Ménière's disease

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Ménière's disease

(mən-yĕrz`), disorder of the inner ear characterized by recurrent vertigovertigo
, sensations of moving in space or of objects moving about a person and the resultant difficulty in maintaining equilibrium. True vertigo, as distinguished from faintness, lightheadedness, and other forms of dizziness, occurs as a result of a disturbance of some part of
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 combined with hearing loss and tinnitustinnitus,
the hearing of sounds in the absence of any external sound, also known as ringing in the ears. The sounds may be perceived as hissing, whistling, buzzing, swooshing, roaring, or clicking in addition to ringing; in rare cases indistinct voices or music may be heard.
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 (a ringing sensation). It was first described by the French otologist Prosper Ménière, in 1861. The sufferer experiences severe dizziness, in which objects may seem to spin around, and often nausea, vomiting, and sweating. Attacks may last for several hours. In the disorder, which occurs most often in men between the ages of 40 and 60, the symptoms are the result of abnormally large amounts of a fluid (endolymph) collecting in the inner ear, but the exact cause of the disease or of the trigger for an attack is unclear. The disease is most typically treated by a reduced-sodium diet and diurectics; an acute attack may be treated by medications that control the vertigo and nausea. Vestibular rehabilitation therapy is sometimes used to help patient cope with the sense of imbalance that may occur between attacks. Surgical procedures that relieve the condition include vestibular neurectomy, labyrinthectomy, sacculotomy (placement of a stainless steel tack through the footplate of the stapes), ultrasonic irradiation, endolymphatic-subarachnoid shunt, and cryosurgery for relief of frequent vertiginous attacks and degenerative hearing.

Ménière’s Disease

 

a condition characterized by vertigo in combination with noise in one ear, impairment of hearing, nausea, vomiting, and loss of equilibrium; named after the French physician P. Ménière (1799-1862), who described it in 1861.

Ménière’s disease generally begins in patients between the ages of 25 and 40. Attacks may last for hours or even days. They are provoked by a decrease in the tonus of the vessels supplying blood to the peripheral portions of the vestibulocochlear nerve, which performs auditory and vestibular functions. According to another view, the disease is caused directly by increased fluid (endolymph) pressure in the inner ear. The vertigo is usually systemic in nature—that is, there is a sensation that surrounding objects or the patient himself is turning in a certain direction. Hearing is often unilaterally impaired after the attack passes. Loss of hearing progresses with repeated attacks, and deafness may result. Ménière-like conditions, with symptoms resembling Ménière’s syndrome, may also occur in some organic brain dis-eases (arachnoiditis, tumor of the cerebellopontile angle).

Ménière’s disease is treated with a series of strychnine and neostigmine-methylsulfate injections, with physical therapy (ultrahigh-frequency therapy, galvanic collar), and exercise. Drugs that dilate the blood vessels of the inner ear (pilocarpine) and brain (nicotinic acid, papaverine) and agents that decrease the excitability of the brain stem (atropine sulfate, chlorpromazine, haloperidol) are also prescribed. Surgery may sometimes be necessary.

REFERENCES

Velikov, K. A. Sindrom i boleznMen ’era. Moscow, 1967.
Patiakina, O. K., and T. D. Zadorova. “Simpozium o bolezni Men’era.”[New York, June 1965.] Vestnik otorinolaringologii, 1966, no. 5.
Bystrzanowska, T. Choroba Ménière’a. Warsaw, 1970.

V. A. KARLOV

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The hydrodynamic model may help explain how symptoms of Meniere disease can be caused by obstructing lesions of the endolymphatic sac and how these symptoms are relieved by the Meniett device, an alternating pressure generator.
Variations in resistance and compliance can result in a transient pressure imbalance, which might help explain the pathophysiology of conditions such as vertigo, BPPV, and Meniere disease.
3) Studies have demonstrated that 20 to 50% of patients classified as having autoimmune inner ear disease have vestibular symptoms that are correlated with Meniere disease.
It is assumed that autoimmunity occurs via one of three basic pathways to cause tissue damage in Meniere disease, which may or may not be organ-specific: (1) autoantibodies directed against antigens found upon or within tissue cells, (6-10) (2) circulation and deposition of antigen-antibody complexes with activation of the complement system and resultant inflammatory tissue destruction, (8,10,11) or (3) an inflammatory reaction mediated by sensitized T lymphocytes.
The association between the human leukocyte antigen (HLA) complex and Meniere disease has been explored, but results have varied among different populations worldwide.
We report 2 cases of HLA-B27-associated Meniere disease, and we describe their clinical and immunocytologic features as determined by the patients' serum reactions with mouse inner ears.
These patients are felt to have an early form of Meniere disease in which their hearing may not yet be affected.
The vertigo of Meniere disease is typically treated with a low-salt diet, diuretics, and labyrinthine suppressants.
Intratympanic streptomycin therapy for the vertigo spells of Meniere disease was first described by Schuknecht in 1957.
In the last 10 years, intratympanic gentamicin has been used extensively to treat the intractable vertigo of unilateral Meniere disease.
This study was undertaken to compare results and efficacy of gentamicin-injection therapy for Meniere disease using subjective and objective end points for duration of therapy.