What is Meniere's Disease
The incidence of meniere's disease in the society varies from 40 to 100 per 100,000. It more frequently starts around 40 years of age, though can be seen at any age. Both ears are diseased at the same time by 20%. It occurs with tinnitus, buzzing, aural fullness, hearing loss and dizziness. People may fall faint in the absence of blackout. These symptoms may take 20 minutes to 24 hours. Nausea and vomiting may occur during the episode of patient. Hearing loss is temporary in the first episodes, typically includes deep sounds and hearing turns normal after episode. However, permanent hearing loss can be seen as the number of episodes increases. Sometimes aural fullness might occur before dizziness starts. Hearing loss occurs during the period of dizziness and in deep sounds. In the first years of disease, hearing loss is reversed after vertigo episodes; but it continues also after episodes in further years. Tinnitus may differ from one patient to the other, and might be intermittent or continuous. Aural fullness and sense of pressure might occur besides hearing loss and tinnitus. Involuntary eye movements (nystagmus) might show up during the periods of dizziness. Anxiety, stress and excessive salt intake can initiate vertigo episodes. Patient can be completely normal or slightly imbalanced during vertigo episodes.
The reason of Meniere's disease is the pressure increase in inner ear structures. As a triggering mechanism; it is believed that the edema causing pressure increase may occur with interminglig of the fluids of endolymph and perilymph in inner ear that contain different properties and should not be interfered with each other, and also with the disorder of endolymph liquid absorption. If fluid production in inner ear is more than excretion or if there is a congestion in the channels through which fluid is discharged, pressure increase may occur in the inner ear. However, certain allergic reactions have recently been considered to play important roles.
What is expected from the examination:
External ear examination of the patients with Meniere's disease is seen to be normal. If patient is examined at a period with absence of dizziness, no findings may be detected. During episodes of vertigo, the most important finding to be seen in patient is involuntary eye movements named as nystagmus. Moreover, difficulty of standing and walking and complaints of nausea-vomiting can be detected, caused by vertigo.
How to Diagnose:
The most important factor for diagnosis is the patient's story. Information is obtained about the reason of disease by evaluating duration, frequency and severity of dizziness and the accompanying findings. The first test to be performed after examination is the hearing test, called as audiometer. These tests provide information about the presence of hearing loss and the condition of inner ear. Inner ear type hearing loss in deep sounds suggests that it may be Meniere's Disease. There are some tests that can be done about the balance system, which is named as vestibular system. It helps to distinguish Meniere's Disease from the other possible balance distorting diseases.
Whıch Tests Are Used In The Dıagnosıs Of Menıere's Dısease:
Meniere's disease is diagnosed by examination findings and advanced testing methods.
Although it is called as glycerol test, it doesn't have specific properties.
The most important point in the diagnosis of Meniere's disease is the presence of typical clinical findings. Then, following tests are applied:
1. Hearing test: While slight hearing loss which keeps only deep sounds is seen initially, then moderate hearing loss which keeps each frequency is seen over the time.
2. Videonystagmography: It gives information about the function of balance organ.
VEMP test: It gives information about utricle and saccular functions and brainstem.
VHIT test: It gives information about functions of semicircular channels.
Computered Tomography and Magnetic Resonance Imaging tests are used to recognize tumours or space occupying lesions in brain or inner ear. In addition, pressure increase in inner ear can be detected by advanced imaging methods.
Doctor evaluates characteristic features of the dizziness and the data of balance tests, eliminates the other diseases which may cause similar clinical table and finally diagnose the disease.
FMRI (functional MRI imaging method): Today, we can now reach the clear reasons by imaging methods providing very detailed information about inner ear.
VHIT and VEMP TESTS HAVE BECOME THE MOST IMPORTANT TESTING METHOD FOR THE DIAGNOSIS OF VESTIBULAR SYSTEM DISEASES FOR THE LAST ONE YEAR. WE REACH THE RESULTS EASILY WITH THESE TESTS IN OUR UNIT.
How to be treated:
Treatment of Meniere's diseases is examined in 3 sections.
- Treatment of dizziness episodes
- Preventing dizziness
- Surgical treatment
We treat our patients with Meniere's disease with new generation drug treatments and achieve highly successful results.
Treatment can be evaluated in two contexts:
Episode treatment and preventive treatment
Patients who comes at the time of vertigo episodes and have nausea and vomiting are generally treated by being hospitalized.
Patient is tried to be relieved as stress plays an important role. Serum is injected and liquid support is provided.
Intravenous or oral vertigo medicines usually reduce complaints and relieve the patient.
Cortisone injections can be applied to the middle ear.
It is not a frequently applied treatment type among surgical treatments today. Problems are often resolved with medical treatments and other treatments.
What precautions to be taken against Meniere's Disease:
Some precautions may be taken to prevent these for patients having frequent episodes. These include:
- Avoiding from excessive salt, sugar, alcohol and caffeine
- Keeping away from stress
- Using diuretics
- Using medicines against dizziness
