the study is conducted are not perceived by the hearing organ, therefore this test cannot provoke an attack of the disease.

Differential diagnosis for Meniere's disease

Differential diagnosis is the stage when doctors exclude others, similar in manifestations of pathology, so as not to make a mistake when making the final diagnosis. Given that Ménière's disease or syndrome can manifest itself in different ways (sometimes, for example, only severe dizziness is present), other diseases should be considered.

The manifestations of Meniere's disease can be mistaken for the following pathologies:

• vertebrobasilar insufficiency (problems with blood circulation in the vessels of the brain);
• tumors in the cerebellar region;
• the consequences of a skull injury;
• inflammation of the auditory nerve;
• acute or chronic otitis media (inflammation in the tympanic cavity).

To exclude most of these pathologies, consultation of various specialists (mainly a neuropathologist or neurosurgeon) and additional examinations will be required. Because Ménière's syndrome is difficult to detect in its early stages, sometimes a tentative diagnosis is made by simply ruling out other possible causes of dizziness. Before use, you must consult with a specialist.

Meniere's disease is a condition of the inner ear. It manifests itself as attacks of dizziness, nausea, vomiting, tinnitus and progressive hearing loss. To diagnose this pathology, it is necessary to conduct otoscopy (examination of the ear canal and tympanic membrane), study the function of hearing and the vestibular analyzer by various methods, MRI of the brain. Treatment of the disease is initially carried out using conservative methods. If this is not enough, then surgical correction and hearing aids are performed. Let's consider in more detail what kind of disease it is, how it manifests itself, how it is diagnosed and treated.

Meniere's disease was first described by a French physician in 1861 and bears his last name. The disease occurs among people of different ages from 17 to 70 years, children are practically not susceptible to Meniere's disease. Most often, people aged 30-50 suffer. There were no sex differences in the frequency of occurrence. Usually the disease affects the inner ear on one side, but in 10-15% the process can be initially bilateral. Sometimes, in the course of the patient's long-term existence, a one-sided process is transformed into a two-sided one.

The reasons

There is no exact reason for the development of Meniere's disease. It is believed that the symptoms of the disease are due to an increase in fluid pressure (endolymph) in the inner ear. The inner ear is located in the thickness of the temporal bone pyramid and consists of semicircular canals, cochlea and vestibule. These formations are the organ of hearing and balance. An increase in pressure in the structures of the inner ear occurs due to an increase in the content of endolymph (as a result of an increase in its formation, impaired absorption and circulation). This leads to impaired perception of sound vibrations (and hearing impairment), coordination and balance (vestibular changes).

It is believed that various factors may serve as prerequisites for increasing endolymph pressure. Among them are the following:

• viral diseases of the inner ear (especially herpes and cytomegalovirus viruses): their role is not in direct damage to the structures of the inner ear, but in starting the autoimmune process, that is, the production of antibodies not only to the virus, but also to the cells of the inner ear. Then, even after recovery from a viral infection, the process of damage to the inner ear continues;
• allergic reactions: apparently, the mechanism of development is similar to that of viral infections;
• head trauma with damage to the temporal bone;
• vascular disorders: changes in blood flow in the inner ear are directly related to the production of endolymph;
• anomalies in the structure of the inner ear: the width of the semicircular canals plays a role, the volume of the pathways that conduct fluid in the inner ear.

It is not always possible to trace the relationship of Meniere's disease with one of the above factors, therefore each of them can be the cause of the development of the disease, but this is not at all necessary.

Cases of hereditary predisposition to Meniere's disease, when the disease was detected in every generation, are described. This indicates the existence of genetically dependent forms.

Symptoms

A characteristic symptom of the disease is attacks of severe dizziness.

There are three forms of the disease, which depend on the patient's symptoms:

• cochlear: when hearing impairment predominates among the clinical symptoms;
• vestibular: the main manifestations are imbalance and coordination;
• classical: combining both auditory and coordination disorders.

