Lesser disease symptoms causes treatment

Our vestibular apparatus, located in the inner ear, is controlled by the so-called semicircular canals, which, incidentally, are just the size of a grain of rice.

Microlites floating inside them in the endolymph, with each change in the position of the human body, irritate the nerve endings, doing this in three planes symmetrically in both the right and left ear. And the brain, thanks to such irritations, receives a signal about what position the body has taken.

If something disrupts the transmission of a signal, a person can not return to a state of equilibrium. One of the reasons for this failure can be a very serious pathology called Meniere’s syndrome.

What kind of disease deprives us of the ability to maintain balance, specialists have been trying to figure it out for many years, but so far they have not been able to get answers to all the questions.

In modern medicine, they distinguish between disease and Meniere’s syndrome. A disease is a pathology that has arisen independently, and a syndrome is one of the symptoms of a previously existing disease. This can be, for example, labyrinthitis (inflammation of the labyrinth), arachnoiditis (inflammation of the lining of the brain) or a brain tumor. With the syndrome, pressure in the maze is a secondary phenomenon, and treatment, as a rule, is directed to correct the underlying pathology.

According to recent studies, in the modern world, manifestations of Meniere’s syndrome are increasingly common, and the disease is becoming a rare phenomenon.

Doctors distinguish two forms of this pathology. In the acute form, Meniere’s syndrome, the causes and treatment of which we are considering, breaks into the patient’s life suddenly, in the form of an attack among normal health, sometimes even in a dream.

  • The patient feels this as a blow to the head and falls, frantically trying to grab hold of some kind of support.
  • Noise appears in the ear, severe dizziness begins. It, as a rule, makes the patient close his eyes and take a forced position, always different, but always with his head raised.
  • Any attempt to change the pose leads to increased seizure.
  • The patient is covered with cold sweat, he is tormented by nausea and vomiting.
  • The temperature drops below normal.
  • Often, all of the above are accompanied by involuntary urination, diarrhea, and pain in the stomach.

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An attack, as already mentioned, lasts several hours, rarely a day. Then the symptoms subside and after a couple of days the patient becomes efficient again. Seizures can be repeated regularly, but with different time intervals: weekly, monthly, or even once every several years.

The second form of pathology, chronic, is characterized by moderate or rare seizures. I must say that the dizziness in this case is more prolonged, although it is less pronounced, as, incidentally, all other symptoms of the disease.

Some patients have signs of an attack. This can be an increase in noise in the ear, impaired gait (it is difficult for the patient to maintain balance when turning the head).

For each new seizure that characterizes Meniere’s syndrome, the causes are usually the same: smoking and drinking alcohol, excessive eating, overwork, any infections, staying in rooms with a loud noise, intense fixing of eyes or disturbances in the intestines.

The true causes of this disease, as well as why the patient suffers from only one ear, are still not known. One can definitely say only that Meniere’s syndrome is always accompanied by an excess of endolymph, which is produced by semicircular canals. Sometimes the channels produce too much of this fluid, and sometimes its outflow is disrupted, but both lead to equally sad results.

By the way, according to statistics, this syndrome is most often observed in women (it is also not clear why). Fortunately, it is not so common: only two out of a thousand people are affected by this ailment.

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The diagnosis performed to confirm the diagnosis of Meniere’s syndrome consists, as a rule, in examining the patient with an otolaryngologist and a neurologist. These examinations should be carried out in several directions:

  • tonal and speech audiometry (helps to clarify hearing acuity and determine the sensitivity of the ear to sound waves of different frequencies – the described disease has a specific pattern on the audiogram, which allows to identify it in the early stages);
  • tympanometry (helps assess the condition of the middle ear);
  • acoustic reflexometry;
  • X-ray of the cervical spine;
  • magnetic resonance imaging and computed tomography, which helps to identify possible tumors that provoke the development of a pathological condition;
  • rheovasography (determines the state of blood circulation in the vessels of the arms and legs);
  • Doppleroscopy (one of the types of ultrasound) of cerebral vessels.

Diagnosis is based on the results of these examinations. Treatment is carried out both during seizures and in the period between them.

From all of the above, it becomes clear that the relief of the patient’s condition can occur if excess fluid accumulating in the semicircular canals can be removed in any way.

Therefore, most often the symptoms associated with Meniere’s syndrome are relieved by the appointment of diuretics. By the way, a decrease in fluid is also caused by a reduction in the body’s salt, which can retain it.

There are drugs that dilate blood vessels in the inner ear. And it also improves the outflow of fluid that interferes with balance.

In severe cases that are not amenable to medical treatment, they also resort to surgical intervention, which helps create a channel for the outflow and get rid of excess fluid in the vestibular apparatus.

In especially severe cases, when seizures lead to a severe form of disability, it is necessary to remove the semicircular canals. This operation is called labyrinthectomy and, unfortunately, deprives the patient of hearing, but then returns him the ability to move normally.

Unfortunately, the described disease is not completely cured. Doctors, when a patient is admitted to a hospital, first of all try to stop another attack, and after some time, Meniere’s syndrome, the causes and treatment of which we describe, goes into an easier form.

But the disease lasts for many years. Therefore, in the period between attacks, the patient has to remember his illness and maintain his condition with the help of a complex of vitamins, as well as drugs that improve microcirculation and act on cholinergic systems.

If the patient does not change anything in his mind in the scheme of taking medications and is responsible for all medical appointments, then a clear relief and return to work will be achieved.

The most common theory about the occurrence of a disease is a change in fluid pressure in the inner ear. The membranes in the maze gradually expand as pressure increases, which leads to impaired coordination, hearing and other disorders.

