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Meniere's Disease

What is this condition?

Meniere's disease is a dysfunction of the labyrinth of the inner ear. It causes severe vertigo, hearing loss, and tinnitus (ringing in the ears). It usually affects adults between ages 30 and 60, men slightly more often than women. After multiple attacks over several years, this disorder leads to residual tinnitus and hearing loss.

What causes it?

Although its cause is unknown, this disease may result from overproduction or decreased absorption of endolymph, the fluid contained in the labyrinth of the ear.

This condition may stem from autonomic nervous system dysfunction that temporarily constricts blood vessels supplying the inner ear. In some women, premenstrual water retention may trigger attacks of Meniere's disease.

What are its symptoms?

Meniere's disease produces three characteristic effects: severe vertigo, tinnitus, and hearing loss. Fullness or a blocked feeling in the ear is also quite common. Sudden, violent attacks last from 10 minutes to several hours. During an acute attack, other symptoms include severe nausea, vomiting, sweating, giddiness, and nystagmus (involuntary movement of the eyeball). Also, vertigo may cause loss of balance and falling to the affected side. To ease these symptoms, the person may assume a characteristic posture: lying on the unaffected ear and looking in the direction of the affected ear.

Initially, the person may not experience any symptoms between attacks, except for residual tinnitus that worsens during an attack. Such attacks may occur several times a year, or remissions may last as long as several years. Eventually, these attacks become less frequent as hearing loss progresses (usually in one ear); they may cease when hearing loss is total.

How is it diagnosed?

The presence of all three characteristic symptoms suggests Meniere's disease. The doctor also orders hearing tests and X-rays of the internal ear.

How is it treated?

The doctor will usually first prescribe drugs to treat Meniere's disease. Treatment with a drug called atropine may stop an attack in 20 to 30 minutes. Epinephrine or Benadryl may be necessary in a severe attack. Dramamine, Antivert, Benadryl, or Valium may be effective in a milder attack.

Long-term management includes use of a diuretic or vasodilator and restricted salt (sodium) intake (less than 2 grams per day). Preventive treatment with antihistamines or mild sedatives (phenobarbital, Valium) may also be helpful.

If Meniere's disease persists after 2 years of treatment,. causes incapacitating vertigo, or resists medical management, surgery may be necessary. Destruction of the affected labyrinth permanently relieves symptoms but leads to irreversible hearing loss.

The doctor will order systemic streptomycin only when the disease affects both ears and no other treatment can be considered.

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