In general, the disease has a paroxysmal course. If between attacks the patient's condition is fully restored, then they speak of a reversible stage of Meniere's disease. If even in the interictal period, coordination and hearing disorders persist, although less pronounced than at the time of the attack, then this is already an irreversible stage.

In addition, according to the frequency and duration of attacks, several forms of the disease are distinguished. Let's call them:

• mild: with this form, the attacks are very short (a few minutes - a couple of hours), repeated once every few months or even years;
• moderate severity: the duration of the attack is up to 5 hours, after the attack, the patient is disabled for several days. Attacks are repeated no more than once a week;
• severe: the attack lasts more than 5 hours, occurs from once a day to once a week. The patient's ability to work in this case is steadily lost.

What are the symptoms of an attack of Meniere's disease? It can be:

• sudden sharp dizziness. There is a feeling of rotation of objects of the surrounding world, a feeling of sinking, rolling. "The world is turning upside down," - this is how patients describe their feelings at the time of an attack. With any, even minor, head movements, the dizziness increases. Dizziness is almost always accompanied by nausea and indomitable vomiting. Patients are unable to sit, much less stand. They lie with their eyes closed, trying not to move. If you ask the patient to touch his nose with the index finger while lying down with his eyes closed, he will not be able to fulfill the request. Patients do not even get into the area of \u200b\u200bthe face, the miss is so sharp. Extremity movements can also increase nausea and vomiting. Thus, coordination at the time of the attack is sharply impaired;
• hearing change. Immunity to low frequency sounds occurs. Loud noises and noises cause discomfort in the head and pain. Tinnitus and ringing also occur without a direct sound source;
• sensations in the ear. Congestion, pressure, distention, just discomfort in the ear;
• vegetative symptoms. Nausea and vomiting, increased sweating, increased heart rate, decreased blood pressure (very rarely, there may be an increase), pale face, shortness of breath;
• nystagmus. Oscillatory involuntary movements of the eyeballs.

Before an attack, there may be a slight lack of coordination, manifested in the patient's instability, noise or ringing in the ears, a feeling of a rush of something to the ear (or filling it).

After an attack that lasts from several minutes to several hours (usually 1-8 hours), patients feel overwhelmed, tired, complain of headache and heaviness in the head, drowsiness. For some time, coordination disorders and instability, hearing loss, and staggering gait persist. As the disease progresses, the period of existence of post-attack phenomena lengthens, and over time, the interval of normal well-being is completely lost. In this case, the disease becomes irreversible.

If at the beginning of the disease the perception of only low-frequency sounds is disturbed, then the audibility of the entire range of sound vibrations is gradually lost. Each new seizure leads to more hearing impairment. Finally, deafness sets in. Dizziness usually disappears with hearing loss.

There are factors that trigger seizures:

• stress;
• alcohol intake;
• drinking coffee;
• smoking and inhalation of tobacco smoke;
• increased body temperature;
• lack of sleep;
• excess salt in food.

Sometimes an attack develops suddenly without any precursors, which can cause the patient to fall and injure himself. A fall on the street on the roadway can be especially dangerous, since patients cannot get up and move as a result of vestibular disorders (even if the fall did not lead to injury).

Meniere's disease is characterized by an unpredictable course. The frequency of seizures, their duration and severity can both increase and decrease.

Diagnostic principles

Before the appointment of a full examination for patients with suspected Meniere's disease, the doctor performs an otoscopy.

To establish a diagnosis, the characteristic clinical picture of seizures is taken into account, an otoscopy is performed, during which no pathological changes are detected (which serves as evidence in favor of confirming the diagnosis).

Testing is carried out with a tuning fork: Weber, Rinne. They make it possible to distinguish the lesion of the sound-receiving apparatus (inner ear) from the sound-conducting one (external auditory canal, middle ear).