The cause of the increase in pressure may be:

  • Blockage of the drainage system of the lymphatic ducts (as a result of scarring after surgery or as a congenital malformation);
  • Excessive fluid production;
  • A pathological increase in the volume of the pathways 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 sensorineural hearing loss of unknown origin. In addition to a decrease in hearing impairment, some patients have a coordination disorder that can cause the development of Meniere’s disease.

Since the study found that not all patients with Meniere’s syndrome have an increased production of fluid in the labyrinth and cochlea, the patient’s immune status became an additional factor determining the occurrence of the disease.

The increased activity of specific antibodies in the examined patients is detected in approximately 25% of cases. Autoimmune thyroiditis is detected in the same amount as a concomitant disease, which confirms the role of the immune status in the development of the disease.

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

  • Viral diseases of the inner ear;
  • Head trauma;
  • Congenital malformations of the structure of the organs of hearing;
  • Allergies and other disorders of the immune system.

Symptoms specific to this disease include:

  • Dizziness (causes), often accompanied by nausea and vomiting. The attack of dizziness is so pronounced that the patient has the impression that the whole room or surrounding objects revolve around him. The duration of the attack lasts from 10 minutes to several hours. When turning the head, the severity of symptoms increases, and the patient’s condition worsens;
  • Hearing impairment or loss. The patient may not perceive sounds of low frequency. This is a characteristic symptom that makes it possible to distinguish Meniere’s disease from hearing loss, in which the ability to perceive high-frequency sounds disappears. Hypersensitivity to loud sounds, as well as pain in noisy rooms, may be noted. In some cases, patients complain of “muffled” tones;
  • Ringing in the ears, not related to the sound source. This symptom is a sign of damage to the auditory organs. In Meniere’s disease, ringing in the ears is perceived as “muffled, wheezing,” “cicadas chatter,” “bell ringing,” or a combination of these sounds. Tinnitus intensifies before an attack. During an attack, the nature of the ringing can change significantly;
  • Sensation of pressure or discomfort in the ear due to accumulation of fluid in the cavity of the inner ear. Before the attack, the feeling of filling increases.

During an attack, some patients complain of headache, diarrhea, and abdominal pain. Immediately before the attack, pain in the ear may occur.

  • Dizziness (causes), often accompanied by nausea and vomiting. The attack of dizziness is so pronounced that the patient has the impression that the whole room or surrounding objects revolve around him. The duration of the attack lasts from 10 minutes to several hours. When turning the head, the severity of symptoms increases, and the patient’s condition worsens;
  • Hearing impairment or loss. The patient may not perceive sounds of low frequency. This is a characteristic symptom that makes it possible to distinguish Meniere’s disease from hearing loss, in which the ability to perceive high-frequency sounds disappears. Hypersensitivity to loud sounds, as well as pain in noisy rooms, may be noted. In some cases, patients complain of “muffled” tones;
  • Ringing in the ears, not related to the sound source. This symptom is a sign of damage to the auditory organs. In Meniere’s disease, ringing in the ears is perceived as “muffled, wheezing,” “cicadas chatter,” “bell ringing,” or a combination of these sounds. Tinnitus intensifies before an attack. During an attack, the nature of the ringing can change significantly;
  • Sensation of pressure or discomfort in the ear due to accumulation of fluid in the cavity of the inner ear. Before the attack, the feeling of filling increases.

Signs of Meniere’s Disease

The main diagnostic signs of Meniere’s disease are attacks of nausea and vomiting, as well as severe dizziness. The patient at this stage of the disease may feel the displacement or whirling of various surrounding objects. There may also be a sensation of falling or spinning in the space of one’s own body. Often dizziness is so strong that the patient can only be in a supine position, but cannot sit and stand. When you try to change the position of the body in one direction or another, the symptoms of nausea and vomiting intensify.

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During an exacerbation, the following symptoms may occur:

  • noise in ears;
  • feeling of fullness;
  • impaired coordination of movements;
  • imbalance;
  • dyspnea;
  • tachycardia;
  • increased sweating:
  • deterioration in the general condition of the patient;
  • nystagmus;
  • pallor of the skin and some others.

If the patient lies on a sore ear, then all symptoms may worsen. Attacks, as a rule, last from 2 to 8 hours, but their duration can vary from several minutes to several weeks. The frequency and intensity of seizures is an individual indicator and it is almost impossible to predict when the next exacerbation occurs.

Among the factors predisposing to the development of relapses are the following:

  • stressful situations;
  • alcohol;
  • adverse environmental factors;
  • overwork;
  • an increase in body temperature, even to subfebrile indicators;
  • noise;
  • carrying out various procedures on the ear.

In some cases, patients experience an improvement in hearing before an attack. The attack may be preceded by a violation of coordination and balance, as well as a characteristic corresponding aura.

Hearing impairment is always progressive. At the beginning of the disease, the patient does not perceive low frequency sounds, but gradually loses the ability to perceive the entire auditory range and at the end there is complete deafness. It is worth noting that with complete loss of hearing, the patient undergoes dizziness attacks.

At the beginning of the disease, one can observe a very clear staged change of periods of exacerbation and remission. During the period of remission, the patient is restored to work capacity. At later stages, one can observe not only rapid fatigue and weakness, when vestibular disturbances are observed during the period of remission, but also heaviness in the head and other symptoms.

The disease affects the inner ear. Another name for this department of the organ of hearing is the labyrinth. Pathology develops due to an increase in the volume of fluid (endolymph) in the labyrinth, as a result of which this fluid begins to exert pressure on the areas responsible for balance and the ability to navigate in space.

As a rule, the disease affects one ear, but over time it can progress and become bilateral in nature. Similar is observed in fifteen percent of cases.

Most often, the ailment is diagnosed in adults aged thirty to fifty years. In childhood, this pathology is extremely rare.

