Meniere’s syndrome (illness): symptoms, treatment,forecast

Update: October 2018

Meniere’s disease or syndrome is a disease characterized by
damage to the structures of the inner ear, manifested by ringing in the ears,
dizziness and transient hearing loss.

Studies have shown that this disease is detected in 1
a person out of 1000 (0.1%). This figure is approximately the same as
the incidence of multiple sclerosis.

Most of the patients are people older than 40 years. Development frequency
among men and women is the same. Disease (syndrome) Meniere affects
approximately 0.2% of the total population of the earth. Most patients are elderly
people older than 50-60 years. Women suffer 1.5 times more often than
men

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

Ежегодно в США диагностируют 46 000 новых случаев
diseases. Although there was no association with a specific gene,
отмечается семейная предрасположенность к развитию diseases. AT
55% of cases of Meniere’s syndrome were diagnosed in relatives
patients, or the disease was present in their ancestors.

Meniere’s disease in famous people

  • Alan Shepard, the first American astronaut and the fifth man,
    landed on the moon. The disease that landed him after
    a single perfect flight into space, was
    diagnosed in 1964. A few years later experimental
    endolymphatic shunting allowed Alan to perform
    flight to the moon as part of the Apollo 14 crew;
  • Jonathan Swift, Anglo-Irish satirist, poet and priest,
    suffered from this disease;
  • ATарлам Шаламов, русский писатель;
  • Su Yu, the general of the People’s Liberation Army, who won the row
    significant victories during the civil war in China, was
    Hospitalized in 1949 with a diagnosis of Meniere’s disease.
    The disease caused him to be removed from his post as commander
    the order of Mao Zeduna during the Korean War;
  • Ryan Adams, an American musician, was forced to interrupt
    creative activity for two years due to rapid progression
    diseases. After a course of treatment, he returned to the scene, not allowing
    diseases take over.

Causes of Meniere’s syndrome

The most common theory about the occurrence of the disease –
change in fluid pressure in the inner ear. Membranes,
those in the maze gradually stretch as they increase
pressure, which leads to lack of coordination, hearing and other
frustrations.

The reason for the increase in pressure can be:

  • The blockage of the drainage system of the lymphatic ducts (in
    the result of scarring after surgery or in the form of congenital
    malformation);
  • Excess fluid production;
  • Pathological increase in the volume of paths that conduct fluid in
    the structures of the inner ear.

An increase in the anatomical formations of the inner ear is
the most common condition diagnosed in children with
neurosensory hearing loss of unknown origin. In addition to reducing
hearing loss in some patients, there is a disorder
coordination, which can cause the development of Meniere’s disease.

Since in the course of the research it was found that not all
patients with Meniere’s syndrome increased production
fluid in the maze and the snail, then an additional factor
causing the occurrence of the disease, became the immune status
the patient.

Синдром (болезнь) МеньераIncreased specific activity
antibodies in the examined patients detected in approximately 25%
cases. AT таком же количестве в качестве сопутствующего
diseases detected autoimmune thyroiditis, which confirms
the role of immune status in the development of the disease.

According to the latest data, the causes of Meniere’s disease
in patients surveyed in 2014, remain unclear. TO
Risk factors include:

  • ATирусные заболевания внутреннего уха;
  • Head injuries;
  • ATрожденные аномалии строения органов hearing
  • Allergies and other disorders of the immune system.

Symptoms of Meniere’s syndrome

Symptoms typical of this disease include:

  • Dizziness (causes), often accompanied by nausea and
    vomiting. The attack of vertigo is so pronounced that
    the patient gets the impression that the whole thing revolves around him
    room or surrounding objects. The duration of the attack lasts from 10
    minutes to several hours. When turning the head severity
    the symptoms increase, and the patient’s condition worsens;
  • Hearing impairment or loss. The patient may not perceive
    low frequency sounds. This is a characteristic symptom to distinguish
    Meniere’s disease of hearing loss, in which the possibility disappears
    perceive high frequency sounds. May be marked by increased
    sensitivity to loud sounds as well as painful sensations in
    noisy rooms. AT некоторых случаях пациенты жалуются на
    �”Muting” tones;
  • Tinnitus not associated with the sound source. This symptom
    is a sign of damage to the auditory organs. With Meniere’s disease
    tinnitus is perceived as “muffled, whistling”,
    �“Chirp cicadas,” “ringing a bell,” or a combination of these sounds.
    Tinnitus is worse before an attack. ATо время приступа характер
    ping can vary significantly;
  • Feeling of pressure or discomfort in the ear due to accumulation
    fluid in the cavity of the inner ear. Pre-seizure feeling
    filling is increasing.

ATо время приступа некоторые пациенты жалуются на головную боль,
diarrhea and abdominal pain. Immediately before the attack is possible
the occurrence of pain in the ear.

The harbingers of an attack are impaired coordination when
making sharp movements, increased ringing in the ears. Usually top
an attack is preceded by a feeling of “filling” or “pressure” in the ear. ATо
the time of the attack the patient is dizzy, upset
coordination, nausea and vomiting. AT среднем приступ длится 2-3 часа. By
the end of the attack, the patient feels a sharp decline in strength, fatigue and
drowsiness. There are various data regarding the duration
sensations of symptoms (from short-term “shocks” to permanent
impairment of well-being).

Relatively serious manifestation of the disease, capable of
worsen the patient’s quality of life and determine the potential risk
is a sudden fall. Coordination failure occurs due to
sudden deformation of the structures of the inner ear, which leads to
activation of vestibular reflexes.