Audiometry is mandatory. When performing tonal threshold audiometry in Meniere's disease, changes in the perception of low frequencies are observed, hearing loss does not exceed degree I (at the onset of the disease). With the progression of the disease, the hearing of all frequencies decreases, the depth of the hearing impairment increases. When performing suprathreshold audiometry, a positive phenomenon of accelerated increase in loudness is determined.

Vestibular disorders are confirmed by a number of techniques: vestibulomeria (with a number of tests such as caloric, rotational, index, finger-nose and others), stabilography (assessment of body stability), studies of spontaneous nystagmus, and so on.

Also, to diagnose Meniere's disease, methods are used that confirm an increase in the amount of endolymph and an increase in its pressure: dehydration tests and electrocochleography.

The dehydration test consists in using a solution of glycerol at a dose of 1.5-2 g / kg of body weight with fruit (usually lemon) juice and water (which makes it possible to enhance the effect of glycerol). Hearing is examined before the test and after 1, 2, 3, 24 and 48 hours from the moment of taking the drug. Glycerol causes a decrease in endolymph pressure, and in the presence of Meniere's disease after taking it, a decrease in the threshold of perception in the range of the studied frequencies is observed (that is, hearing improves somewhat). There are certain digital criteria for hearing changes that can confirm an increase in endolymph pressure.

Electrocochleography allows recording electrical impulses from the cochlea and the auditory nerve in 1-10 ms from the reproduced stimulus. Changes in the amplitude of the recorded action potentials and their duration make it possible to confirm an excess of endolymph and an increase in its pressure in the inner ear.

Diagnosis of the disease requires computed tomography (CT) or magnetic resonance imaging (MRI) of the brain to exclude other causes of symptoms similar to Meniere's disease (for example, neuroma of the auditory nerve, circulatory disorders in the vertebrobasilar basin, etc.). For the purpose of differential diagnosis, echoencephalography, electroencephalography, rheoencephalography, ultrasound examination of the vessels of the head and neck, and the study of auditory evoked potentials are also performed.

In most cases, such a complex use of various diagnostic methods allows you to correctly establish a diagnosis.

Treatment

Meniere's disease is believed to be incurable. But it is possible to stop the progression of the process and minimize the symptoms.

Treatment of Meniere's disease is complex. Only the simultaneous use of a number of methods can alleviate the suffering of the patient.

The first step is diet. Certain nutritional recommendations allow you to influence metabolic processes, including in the inner ear. Limiting the use of salt, avoiding alcohol and coffee, hot spices contribute to a decrease in endolymph pressure, which means a more rare occurrence of seizures.

It is desirable to quit smoking (including passive smoking), maintain a healthy lifestyle with enough sleep, and minimize the number of stressful situations.

To increase the stability of the vestibular apparatus, the patient is shown special exercises that allow him to train, increase the threshold of his excitement, and improve body coordination.

Drug treatment

Drug treatment consists in the use of various drugs at the time of an attack to eliminate it and in the interictal period.

The relief of an attack is carried out using:

If possible, drugs are used in injectable form.

In the interictal period, treatment is carried out in order to prevent new attacks and reduce the manifestations of Meniere's disease between attacks. To do this, use:

• betahistine preparations (for example, Betaserc, 24 mg 2 times a day for a course of 1 month, with repetitions of courses);
• diuretics (Triamteren, Veroshpiron, Hydrochlorothiazide, Diacarb), which help to reduce endolymph pressure. Their use requires correction of the diet, since the drugs remove potassium from the body. It is necessary to include in the diet such foods as apricots (dried apricots), bananas, potatoes. If necessary, additionally prescribe potassium preparations (Asparkam, Panangin);
• venotonics (Escuzan, Troxevasin, Detralex, Phlebodia);
• drugs that normalize microcirculation (Pentoxifylline, Trental).

Surgical treatment

This type of treatment is resorted to in case of ineffectiveness of conservative methods. The goal of surgical treatment is to improve the outflow of endolymph, decrease the excitability of vestibular receptors, and preserve and improve hearing.