Medical statistics show that the disease occurs in one out of a thousand people. Both men and women are equally affected.

It is also necessary to distinguish between Meniere’s disease and Meniere’s syndrome. A disease is an independent disease that requires some therapy. Meniere’s syndrome is secondary. This is one of the symptoms of another disease, for example, labyrinthitis. In this case, it is necessary to treat not the syndrome itself, but the primary ailment.

Three types of the disease are distinguished, depending on the manifesting symptoms: vestibular, classic and cochlear. The vestibular is characterized by dizziness and problems with balance (this form is diagnosed in 15-20% of cases). In the classical form, the patient has problems with hearing and with balance (diagnosed in 30% of patients). In 50% of cases, the diagnosis reveals a cochlear form, which occurs with impaired auditory function.

The main signs of Meniere’s disease at one time were described by the discoverer of this ailment, the French audiologist, in whose honor she was named.

  1. Hearing impairment (often not pronounced). Typically, a patient is affected by one ear, and the most affected person is the perception of low frequencies. True, the researchers claim that in 20% of cases of this disease, the patient suffers from both ears.
  2. Sudden bouts of severe dizziness, which can last from one to twenty-four hours (and occasionally up to several days). Moreover, it should be noted that these dizzinesses are systemic. That is, the patient feels either the rotation of objects around him, or his own rotation in one direction.
  3. Dizziness is usually accompanied by nausea and vomiting, which does not bring relief.

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Tinnitus to this day remains a complex problem with significant medical, medical and social aspects.

Do not confuse Meniere’s disease with Meniere’s syndrome, which have a lot in common, but remain different conditions. Meniere’s disease is an independent disease, the classification of which depends on the symptoms in the initial stages of development. There are three main forms of this disease:

  • cochlear form – occurs in about 50% of all cases, while it is characterized by severe hearing impairment;
  • vestibular – occurs in 20% of patients and is manifested by vestibular disorders;
  • classical – diagnosed in 30% of cases, while patients have vestibular and auditory disorders.
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As the disease progresses, the patient has remission (a temporary absence of painful manifestations) and an exacerbation phase, when pronounced seizures occur. Based on the time duration of the attacks and the intervals between their occurrences, the disease has three degrees:

  • The first (easy) – differs in minor attacks, breaks between which can last for months or even years.
  • The second (average) – seizures can last up to 5 hours, while for several days, patients are disabled.
  • The third (severe) – the duration of seizures exceeds five hours, while the frequency can vary from once a day to once a week. Such patients are completely disabled.

Important! When the duration of seizures and the frequency of their occurrences increase significantly, there are serious vestibular disorders and rapid hearing impairment due to damage to the sound-conducting and sound-receiving apparatus, this indicates the irreversibility of the course of Meniere’s disease.

The leading symptom of the disease is repeated dizziness, which occurs along with a feeling of nausea and vomiting.

Patients complain of a feeling of rotation of everything around, as well as the failure and movement of their own body in space.

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Dizziness can reach such a strength that people are not able to stand or sit, and when changing their position, an increase in the severity of manifestations is observed.

Also, with seizures of Meniere’s disease, the following conditions are formed:

  • noise in the affected ear;
  • lack of coordination;
  • loss of balance;
  • auditory disorders;
  • tachycardia;
  • increased sweating;
  • dyspnea;
  • pallor of the skin.

How many seizures last, and what intervals between their occurrences, depends on the stage of progression of the disease. Such factors can cause a new attack:

  • smoking;
  • stress;
  • alcohol abuse;
  • increase in general temperature;
  • medical actions.

Often, patients in advance anticipate an attack according to a previous condition, expressed by increased tinnitus, loss of balance and impaired auditory capabilities.

Dizziness with tinnitus and hearing impairment allows the otolaryngologist to identify the disease during the first examination, but an accurate diagnosis of Meniere’s disease requires additional diagnostic measures. To determine the degree of auditory disorders, it is necessary to conduct special studies:

  • audiometry;
  • tuning fork study;
  • acoustic impedancemetry;
  • otoacoustic emission;
  • electrocochleography.

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Audiometry – allows you to diagnose the mixed nature of hearing impairment. At the first stages of the disease, the study allows us to note a decrease in hearing in frequencies from 125 to 1000 Hz.

Acoustic impedanometry allows you to evaluate how mobile the auditory ossicles and functional muscle tissue are. The purpose of this study is to detect abnormalities in the auditory nerve. Also, to exclude the risk of neurinoma, patients should have an MRI of the brain.

Otoscopy and microotoscopy are necessary to detect changes in the eardrum and external auditory canal. Thus, the possibility of an inflammatory process can be excluded.

The following studies are prescribed to determine vestibular disorders in Meniere’s disease:

  • vestibulometry;
  • indirect otolithometry;
  • stabilography.

When a patient experiences systemic dizziness, but the hearing does not worsen, he is diagnosed with Meniere’s syndrome. Then the diagnosis of the disease, due to which the syndrome arose, requires the involvement of a neurologist and the appointment of other diagnostic measures:

  • electroencephalogram;
  • ECHO-EG;
  • duplex scanning;
  • REG and USDG.

At the time of diagnosis, Meniere’s disease is important to differentiate it from other diseases that have similar manifestations, for example, labyrinthitis, otosclerosis or otitis media.

In medicine, Meniere’s disease is attributed to incurable diseases, but nevertheless, it is possible to stop its further progression and minimize symptoms.

Typically, patients are prescribed complex treatment, which involves the use of a number of different methods designed to alleviate the patient’s condition.

Also during therapy, it is important to get rid of bad habits and adhere to a healthy diet. The functionality of the vestibular apparatus can be improved by special gymnastics.

