Meniere,s disease : Most common cause of vertigo

Ear is a balancing organ as well apart from hearing and when there is any pathology in the inner ear, it affects the balance of a person.
Meniere,s disease is the distention of endo-lymphatic system in the inner ear and is characterized by fluctuating deafness, vertigo and tinnitus means ringing in the ear. It occurs when there is failure in proper absorption of endolymph.

Causes of Meniere's disease

None of the established etiology is thee, however there are various factors and concepts establishing the role in causing Meniere's disease. These are

Any fault in the metabolism or water and sodium retention in the body may cause less absorption of endolymph.

Any focal infection and disturbance in endocrine function may lead to Meniere's disease.

An ischemia an vasomotor disturbances due to sympathetic overactivity may lead to faulty absorption of endolymph causing Meniere's disease.

Another concept is histamine sensitivity due to allergy, toxics leading to liberation of fluid by subepithelial vesicles. Disturbance of osmotic pressure gradient at the blood endolymphatic barrier. Disturbance of water and electrolyte transport across the cell.

There may be history of syphilis, viral infection or any auto immune disease. Cochlear otosclerosis can also cause distention of inner ear.

The modern concept indicates the role of metabolic disorder, particularly of carbohydrate metabolism.

In Meniere's disease there is gross dilatation of scala media and saccule of the inner ear. The reissener membrane bulges and eventually rupture. Endolymphatic pressure and chemical imbalance damages organ of corti and vestibular epithelium.

Sign and symptoms of Meniere's disease

Meniere's disease is usually unilateral, but sometimes other ear can also get affected. The disease is more commonly seen in person between the age of 35 to 50 years.

The symptoms of Meniere's disease included rotatory vertigo, nausea, vomitimg, there is fullness of ear with fluctuating deafness and tinnitus ie a feeling of ringing in the ears. The person dont always have this symptoms but all these occur in episodes. In the initial phase these symptoms occur at long intervals and subsequently the frequency of attack increases with increasing severity..

The most disabling symptoms at times at giddiness and vomitting. The attacks last for few hours or days and then pass off, completely and patient may feel completely normal. During the attack if anyone observe the eye of patient , nystagmus is clearly seen.

Deafness is sensorineural types and of lower frequency. Many patients show intolerance to carbohydrate diet.

Diagnosis of Meniere's disease

Following investigations can be done by an ottorhinolaryngologist (ENT specialist) to confirm the diagnosis apart from proper history.
Otoscopy to detect any internal pathology.
Tuning fork test to detect type of deafness either sensorineural or conductive.
Audiometry.
Vestibular function test also called caloric test which can reveal canal paresis.
Recruitment test is done which is usually positive.
Some other tests like electrocochleography, electronystagmography, Bekesy audiometry - type II tracing is done.
Glucose tolerance curve and insulin tolerance curve disorder can be seen in some cases of Meniere's disease.

Treatment of Meniere's disease

Usually a conservative approach is preferred for treatment of Meniere's disease. In severe case surgical method is applied and an operation called Cody tack operation may be performed. Details about treatment of Meniere's disease can be seen here at Treatment of Meniere's disease.