All surgical interventions for Meniere's disease are divided into several types (according to the mechanism of the operation):

• drainage (decompression): aimed at improving the outflow of endolymph (drainage of the labyrinth through the middle ear, fenestration of the semicircular canal, and others);
• destructive (destructive): allow you to interrupt the transmission of impulses (removal or destruction of the labyrinth, crossing the branch of the VIII cranial nerves, destruction of the cells of the labyrinth by ultrasound);
• operations on the autonomic nervous system (removal of cervical sympathetic nodes, resection of the tympanic string).

Unfortunately, some of the operations performed on the structures of the inner ear lead to hearing loss on the side of the operation. This circumstance has become an incentive for the search for alternative ways to combat the disease. These include chemical labyrintectomy (ablation): the introduction of small doses of gentamicin into the tympanic cavity (middle ear). Gentamicin is an antibiotic that causes cell death in the vestibular apparatus. In this way, a break in impulses from the affected side is achieved, and the healthy ear takes over the balance function. For the same purpose, alcohol, streptomycin can be used.

Bilateral Meniere's disease gradually leads to complete hearing loss. In this case, hearing aids are indicated.

Prognosis for Meniere's disease

The disease does not pose a threat to life and does not shorten its duration.

Meniere's disease is unpredictable. It can be characterized by a steady progression, an undulating course, and in some cases an improvement in the condition in the form of a decrease in the frequency of attacks (sometimes even without treatment).

Such a diagnosis implies limitations in professional activities (work at height, on a lathe and milling machine, with any rotating structural elements, in conditions of noise and vibration, driving professions are contraindicated).

Severe coordination disorders and hearing loss can cause disability.

Thus, it becomes clear that Meniere's disease is not a fatal, but an insidious disease that can cause a lot of inconvenience in everyday life and cause disability. Due to the symptoms present with this disease, many patients have restrictions in work, and sometimes they lose their jobs. Meniere's disease is treated in various ways, trying to slow down the progression and preserve hearing, eliminate vestibular disorders. In most cases, with timely diagnosis and complex treatment, this is possible.

Channel One, the program “Living Healthy” with Elena Malysheva on the topic “Meniere's Disease. What to do when your head is spinning "

Is a unique channel system that is responsible for the balance of our body and the transformation of sound waves into nerve impulses perceived by the brain. Inner ear pathologies are not uncommon in medical practice. Loss of hearing, loss of balance, dizziness and weakness may indicate damage to the hearing or vestibular system.

Let us consider in more detail what diseases of the inner ear are, their symptoms, causes of occurrence, and also talk about the prevention of these diseases.

Types of Inner Ear Disorders: Symptoms and Causes

The most common types of inner ear disorders are:

• labyrinthitis;
• meniere's disease;
• sensorineural hearing loss;

Reference. In most cases, with timely access to, the pathology of the inner ear lends itself to conservative treatment.

However, the need for surgical intervention cannot be ruled out, because sometimes this may be the only chance to restore a person's hearing. How exactly diseases affect the organ of hearing and how to check the inner ear for pathology, we will try to figure it out further.

Magnetic resonance imaging of the inner ear does not harm the patient and does not require special training

Labyrinthitis

Labyrinthitis is an inflammatory disease that occurs as a result of injury or damage to other parts of the ear. The main reason for the development of labyrinthitis is otitis media of the middle ear..

In the process of inflammation, the density of the membrane wall decreases, and pathogenic microflora begins to penetrate through it. With a prolonged course of the disease, a membrane breakthrough occurs, followed by purulent lesions of the auditory receptors.

It can also provoke the development of inflammation meningitis, syphilis, herpes virus and mumps... Traumatic labyrinthitis of the inner ear due to rupture of the tympanic membrane with a sharp object or infliction of traumatic brain injury with a fracture is somewhat less common.

Important!Banal hypothermia can provoke an inflammatory disease of the inner ear and the death of nerve endings. For prophylaxis, it is recommended not to be in a cold, harsh wind for a long time.