List of Abbreviations

BM – Meniere’s Disease

BPPG – benign paroxysmal positional dizziness

KVI – bone-air interval

KP – bone conduction

LDL – selective laser destruction

PD – action potential

Joint venture – total potential

FUNG – the phenomenon of accelerated increase in volume

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EM – endolymphatic bag

AAO-HNS – American Academy of Otolaryngology – Head and Neck Surgery

EGb 761 – Ginkgo biloba leaf extract dry standardized

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  2. Kryukov A.I., Fedorova OK, Antonyan R.G. et al. Clinical aspects of Meniere’s disease. M., 2006 s.
  3. Rational pharmacotherapy of diseases of the ear, throat and nose.
    Guide for practitioners. Ed. Lopatin A.S. Moscow,
    LITTERA, 2011, 66,3 pp (815s.), P. 547-554
  4. Sagalovich B.M., Palchun V.T. Meniere’s disease. M., 1999, 525 pp.
  5. Soldatov I. B. Meniere’s Disease/Guide to Otorhinolaryngology. Ed. I.B. Soldiers. M., 1997,200 p.
  6. Zaitseva O. V. Meniere’s disease: clinical diagnostic criteria, therapeutic tactics. – Therapist. – 2013. – No. 9. – S. 10-14
  7. Ahsan SF, Standring R, Wang Y. Systematic review and meta-analysis
    of Meniett therapy for Meniere »s disease. Laryngoscope 2014 Jun 10.
    doi: 10.1002/lary.24773.
  8. Kitahara T, Horii A, Imai T, Ohta Y, Morihana T, Inohara H, Sakagami
    M. Does endolymphatic sac decompression surgery prevent bilateral
    development of unilateral M? ni? re disease? Laryngoscope 2014
    Aug; 124 (8): 1932-6. doi: 10.1002/lary.24614. Epub 2014 Feb 10.
  9. Eugenio Mira, G. Guidetti, PL Ghilardi, B. Fattori, N. Malannino,
    R. Mora, S. Ottoboni, P. Pagnini, M. Leprini, E. Pallestrini, D. Passali,
    D. Nuti, M. Russolo, G. Tirelli, C. Simoncelli, S. Brizi, C. Vicini, P.
    Frasconi. Betahistine in peripheral vertigo. A double blind, placebo
    controlled, crossover study of sere versus placebo 1/J.Eur. Arch.
    Otorhino1aryngol.- 2003.-Vol.260:73-77
  10. Lopez-Escamez JA, Carey J., Chung WH., Goebel JA, Magnusson
    M., Mandal? M., Newman-Toker DE, Strupp M., Suzuki M., Trabalzini F.,
    Bisdorff A. Diagnostic criteria for Meni? S disease. Consensus
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    Research, the European Academy of Otology and Neurotology (EAONO), the
    American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and
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    67 (1) 1-7.
  11. Nauta JJ. Meta-analysis of clinical studies with betahistine in
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    2014, May, 271 (5): 887-97.
  • ICD-10 (International >To date, the etiology and pathogenesis of BM are not well understood.
    According to the classical theory of pathogenesis, the development of BM is associated with idiopathic
    endolymphatic hydrops, which is an increase
    the volume of the endolymph filling the membranous labyrinth of the inner ear and
    causing stretching of the Reisner membrane. Among the possible reasons
    development of endolymphatic hydrops emit:
    • strengthening the processes of endolymph production by the vascular strip of the spiral organ and the cells of sacculus and utriculus;
    • violation of the process of its resorption.

    Repeated bouts of dizziness in BM are associated with
    periodic rupture overstretched from high blood pressure
    Reisner membrane, mixing endo-and perilymph, getting rich
    potassium endolymph in perilymph followed by vestibular depolarization
    nerve and its overexcitation. Hearing loss and ear noise apparently
    caused by the processes of gradual degeneration of spiral neurons

    Currently, the relationship between the presence of the hydrops of the labyrinth and
    BM attacks is the subject of debate. It is known that
    endolymphatic hydrops can be combined with other diseases
    middle and inner ear, for example, with otosclerosis. According to
    Literature Hydrops labyrinth on autopsy found in subjects not
    suffering from symptoms of BM during life, so it would be logical
    suggest that the hydrops of the maze is not the only one
    a pathogenetic factor in the development of the symptoms of the disease and
    suggests the presence of additional factors.

    1.3 Ep >In different countries, the incidence of BM ranges from 3,5 to 513 people.
    per 100 thousand people. Most often, the first attack of BM occurs at the age of
    from 40 to 60 years. Women get sick more often than men. According to statistics,
    0,5% of the European population is diagnosed with BM, which in total is
    about 1 million people.

    Classification of Meniere’s Disease

    Meniere’s disease should be distinguished from the syndrome of the same name. Meniere’s syndrome is a concomitant factor of a certain disease, BM is an independent nosological unit.

    According to ICD-10, Meniere’s disease corresponds to class H81 — vestibular function disorders, code H81.0.

    With the course of endolymphatic hydrops happens:

    1. Classic, when auditory and vestibular disorders appear simultaneously;
    2. If at first the balance is disturbed – the vestibular;
    3. With the cochlear form, auditory disorders primarily occur.

    The severity of BM is classified into mild (short seizures with a break of at least a month), moderate (crises up to 6 hours) and severe (exacerbations 1 time per day with disability). Reversible and irreversible forms of the disease are also distinguished. With reversible, it is possible to restore the functions of the auditory analyzer.

    American Academy of Otorhinolaryngology and Head and Neck Surgery
    (AAO-HNS) developed diagnostic criteria for certain, reliable,
    probable, possible BM (1972, 1985, 1995) [10]. Given criteria in
    last reviewed by the Committee of the B? r? ny Society, The Japan
    Society for Equilibrium Research, the European Academy of Otology and
    Neurotology (EAONO), the Equilibrium Committee of the American Academy
    of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance
    Society 2015 [10].

