The Ménière’s disease it is a syndrome characterized by vertiginous crises, fluctuating deafness, tinnitus. It involves the entire inner ear, both the auditory part (cochlear labyrinth) and the balance part (vestibular labyrinth). The underlying mechanism of the disease is theendolymphatic idropei.e. a dilatation of the membranous labyrinth. It manifests itself in adulthood with a peak of onset around the age of 40. It is initially unilateral, with up to a 50% chance of bilateral forms. In Italy it is estimated that it affects around 300,000 patients with 2,000 new cases each year.
In this article
Meniere’s disease: causes
It is not yet clear what causes hydrops, although possible viral, neurovascular (migraine-like), genetic, or autoimmune mechanisms have been proposed.
Symptoms
The symptoms of Ménière’s disease are:
Fluctuating hearing loss, i.e. a hearing loss characterized by phases of reduction of hearing capacity to phases of remission of the disorder. Sometimes it seems to feel good, other times not
Rotational vertigo
Severe pitched tinnituswhich is associated with a characteristic symptom, namely the sense of fullness in the ear. Annoying intolerance to even medium-intensity sounds, which is defined as recruitment In the advanced stages of the disease, the Tumarkin’s otolytic crisis: that is, the patient falls to the ground suddenly, without loss of consciousness.
Diagnosis
The diagnosis of Ménière’s disease is based primarily on the history. The instrumental tests that confirm the suspected diagnosis are mainly:
Audiometric and impedancemetry examination Vestibular examination Electrocochleographic examination and vestibular myogenic potentials (VEMPs).
The MRI of the brain with contrast medium is useful to rule out a shwannoma (benign tumor) of the vestibular nerve. Recently it has been observed that about 80% of patients are positive for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI) using color Doppler ultrasound examination of the intracranial and cervical venous vessels.
Meniere’s disease: treatment
Medical treatment during the periods between seizures is limited to low-dose diuretics, avoiding or moderating the use of alcohol, smoking and salt, and trying to resolve any personal or professional conflicts. During the crisis they are used osmotic diuretics (mannitol or glycerol), anti-vomiting drugs e corticosonicoften associated with vestibulo-suppressive sedatives.
In selected cases, the intratympanic administration of steroids or an antibiotic with a toxic action on the cells of the balance, with the aim of controlling vertigo. Surgery is reserved for patients refractory to medical therapies and consists mainly of surgery of the endolymphatic sac and section of the vestibular nerve.
In cases of instability and disequilibrium, the vestibular rehabilitation and in those with stabilized hypoacusia and disabling tinnitus hearing rehabilitation.