The main symptoms of acute labyrinthitis:

• nausea and dizziness, aggravated during physical activity;
• violation of balance and coordination of movement;
• discoloration of the face (redness or excessive pallor of the skin);
• increased sweating.
• hearing impairment, tinnitus.

One of the hallmarks of a labyrinthitis is sudden dizzinessthat occur several weeks after the infection.

The attack can last long enough, up to a month. In addition, the symptom most often persists for several more weeks and after treatment.

Meniere's disease

Meniere's disease, or, as it is also called, dropsy of the labyrinth of the inner ear, is a non-purulent disease. In the process of its development, there is an increase in the amount of fluid in the labyrinth and an increase in internal pressure.

Reference. Often the disease is unilateral, but in 15% of cases it can affect both auditory organs.

There is no unequivocal answer to the question of what are the reasons for the development of Meniere's disease in medical practice. But, presumably, diseases such as can provoke an increase in fluid in the inner ear. violation of the water-salt balance in the body, allergies, syphilis, viruses, endocrine and vascular pathologies... Deformation of the bone canals can also play an important role in this.

Meniere's disease is characterized by a paroxysmal course... During periods of remission, the patient may experience improvements in both hearing and general health. As for the exacerbation, they correspond to very vivid symptoms that the patient should be aware of.

Dropsy of the labyrinth of the inner ear has the following symptoms:

• gradual deterioration of hearing with sudden temporary improvements;
• dizziness attacks;
• persistent tinnitus;
• disorientation in space, loss of balance;
• nausea and vomiting;
• pallor of the face;
• sweating;
• decrease in temperature.

Attention! At risk are mainly people aged 30 to 50 years.

Sensorineural hearing loss

Sensorineural hearing loss is usually called hearing loss due to damage to the sensitive nerve endings of the inner ear and the auditory nerve itself. Factors such as viral infections such as influenza and ARVI, vascular pathologies (hypertension, atherosclerosis) and even stress.

Medicines (salicylates, diuretics, antibiotics of the aminoglycoside class) and industrial chemicals can also become a provoking factor. In addition, the cause of sensorineural hearing loss are injuries of various types: mechanical damage, acoustic,.

Vestibular dysfunction in sensorineural hearing loss is a common phenomenon. Therefore, the following symptoms are added to hearing loss:

• noise in ears;
• dizziness;
• lack of coordination;
• bouts of nausea;
• vomiting.

Reference. With the correct treatment of sensorineural hearing loss, the prognosis for the patient is quite favorable.

Cochlear implant - a medical device, a prosthesis that allows to compensate for hearing loss in some patients with severe or severe degree of sensorineural (sensorineural) hearing loss

Otosclerosis

Is a pathological condition characterized by the growth of bone tissue and a change in its composition in the hearing aid, in particular in the inner ear. To date, the true causes of the development of this disease have not been established.

But anyway experts are inclined to believe that this is a congenital anomaly of the auditory organ... At the same time, one should not discount the hereditary factor.

Inner ear disease and dizziness always go hand in hand. And otosclerosis is no exception. This symptom is especially disturbing when turning the head, bending. However, the main sign of the development of the disease is tinnitus, the intensity of which increases with its course.

At the third stage of otosclerosis, complaints of tinnitus are complemented by severe headaches, sleep disturbances, memory impairment, and decreased concentration.

Prevention of diseases of the inner ear

Hearing is a treasured gift to cherish... In modern medicine, methods of prosthetics of hearing organs have been developed, but such techniques cannot become a full-fledged replacement for the lost feeling. So the prevention of hearing aid pathologies should become an integral part of every person's lifestyle.