    • histologically confirmed endolymphatic dropsy;
    • two or more episodes of dizziness lasting more than 20 minutes to 12 hours each;
    • Audiologically confirmed hearing loss (sensorineural) at low
      and medium frequencies during or after an attack of dizziness;
    • Fluctuating auditory symptoms: hearing, subjective noise, fullness in the ear.
    • Two or more spontaneous dizziness attacks lasting 20 minutes or more. till 12 o’clock;
    • Audiologically confirmed hearing loss (sensorineural) at low
      and medium frequencies during or after an attack of dizziness;
    • Fluctuating auditory symptoms: hearing, subjective noise, a feeling of fullness in the ear;
    • The absence of other reasons.
    • at least one dizzy spell;
    • sensorineural-type hearing loss, confirmed by at least a single audiometry;
    • noise or a feeling of stuffiness in the affected ear;
    • absence of other reasons explaining the listed symptoms.
    • dizziness without confirmed hearing loss;
    • sensorineural hearing loss, persistent or unstable, with imbalance, but without obvious bouts of dizziness;
    • absence of other reasons explaining the listed symptoms.

    BM is characterized by a clinical triad of symptoms, well described
    as early as 1861 by the famous French doctor Prosper Menier.

    Attacks of systemic dizziness. Bouts of systemic
    dizziness with Meniere’s disease is very characteristic. They arise
    suddenly, at any time of the day and at any time of the year, against the backdrop of “full
    health ”, are not provoked by anything, sometimes they have an aura in the form of strengthening or
    the appearance of congestion in a sick ear, noise in the ear, etc.

    Noise in the ear – one-sided, most often low or
    mid-frequency amplifying before and during an attack of systemic

    Hearing loss. Hearing loss in BM also has its own characteristic
    features. It is primarily one-sided, wears fluctuating
    character, and in an audiological study, the so-called
    scalar or false sensorineural hearing loss – horizontal or
    ascending type of audiological curve with a bone-air interval (CVI
    5-10 dB) in the low or medium frequency range. Normal thresholds
    ultrasound (ultrasound) and its lateralization in the direction worse than the hearing ear.

    There are three main options for the course of the disease. At the first
    variant (cochlear form) at first there are auditory disorders, and
    then vestibular. In the second (classic) version, auditory and
    vestibular disorders appear simultaneously, the first attack
    dizziness is accompanied by hearing loss and noise in the ear.

    At the third
    (rarer) variant of the course (vestibular form of BM) disease
    begins with attacks of vestibular dizziness, to which
    further join auditory disorders. According to a number of authors
    hearing fluctuation with dizziness is observed in 82,7%, and without
    dizziness – in 17,3%. Other cochlear monosymptomatic early BM
    observed in 54,4%, and the classic in 45,6%.

    Three stages are distinguished in the development of BM.

    The first stage is the initial one. Attacks of systemic dizziness
    rarely occur 1-2 times a year, or even in 2-3 years. These bouts
    appear at any time of the day, last an average of 1 to 3 hours,
    accompanied by nausea and vomiting. Noise in ear, stuffiness or sensation
    bursts in the ear occur before or during an attack, but are not
    persistent symptoms.

    Unilateral hearing loss occurs or
    amplified at the time of the attack, that is, for the first stage of the disease
    hearing fluctuation is characteristic – its periodic deterioration, as a rule,
    before the onset of dizziness, and subsequent improvement.
    Some patients report a significant improvement in hearing immediately after
    an attack and its subsequent decrease over the next day to
    normal level.

    The second stage is the height of the disease. Attacks acquire typical for
    BM character with intense systemic dizziness and severe
    vegetative manifestations occur several times a week (daily)
    or several times a month. The noise in the ears bothers the patient constantly,
    often intensifying at the time of the attack. Typical daily sensation
    nasal discomfort in the affected ear. Hearing loss progresses
    from attack to attack.

    The third stage is the fading stage. There is a reduction or complete
    the disappearance of typical bouts of systemic dizziness, but the patient
    constantly worried about the feeling of fragility and instability. Is celebrated
    marked hearing loss in the affected ear, often at this stage in the process
    the second ear is involved. Otolith crises may occur.
    Tumarkin – conditions in which there are attacks of a sudden fall,
    which occur due to a sharp mechanical displacement of the otolithic
    receptors leading to sudden activation of vestibular reflexes.
    Such severe symptoms can lead to serious injury.

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    Given the frequency and duration of dizziness attacks, conservation
    disability distinguish three degrees of severity BM: severe, moderate and

    In severe cases, dizziness is frequent (daily or
    weekly) lasting several hours with the whole complex
    statokinetic and autonomic disorders;

    With moderate severity, dizziness is also enough
    frequent (weekly or monthly), lasting several
    hours. Statokinetic disorders – moderate, autonomic –
    expressed. Disability was lost during an attack of dizziness and
    a few hours after it.

    With mild severity of BM, dizziness attacks are short-lived, with long-term (several months or years) remissions.

    Outpatient treatment and prognosis for the patient

    Since it is not possible to completely get rid of the pathology with the technologies of modern medicine, treatment goes in the following areas:

    • relief of arising attacks,
    • decrease in the frequency of attacks and their strength,
    • long-term treatment aimed at preventing exacerbation.

    To stop sudden conditions and reduce the number of seizures, medication is used:

    • diuretics (diuretics) that prevent excessive accumulation of lymph,
    • antihistamines and sedatives.