The patient feels that he is shaking from side to side or that he
falls (although at this time it can remain in a smooth vertical
position), and involuntarily changes posture to keep
equilibrium. This symptom опасен тем, что он возникает без
precursors and can cause severe injuries. Often
The only way to get rid of this problem is so
called “destructive treatment” – labyrinthectomy or excision
vestibular nerve.

Exacerbations may occur at short intervals in
in the form of “clusters” – a successive series of attacks, the following
in sequence. AT других случаях, перерыв между приступами может
last a few years. ATне обострения больной не отмечает
any symptoms or complains of a non-expressed violation
coordination and easy tinnitus.

Treatment

Is there a cure?

AT настоящее время болезнь Меньера остается неизлечимым
disease but to control the symptoms and
stopping further progression is successfully applied
symptomatic therapy. Some new treatment guidelines are very
close to providing a complete cure (for example,
use of gentamicin in low doses).

Oftenту и интенсивность приступов можно значительно снизить с
using simple methods, even without the use of drugs.
Patients are advised to follow a diet and a healthy lifestyle.
It is necessary to refuse alcohol, smoking, drinking coffee and
других продуктов, способных ухудшить симптомы diseases.

To control the manifestations of the disease in patients with a diagnosis
Meniere’s syndrome treatment involves the use of drugs from
nausea, including antihistamines (meklozin,
trimethobenzamide) and other groups (betahistine, diazepam). Special
attention is paid to betahistine, since it is the only drug
having a vasodilating effect on the internal vessels
ear.

Drugs for long-term use

To reduce the amount of fluid retention can be applied
diuretics. A common combination is triamteren and
hydrochlorothiazide (diazid). Taking diuretics reduces the amount of
body fluids and normalizes the pressure in the cavity of the internal
ear.

Taking diuretics also helps to eliminate large
quantities of mineral substances (in particular – potassium), therefore
you need to adjust the diet so that the potassium in it
exceeded the minimum daily dosage (add
bananas, oranges, spinach, sweet potatoes).

Surgery

If, against the background of the treatment, the symptoms continue to grow,
applied more radical surgical treatment. TO сожалению,
operation does not provide 100% guarantee of conservation
слear.

Organ-saving operations are used to normalize the work.
vestibular apparatus without removing any anatomical
structures. Usually such operations are accompanied by the introduction of
hormonal drugs (dexamethasone, etc.) in the middle ear.

In order to temporarily improve the patient’s condition, apply
surgical decompression of the endolymphatic sac. Most
patients undergoing this operation, note a decrease in the frequency and
выраженности головокружения без ухудшения или потери слear. None
however, this method does not provide long-term improvement and complete
cessation of seizures.

Radical operations are irreversible and suggest complete
or partial removal of the functional parts of the auditory system in
within the affected area. ATсе структуры внутреннего уха
removed by labyrinthectomy. Byсле лечения значительно
accompanied by Meniere’s disease, symptoms significantly regress. TO
Unfortunately, patients have completely lost the ability
perceive sounds on the side operations.

AT качестве альтернативы применяется химическая лабиринтэктомия,
which is carried out through the introduction of the drug (gentamicin),
cell death causing vestibular apparatus. This method
has the same healing effect as surgery, but allows
keep the hearing of the patient.

Medium Ear Injections

To combat dizziness and other symptoms, a series of
innovative methods. Treatment синдрома Меньера производится
through the introduction of various drugs in the middle
an ear. ATпоследствии они проникают в полость внутреннего уха и
have a similar effect to the operation.

  • Gentamicin (an antibiotic with an ototoxic effect)
    reduces the ability to coordinate the movement of structures on
    affected side. AT результате вестибулярную функцию берет на
    себя здоровое an ear. ATведение препарата производится под местной
    anesthesia. Byсле лечения частота и выраженность приступов
    significantly reduced, although there is a high probability of loss
    hearing
  • Hormonal drugs (dexamethasone, prednisone) are also
    помогают контролировать симптомы diseases. TO плюсам применения
    стероидов относят низкую частоту нарушения слear. The downside is
    less efficacy than gentamicin.

Physiotherapy

For vestibular rehabilitation apply methods that allow
improve gaze fixation, reduce dizziness and improve
coordination with specific exercises and specific
lifestyle.

Such a complex of medical techniques was called “vestibular
rehabilitation”. It provides a steady decline.
severity of disease symptoms and improved quality of life
patients.

Forecast

Meniere’s disease is incurable, but not fatal. Progressing
hearing loss can be prevented with medication
лечения, проводимого между приступами, или operations. Sick with
moderately severe manifestations can successfully control
a disease just by dieting.

The long-term effects of Meniere’s disease include hearing loss,
increasing dizziness or constant tinnitus.

Although the disease itself is not fatal, it can
cause injury in the fall or as a result of an accident.
Patients are recommended sports exercises with moderate
loads, while avoiding sports for which
a healthy vestibular apparatus is necessary (riding
bike, motorcycle, mountaineering, some types of yoga).
Also, patients are prohibited from engaging in activities related to
climbing stairs (construction, repair and painting of rooms and
etc.).

Most пациентов (60-80%) восстанавливают утраченные
functions, sometimes even without medical care. Sick heavy and
complicated forms become disabled and subsequently need
in special care.

Byтеря слуха в начальном периоде имеет преходящий характер, со
time acquiring a permanent character. To improve the condition and
auditory function restoration successfully used hearing
devices and implants. Tinnitus degrades quality somewhat
life, but the patient quickly gets used to it.

Болезнь Меньера – заболевание с непредсказуемым forecastом.
Oftenта и интенсивность приступов может нарастать или убывать, а
when a patient loses vestibular function seizures
cease.

Автор: TOоробов Никита Александрович врач-анестезиолог

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