Do not listen to music too loudly through headphones as this can cause hearing loss

The following recommendations will help prevent diseases of the inner and middle ear:

1. Cover your head during the cold season. No matter how ridiculous you look in a hat or a hood pulled almost over your eyes, this is the least you can do to maintain your health.
2. Right ... Do not use tools or sharp objects to remove wax from the ear canal. Caution should also be exercised when using regular cotton swabs, with which you can accidentally seal the stopper by pushing it towards the eardrum.
3. Use soundproofing accessories with constant exposure to loud sounds.
4. Buy if you go swimming or just like to visit the pool periodically. Infection in the ear through contaminated water is common.
5. Do not neglect qualified help in the treatment of diseases of the throat and nasopharynx. Even a banal runny nose can cause otitis media.

And remember, you can't underestimate the importance of healthy ears and good hearing!

Disease or Meniere's syndrome is a pathology in which there is damage to the structures of the inner ear, which is accompanied by dizziness, tinnitus and develops into hearing impairment.

Studies have shown that this pathology is diagnosed in 1 person in 1000, accounting for 0.1%. This indicator roughly corresponds to the incidence of multiple sclerosis.

Most of the patients are people over the age of 40. The incidence of development among women and men is the same. Meniere's syndrome affects about 0.2% of the world's population.

The disease begins as a one-sided process and subsequently spreads to both ears. According to various studies, the disease becomes bilateral in 17-75% of cases for 5 to 30 years.

Every year in the United States, 46,000 new cases of this pathology are diagnosed. However, there is no data on the association of the disease with a particular gene, while a familial predisposition to the development of Meniere's disease is present. In 55% of cases, this disease is diagnosed in relatives of patients or in the presence of such a pathology in his ancestors.

Meniere's disease in famous people

Ryan Adams is an American musician who had to interrupt his creative activity due to the rapid progression of this pathology. After a course of therapy, he returned to the stage, overcoming the illness.

Su Yu, a general of the People's Liberation Army who is remembered for a number of high-profile victories during the Chinese Civil War, was hospitalized in 1949 with a diagnosis of Meniere's syndrome. Pathology was the reason for the removal of the general from the post of commander on the orders of Mao Zedong at the height of the Korean War.

Varlam Shalamov is a Russian writer.

Jonathan Swift, an Anglo-Irish priest, poet and satirist, also suffered from this disease.

Alan Shepard is the first American astronaut to land fifth on the lunar surface. The disease was diagnosed to the astronaut in 1964 and became one of the reasons for his accomplishment of only one flight. Several years later, an experimental endolymphatic shunting operation allowed the astronaut to make his flight as part of the Apollo 14 team.

Reasons for the development of Meniere's syndrome

The most common cause of this pathology is a change in fluid pressure in the inner ear. The membranes in the labyrinth gradually begin to stretch under the influence of increased pressure, which as a result leads to impaired coordination, hearing and other disorders.

The reason for the increase in fluid pressure inside the ear can be:

pathological increase in the volume of the pathways that carry fluid through the internal structures of the ear;

excessive fluid secretion;

blockage of the drainage system of the lymphatic ducts (due to scarring of scars after congenital malformations or after surgery).

The most common condition is enlargement of the anatomical formations of the inner ear, which is diagnosed in children with an uncertain origin of sensorineural hearing loss. In addition to hearing loss and impairment, some patients have a coordination disorder, which can also be the cause of the development of Meniere's syndrome.

Since during the research it was found that not all patients with Meniere's disease have an increase in fluid secretion in the cochlea and labyrinth, an additional factor that provokes the development of pathology is the patient's immune status.

The presence of increased activity of specific antibodies during diagnosis in patients is detected in 25% of cases. The same number of cases of the presence of autoimmune thyroiditis as a concomitant pathology, which once again confirms the role of the immune status in the development of the disease.

According to the latest data, the reasons for the development of Meniere's syndrome in patients who were examined in 2014 remained unclear. Risk factors include:

allergies and other immune disorders;

congenital anomalies in the structure of the organ of hearing;

head trauma;

viral pathologies of the inner ear.