    The systemic drug effect aimed at stopping the attack combines the following set:

    • antipsychotics – chlorpromazine, triftazine,
    • atropine and scopolamine preparations – Belloid, Bellaspon,
    • antihistamines – diphenhydramine, pipolfen, suprastin,
    • vasodilator – no-shpa, nikoshpan,
    • diuretics.

    Comprehensive treatment involves the use of medications that improve the microcirculation of the structures of the inner ear, as well as reduce the permeability of capillaries:

    • venotonics improve the walls and compensate for vascular dysfunction,
    • neuroprotectors limit and stop brain tissue damage,
    • betahistine has a histamine-like effect.

    Usually, outpatient therapy is sufficient, but if vomiting occurs and if vomiting occurs, hospitalization with intravenous and intramuscular administration of drugs is possible.

    At the same time, drug therapy does not fully prevent hearing loss and the progression of hearing loss, but can only help reduce noise in the ear, severity and duration of the attack. If drug therapy does not produce the expected results, surgical intervention is prescribed, which, however, is highly likely to lead to complete hearing loss. Therefore, with bilateral lesions, patients are shown hearing replacement. Surgical interventions may be of the following nature:

    1. Draining operations. Their goal is to increase the outflow or drainage of the endolymph from the inner ear. This also includes decompression surgery:
      • labyrinth drainage through the middle ear
      • endolymphatic bag drainage,
      • fenestration of the semicircular canal,
      • perforation of the base of the stapes.
    2. Destructive operations. These include:
      • intracranial intersection of the vestibular branch of the 8th nerve,
      • laser exposure and ultrasonic destruction of labyrinth cells,
      • labyrinth removal.
    3. Operations on the autonomic nervous system, including:
      • the intersection of the drum plexus or drum string,
      • cervical resection.

    As an alternative therapy, chemical ablation is considered. This method consists in the introduction of antibiotics (gentamicin, streptomycin) or alcohol into the labyrinth cavity. The use of surgical therapy in the early stages improves the prognosis, but does not provide hearing restoration.

    The treatment of Meniere’s disease is carried out against the background of a proper diet, a healthy lifestyle and a comfortable psychological atmosphere in the patient’s environment. Moreover, physical activity between seizures is not limited. On the contrary, to improve well-being, the patient should regularly perform coordination exercises and train the vestibular apparatus.

    It happens that in front of your eyes a patient with a diagnosis of Meniere’s syndrome suddenly begins to experience a dizziness. What should the witness do then? First of all, do not panic or fuss!

    • Help the patient lie on the bed more comfortably and hold his head.
    • Advise patient not to move and lie still until the attack is over.
    • Ensure peace and quiet by removing all noise and light stimuli: turn off the bright lights, as well as the TV or radio.
    • At the feet of the patient it is best to attach a heating pad with warm water (a bottle will come off if there is no heating pad), and put mustard plasters on the back of the head. In these cases, you can use the balm “Golden Star”, which has a warming effect: it is rubbed with soft movements into the collar zone and behind the ears.
    • Call an ambulance.

    Treatment in the interictal period consists of complex therapy: a salt-free diet, diuretics and long-term courses of betahistine hydrochloride. The salt-free diet aims to change the osmolarity of plasma and endolymph. Patients need to limit salt intake to 2 g per day. A course of intravenous injection of sodium bicarbonate is required to maintain the acid-base balance of the blood.

    In order to reduce the frequency of seizures, patients are advised to limit the triggering factors: stress, smoking, alcohol, diving, caffeine use, work at heights with moving objects is contraindicated. Currently, there is a good therapeutic effect of taking glucocorticoids inside or as injections into the eardrum.

    Surgical interventions on the nerves and their plexuses are effective at the initial stage of Meniere’s disease in the first two years. These include:

    • Crossing the vestibular nerve is a complex neurosurgical operation. Allows you to save your hearing, since only the vestibular part of the vestibulo-cochlear nerve is removed. However, the following complications are possible: intracranial infections, headaches, cerebrospinal fluid;
    • Destruction of the cervical ganglion;
    • At any stage of the disease, laser destruction of the semicircular canal receptor is possible. This allows you to save auditory functions;

    Operations aimed at restoring pressure in the membranous labyrinth are shown with constant hydrops at the II-III stage:

    • Drainage of the cochlear duct is carried out by dissecting it;
    • Shunting of the endolymphatic bag;
    • Opening the sacs of the vestibule.

    Such surgical manipulations have a high therapeutic effect and are not accompanied by complications from the auditory perception.

    Intrathimpanic administration of antibiotics, in particular gentamicin, is usually carried out with a unilateral lesion and may be accompanied by a progression of hearing loss.

    Among alternative approaches for the treatment of Meniere’s disease, patients often resort to taking herbal remedies, nicotinic acid, bioflavonoids, ginger root, and acupuncture. Currently, patients often independently, without the recommendation of a doctor, use creosote to relieve vomiting. Creosote therapy is classified as homeopathy, this type of treatment is poorly understood and includes a large number of side effects.

    The complex treatment of Meniere’s disease includes physiotherapeutic procedures:

    1. Head and neck massage;
    2. Electrophoresis;
    3. Sea, coniferous baths;
    4. UV irradiation of the collar area.

    da74b48c0612743c2c53379204f8e58f - Lesser disease symptoms causes treatment

    For several years, the Yusupov hospital has been successfully treating Meniere’s disease using new techniques. In the clinic, you can get the consultation of the necessary specialist.

    Meniere’s disease – what is dangerous. Symptoms, diagnosis, treatment

    • Testing for glucose tolerance and function recommended
      thyroid gland, clinical and biochemical blood tests for
      generally accepted methods.

