Meniere's disease
Ménière’s disease (or syndrome, since its cause its unknown) was first described by French physician Prosper Ménière in 1861. It is a disorder of the inner ear characterized by vertigo (abnormal sensation of movement), a feeling of fullness or pressure in one or both ears, and possibly loss of hearing and tinnitus (noises or a sensation of ringing). Moreover, nausea, vomiting, sweating and nystagmus (uncontrollable rhythmical and jerky eye movements; usually in horizontal plane with Ménière's) may frequently accompany other symptoms. These complaints and findings occur as episodic bouts, which may last from minutes to hours and worsen with movements.The exact cause of Ménière's disease is not known, but it is believed to be caused by the swelling of the endolymphatic sac, part of the vestibular system of the inner ear, which is responsible for the body's sense of balance. The symptoms may occur in the presence of a middle ear infection, head trauma or an upper respiratory tract infection, or by using aspirin, smoking cigarettes or drinking alcohol. They may be further exacerbated by excessive consumption of caffeine and even salt in some patients.
The diagnosis is usually established by clinical findings and medical history. However, a detailed neurologic examination, audiometry and even head MRI scan can be performed to exclude a tumor of the cranial nerve VIII (which would cause similar symptoms).
Treatment is aimed at lowering the pressure within the inner ear. Antihistamines, anticholinergics, steroids, and diuretics may be used for this purpose. Also, the symptoms may be treated with antiemetics (to relieve nausea) or benzodiazepines (which control vertigo directly). Some clinicians may recommend a low salt diet for the same purpose. Surgery of the semicircular canals or the vestibular nerve is very rarely performed in some untreatable and most severe cases. Another treatment is chemical labyrinthectomy, in which a drug (such as Gentamycin) that "kills" the vestibular apparatus is injected into the inner ear. These radical treatments eliminate vertigo, but they also eliminate the patient's normal sense of balance, and so are used only as a last resort. The disease may end spontaneously and never repeat again, recovery may be managed by using medications only, and in some limited occasions the symptoms may last despite any kind of medications.
See also: balance disorder