Meniere's disease symptoms

The characteristic symptoms for this pathology are:

Dizziness, often accompanied by vomiting and nausea. An attack of dizziness can be so pronounced that the patient thinks that the room begins to revolve around him, along with the objects around him. The duration of an attack can range from 10 minutes to several hours. When turning the head, the severity of manifestations increases, the patient's condition worsens.

Hearing impairment or loss. The patient may lose the ability to perceive low sounds. This is a characteristic symptom that distinguishes Meniere's syndrome from hearing loss, which in turn is manifested by impaired perception of high frequency sounds. The sensitivity of hearing to loud sounds may also increase, as well as the presence of pain in the presence of noise in the room. In some cases, patients complain of a feeling of muffled tones.

Tinnitus that is not related to the sound source. This symptom indicates damage to the auditory organs. In the presence of Meniere's disease, patients characterize ringing in the ears as ringing of a bell, chirping of cicadas or muffled, whistling sounds, often a combination of the presented sounds. Before the attack, the ringing in the ears increases. During an attack, the nature of the ringing can change dramatically.

Feeling of discomfort and pressure in the ear due to the accumulation of fluid in the inner ear cavity. Before the onset of an attack of the disease, the feeling of pressure increases.

Also, during an attack, some patients note the presence of headache, abdominal pain and diarrhea. Ear soreness may appear before the attack itself.

The harbingers of an attack of the syndrome is a lack of coordination as a result of a sharp change in body position, movements, increased sensation of ringing in the ears. Usually the onset of an attack is associated with a feeling of fullness or pressure in the ear. During an attack, the patient complains of vomiting, nausea, coordination disorder, dizziness. The average duration of an attack is about 2-3 hours. At its end, the patient feels a breakdown, drowsiness, fatigue. There are various data on the characteristics of the duration of symptoms (from short-term attacks to persistent disturbances in well-being).

A relatively serious symptom of this disease, which can significantly disrupt the patient's quality of life, is the potential risk of a sudden fall. Impaired coordination develops against the background of a sudden deformation of the structures of the inner ear, which provokes the activation of vestibular reflexes.

It seems to the patient that he is shaking to the sides, and he begins to fall (although in fact at this time he is in an upright position), so the patient begins to involuntarily change his posture, trying to maintain the "lost" balance. This symptom is characterized by the absence of precursors, therefore, it is fraught with serious injury to oneself. The only way to get rid of such an unpleasant problem is "destructive treatment" - excision of the vestibular nerve or labyrintectomy.

Exacerbations of pathology can occur after short periods of time in the form of clusters - a series of sequential attacks that follow in turn. In other cases, the interval between two consecutive attacks can be several years. Outside of an exacerbation, the patient does not notice any signs of the disease or complains of an unexpressed coordination disorder and a slight ringing in the ears.

Treatment

Is there a cure?

Nowadays, Meniere's disease belongs to the category of untreated pathologies, however, symptomatic therapy is successfully used to ensure control over the symptoms of the disease and stop its progression. Some of the newer signs of treatment are quite close to leading to a complete cure of the disease (for example, the use of gentamicin in small doses).

The frequency and intensity of such attacks of the disease can be significantly reduced using special, simple methods, without even resorting to drug therapy. Patients are advised to lead a healthy lifestyle and diet. You also need to stop drinking coffee, smoking, alcohol and a number of other products that can worsen the clinical picture of the disease.

To control the manifestations of pathology, if the patient has a diagnosis of Meniere's disease, therapy involves the use of drugs for nausea, including antihistamines (trimethobenzamide, meclozine) and other groups (diazepam, betahistine). Particular attention is paid to betahistine, since it is the only agent that has a vasodilating effect on the circulatory system of the inner ear.

Preparations for prolonged use

Diuretic drugs can be used to reduce the volume of retained fluid. A common combination is hydrochlorothiazine and triamterene. Taking diuretics can reduce the amount of fluid in the body and normalize the pressure level in the cavity of the internal structures of the ear.