    Level of credibility of recommendations C (level of evidence credibility – IV)

    • Recommended conducting:
    1. tonal threshold, suprathreshold (SISI, Luscher test);
    2. impendanceometry (tympanometry and acoustic reflexometry);
    3. determination of thresholds of sensitivity to ultrasound and the phenomenon of its lateralization;
    4. recording evoked otoacoustic emission and evoked auditory potentials;
    5. clinical vestibulometry;
    6. posturography (stabilography).
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    lorenkerns flickr

    The disease has a very characteristic clinical picture, which allows specialists to easily diagnose. Differential diagnosis is required from pathological conditions such as:

    • cerebrovascular accident (stroke, atherosclerosis, transient ischemic attack, etc.);
    • violation of the venous outflow;
    • stenosis of the carotid and brachiocephalic arteries;
    • ear injuries, etc.

    In order to determine the degree of damage to the auditory apparatus in Meniere’s disease, a number of diagnostic measures are carried out:

    • audiometry;
    • promontorial test;
    • acoustic studies;
    • cerebral vascular examinations;
    • MRI;
    • vestibulometry;
    • otoscopy;
    • REG;
    • USDG and other events.

    A patient who is suspected of having Meniere’s disease must necessarily consult a neurologist who determines the nature of specific disorders.

    • otoscopy;
    • verification of the activity of the vestibular apparatus;
    • auditory analyzer;
    • magnetic resonance imaging of the brain;
    • electroencephalography;
    • echoencephaloscopy;
    • rheoencephalography;
    • ultrasound dopplerography of cerebral vessels.

    If Meniere’s syndrome is detected, the treatment will consist of the use of drugs. If this method of therapy does not bring the desired effect, surgical treatment will be carried out, wearing a hearing aid is prescribed.

    Not many people know what kind of disease is called Meniere’s syndrome, since it is quite rare. This is the pathology of the inner ear. There is an increased production of endolymph – a specific fluid that fills together with the perilymph of the cavity of the auditory organs and the vestibular apparatus, which takes part in sound conduction.

    Excessive production of this substance leads to an increase in internal pressure, disruption of the functioning of the auditory organs and the vestibular apparatus. In Meniere’s syndrome, the signs, symptoms and treatment will be similar to those in Meniere’s disease.

    But, if the latter is an independent disease, the causes of which are not clarified, then the syndrome is a secondary sign of other pathologies. This means that there are diseases (systemic or hearing) that provoke excessive production of endolymph and cause the occurrence of such reactions.

    In practice, Meniere’s syndrome and Meniere’s disease do not differ in symptoms.

    It has been proven that Meniere’s disease or syndrome is also common in women and men. In most cases, the first symptoms of the disease begin to appear in the period of 40-50 years, but there is no explicit link to age. The disease can also affect young children. According to statistics, more often people of the Caucasian race are faced with the disease.

    There are several theories. They connect the appearance of the syndrome with the fact that the inner ear reacts in a similar way (the volume of the endolymph increases, the internal pressure rises) under the influence of the following provoking factors:

    • allergy;
    • impaired functioning of the endocrine system;
    • vascular disease;
    • failures in water-salt metabolism;
    • syphilis;
    • pathologies caused by viruses;
    • deformed Bast valve;
    • clogged water supply vestibule;
    • impaired functioning of the endolymphatic duct or sac;
    • decrease in airiness of the temporal bone.

    A common version is that linking the appearance of this disease with a malfunction of the nerves that innervate the vessels inside the auditory organ.

    The diagnosis of Meniere’s disease is established taking into account specific symptoms and the results of instrumental studies. On the basis of clinical manifestations, the American Academy of Otolaryngologists distinguishes three degrees of reliability of BM: possible, probable, and reliable BM. An important diagnostic criterion is the triad of symptoms – dizziness, tinnitus and hearing loss. As a confirmation of the diagnosis, a gradual hearing impairment and recurring episodes of vestibular attacks appear.

    Among the instrumental methods for diagnosing Meniere’s disease are used:

    • The main method, according to international diagnostic criteria, is tonal threshold audiometry. The result of such a study will be an audiogram that graphically depicts the function of the organ of hearing;
    • Otoscopy is performed to exclude the pathology of the middle ear;
    • Extrathympal electrocochleography evaluates the performance of the auditory nerve;
    • A tuning fork study determines the type of hearing loss. In this case, conductive hearing loss.

    These methods allow you to analyze the degree of hearing loss. Audiometry is the main criterion for choosing treatment tactics. In order to detect endolymphatic hydrops, doctors use electrocochleography and a dehydration test.

    An audiogram is used to recognize the degree of hearing loss. Before the procedure, the doctor examines the auricles, if ear plugs are detected, they must be removed. Headphones are put on to the patient, and signals of different frequencies are fed through the computer. The subject must press the button when he hears a signal. In the initial stages, poor perception of low frequencies is recorded.

    To perform extrathympal electrocochleography, electrodes are applied to the patient’s skin on the auricle or eardrum. Electrodes determine the ability of the auditory nerve to generate nerve impulses after a signal is given.

    Before the breakdown, the patient undergoes a threshold tonal audiometry. Then osmotic diuretics (furosemide) are administered and audiometry is repeated again every three hours, after 24 and 48 hours. The test is positive if there is an improvement in hearing of 10 dB or more after 3-4 hours. During remission of the disease, the study is uninformative.

    MSCT allows you to detect the smallest changes in all organs. Pathognomonic processes in the inner ear for BM are visualized in the pictures.

    The following studies are used to evaluate disorders of the organ of equilibrium:

    • Video nystagmography for detecting horizontal nystagmus;
    • The video-pulse test displays the vestibulo-ocular reflex and the presence of asymmetry;
    • Stabilization;
    • Bitermal bitemporal calorization is performed to evaluate the function of semicircular canals;
    • Rotational tests.