Also, the use of diuretics promotes the excretion of a significant amount of minerals (especially potassium), so the diet should be adjusted so that the dose of potassium is higher than the minimum daily dosage (add sweet potatoes, oranges, bananas).

Surgery

If, against the background of ongoing therapy, the symptoms continue to increase, more radical surgical methods of treatment are used. It should be noted right away that the operation does not guarantee 100% preservation of hearing.

Organ-preserving operations are performed in order to normalize the functioning of the vestibular apparatus without resecting any anatomical structures. In most cases, such operations are accompanied by injections of hormonal drugs (for example, dexamethasone) into the middle ear.

In order to temporarily improve the general condition of the patient, surgical decompression of the endolymphatic sac is used. In most cases, patients who underwent this operation notice a decrease in the severity and frequency of dizziness without loss or deterioration of hearing function. However, this method is not able to provide long-term improvement or completely prevent the development of seizures.

Radical surgeries are irreversible and involve partial or complete removal of functional parts of the hearing aid within the affected area. All structures of the inner ear are removed with a labrintectomy. After therapy, the symptoms of Meniere's syndrome significantly regress. To our great regret, patients completely lose the ability to perceive sound by the auditory organ on which the operation was performed.

Alternatively, they resort to chemical labrintectomy, which is performed by introducing gentamicin, which provokes the death of cells of the vestibular apparatus. This technique has the same therapeutic effect as surgery, but allows you to preserve hearing.

Medication injections into the middle ear

In order to get rid of dizziness and other symptoms, a number of innovative methods have been developed. Therapy for Meniere's disease is carried out by injecting various drugs into the middle ear. Subsequently, they penetrate into the inner ear cavity, providing an effect similar to surgical intervention.

Hormonal drugs (prednisone, dexamethasone) also allow you to control the clinic of the disease. The benefits of steroid use include low rates of hearing loss after treatment. Among the disadvantages is low efficiency compared to gentamicin.

Gentamicin (an antibiotic that has an ototoxic effect) reduces the ability of structures on the affected side to coordinate movements. As a result, vestibular function is regulated by the healthy ear. The drug is administered under local anesthesia. After treatment, the severity and frequency of seizures are significantly reduced, although there is a high probability of loss of sound sensitivity.

Physiotherapy

For vestibular rehabilitation, methods are used that improve the function of gaze fixation, improve coordination and reduce dizziness by performing a special set of exercises and adhering to a specific lifestyle.

Such a complex of therapeutic techniques is called "vestibular rehabilitation". With its help, they provide a stable decrease in the severity of the manifestations of pathology and achieve a significant improvement in the patient's quality of life.

Forecast

Although Meniere's disease is an incurable pathology, it is not fatal. The progression of hearing loss can be stopped by the use of special drug therapy, which is carried out in the intervals between attacks, or with the help of surgery. Patients with moderately severe symptoms can quite successfully control the pathology by following a diet.

Long-term consequences of Meniere's syndrome include persistent tinnitus, increasing dizziness and hearing loss.

Although the pathology itself cannot cause death, it can provoke injuries that will be received in an accident or fall as a result of an attack of dizziness. Patients are advised to perform sports exercises with moderate stress, while it should be borne in mind that you need to avoid those sports that involve a good vestibular apparatus (mountain climbing, riding a motorcycle, cycling). Also, patients are prohibited from engaging in activities related to climbing stairs (painting and repairing premises, construction).

The majority of patients (about 60-80%) recover the lost functions, in some cases even without special medical care. In the presence of complicated or severe forms of the disease, patients become disabled and further need specific care.

Hearing loss in the initial stages of the disease is of a transient nature, turning over time into a permanent deviation. Implants and hearing aids are successfully used to restore hearing and improve the general condition of the patient. At first, ringing in the ears worsens the quality of life of such patients, but over time the body gets used to this "background".

Meniere's syndrome is a pathology with an unpredictable outcome and prognosis. The intensity and frequency of seizures may decrease or increase, while after the loss of vestibular functions, seizures cease.