    Differential diagnosis of Meniere’s disease is carried out with such diseases:

    • Craniocerebral injuries;
    • Ischemic attacks. Such attacks last minutes, observed with the elderly with vascular pathology;
    • Other vestibulopathies, they can occur as a result of purulent otitis, otosclerosis, labyrinthitis;
    • Tumors of the cerebellar fossa;
    • Vestibular migraine;
    • Otosclerosis. The disease is often bilateral, the main symptoms are cochlear;
    • Benign paroxysmal positional dizziness. The attack is intense, occurs in a certain position of the body;
    • Osteochondrosis.

    To exclude neoplasms of the brain, injuries, abnormalities in the structure of the temporal bone, CT and MRI are highly informative.

    To choose the right treatment tactics, timely and accurate diagnosis is necessary. In the Yusupov hospital, you can conduct the necessary examinations and get advice from a highly qualified specialist. The clinic has modern high-quality equipment and diagnostic laboratories.

    Traditional medicine and home methods

    Please note that treatment with folk remedies does not imply Meniere’s syndrome, since in folk medicine there are no effective methods that can somehow significantly improve the condition of the patient with this ailment.

    Herbal remedies, offered as a panacea for Meniere’s disease, are not. They can only alleviate the symptoms and somewhat delay the onset of a new attack.

    Herbs that are recommended for use with the described syndrome include diuretics and diaphoretic drugs that help reduce the amount of fluid in the body, which, in turn, will reduce the pressure in the maze.

    In addition to them, regular exercise, reducing the amount of salt consumed and avoiding allergens also help to reduce the intensity of attacks and increase the intervals between them.

    To apply the methods of traditional medicine, first of all, it is necessary to confirm the diagnosis professionally, so as not to mistake for Meniere’s disease, for example, a hypertensive crisis characterized by similar manifestations. And in no case do not refuse the help of a doctor who will help to avoid mistakes and tell how to treat Meniere’s disease.

    During periods of the acute phase of the disease, it is necessary to help the patient to do the following:

    1. Take a horizontal position – preferably in a comfortable position, because any movement exacerbates the patient’s condition.
    2. Refuse compresses and lotions.
    3. If the acute phase is over and the patient still feels unwell, you can suggest 1-2 slices of lemon with a peel in tea before bedtime. There you can add mint, lemon balm, lime color.
    4. After the acute phase is over, the patient may still hear tinnitus for some time. To get rid of noise, the following exercise is proposed: the palm is pressed firmly to the ear and rotates clockwise for 2 minutes, after which the palm needs to be sharply pulled back.

    The amount of water and salt trapping it should be limited.

    Instead, traditional medicine recommends introducing phosphorus-containing foods into the diet: fish, bran, nuts, yolk. Also recommended is sea kale, which can be eaten fresh or dried, adding a teaspoon to various dishes.

    8eeb550e3894924bf4255b953793e703 - Lesser disease symptoms causes treatment

    Among the popular infusions and mixtures, the following are described:

    • Dried ivan tea and red clover in inflorescences (1 tbsp. Spoon), taken in equal parts, boil for about three minutes, then they are filtered and taken three times a day before meals in a tablespoon.
    • Clover inflorescences at the rate of 2 g per 300 ml are kept in boiling water for half an hour. After this, the infusion is filtered and taken four times a day before meals, ¼ cup.
    • In the initial phase of clover blooming, heads are collected that are placed in the jar, but are not rammed. The embankment is filled with vodka and infused for three weeks. It is taken three times a day before meals on a teaspoon.
    • Dry dill (a handful) is poured with boiling water and stored in a thermos for half an hour. It is used three times a day before meals for half a glass for 1,5 months. Dill essential oils dilate blood vessels and lower blood pressure, improve blood flow.
    • With dizziness, 250 g of onion is ground in a meat grinder, mixed with a glass of honey and added to the diet for a month – three times a day before meals in a tablespoon.
    • Rosehips, flowers of meadowsweet, Hawthorn and motherwort grass in a tablespoon are mixed and poured with a liter of boiling water, hiding the mixture in the heat for a day. And then for 3 months three times a day before meals, drink one glass.
    • From nausea and vomiting, 20 g of mint is immersed in half a liter of boiling water and insisted for 20 minutes. For the same amount of water, you can take 12-13 g of dry centaury or caraway seeds. This infusion is drunk in 2 tablespoons: mint – every half hour, centaury and caraway seeds – every hour or two.

    A few herbal recipes

    Here are recipes for herbal supplements that help with the diagnosis of Meniere’s Syndrome. Their treatment should be carried out only in agreement with the attending physician and in no case should these drugs be replaced with the herbs prescribed by him!

    Mix ground grass of clover, edelweiss, wormwood and violet tricolor in equal parts with the root of a penny, flowers of calendula, tansy, clover and buds of birch. Pour two tablespoons of this mixture with hot boiled water (the volume of a half-liter jar) and insist in a thermos all night. Strained infusion should be taken 3 times a day, 80 ml for two months. If necessary, you can take a break for two weeks and repeat the course again.

    An infusion is also made from the collection, which contains equal parts of mint, geranium, shiksha, tricolor violet, adonis, motherwort, calamus root and scutellaria. Take it according to the previous scheme.

    Patients with Meniere’s syndrome will have to slightly adjust their diet. It is necessary to exclude everything sharp and salty from it and enrich it with juices, as well as fresh vegetables and fruits. Soups will have to be cooked in vegetable broth or in milk. And three times a week, replace them with fresh vegetable salads.

    The daily diet should include potassium-rich foods: dried apricots, cottage cheese and baked potatoes. And twice a week to arrange fasting days to cleanse the body of accumulated toxins.

    This diet, along with regular training of the vestibular apparatus, will also help alleviate your condition. Be healthy!

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.