Ménière’s syndrome: what it is, symptoms, causes and treatment

Globally, 12 out of 1000 subjects suffer from Ménière’s syndrome: it is a disorder that affects the inner ear, causing dizziness, tinnitus, hypoacusia, loss of balance, feeling of full ear and, very frequently, even nausea and vomiting

They are typically episodic seizures, lasting anywhere from 20 minutes to a day or more.

Although these phenomena can occur at any age and affect anyone, they appear to be slightly more common in female subjects, arising after the age of 40.

Ménière syndrome, what is it?

Generally the disease affects only one ear (unilateral disorder), but in a percentage that varies between 15 and 40% of cases it affects both ears (bilateral) within 2-3 years.

It is also important to note that 7-10% of clinical cases have a family history of Ménière syndrome.

Over time, the recurrence of this type of manifestation implies a worsening of the patient’s general state of health.

For example, hearing loss can become permanent, even leading to complete deafness.

It is important to promptly rely on a specialist visit when the first symptoms appear, in order to distinguish Ménière’s syndrome from other diseases capable of inducing vertigo such as labyrinthitis or cervical dysfunction.

Unfortunately, to date there is no ad hoc cure for this pathology, however there are symptomatic treatments, capable of improving the quality of life of those affected by the disorder.

Ménière’s syndrome: the symptoms

The main symptoms of Ménière’s disease are:

  • noises in the ear and tinnitus; they can appear as tinkling, rumbling or buzzing, but they are mainly hiss in the low frequency range. In some cases, the noises may persist throughout the course of the disease.
  • sudden dizziness, hallmark of Ménière syndrome. This is the so-called rotational vertigo, as a result of which the subject has the impression that the environment around him rotates whirlwind. The dizziness can last a few hours, but also up to several days.
  • nausea and vomiting, followed by cold sweats and arterial hypotension
  • unilateral hearing loss, i.e. loss of hearing in the affected ear. It may happen that during the course of the disease this hearing loss also extends to the other ear, but it usually happens that the patient initially presents a sudden worsening of hearing in only one ear. It is above all the low tones that are no longer heard and sounds and speech are noticeably distorted.
  • sensation of “blocked ear” or auricular fullness

Less frequent symptoms

  • nystagmus (condition characterized by involuntary, rapid and repetitive movement of the eyes)
  • sudden fainting without loss of consciousness.

In the initial phase of the syndrome, the symptoms appear as transient and episodic attacks, the duration of which can vary from 20 minutes to a few hours.

The episodes, typically sudden and in an acute form, are repeated approximately 3-4 times a day and concern only one ear.

It often happens that for several days in a row, and sometimes up to a week in a row, the patient experiences manifestations that are very close in time.

After a period of remission, new attacks will follow several times.

On average, a patient with early-stage Ménière syndrome experiences 6 to 11 such seizures in a year.

Permanent symptoms

As the disease progresses, some symptoms may become permanent.

This is what happens, for example, with the decrease in hearing ability: a person subjected to repeated attacks over the years develops irreversible damage to the structures affecting the labyrinth and the cochlea.

In some cases, the situation can be so compromised as to lead to complete deafness in the affected ear.

Tinnitus (perception of ringing or ringing in the ear) can also become permanent, although it is a less common phenomenon.

The same goes for dizziness and lack of balance.

The main complications of Ménière’s disease are those, partially already mentioned, typical of the advanced stage of the syndrome:

  • complete deafness of the affected ear
  • involvement of the sound ear, after 2-3 years
  • depression and anxiety, attributable to a lower quality of life, due to repeated attacks of nausea and vomiting.

Ménière syndrome: the causes

To date, it is not possible to identify with certainty the origin of Ménière’s syndrome.

However, a hallmark of the disease is an abnormal accumulation of endolymph within the labyrinth of the inner ear.

This phenomenon can present itself as full-blown Ménière syndrome or generate attenuated forms.

Other possible triggers include infections of the inner ear or upper airways, trauma to the head, and genetic predisposition.

Some bad habits such as smoking, excessive consumption of caffeine and alcohol, or exposure to loud noises can act as a catalyst for the seizure.

Ménière’s syndrome can be hereditary and affect anyone, regardless of age, but gets worse over the years.

As seen in the previous paragraph, it generally has a fluctuating trend, with acute phases followed by periods of remission.

Approaches in the treatment of Ménière’s syndrome

In order to obtain the most suitable diagnosis and related treatment, it is essential to go to a specialist for a visit and undergo an audiometric, impedancemetry and possibly a brain magnetic resonance investigation.

Unfortunately, as anticipated, there is currently no specific cure for Ménière’s disease.

In any case, there are several treatments capable of alleviating the symptoms and thus raising the quality of life of the affected patients.

There are two main types of approach:

  • pharmacological, suitable for less severe cases
  • surgical, to intervene in the most acute forms of the pathology, where pharmacological treatments are not able to obtain the desired effects.

To combat the sensation of dizziness, nausea and vomiting, antiemetic, prokinetic and antivertiginous drugs are used.

Instead, as regards the prevention of attacks (vertigo and nausea), drugs such as:

  • betahistine, which positively affects the number and severity of crises
  • gentamicin, administered by transtympanic injection, acts on the nerve signal that regulates balance. Its use is reserved only for cases in which other drugs have shown little efficacy
  • diuretics and beta-blockers, to decrease the pressure within the vestibular apparatus, which is elevated due to the accumulation of endolymph.

The surgical approach

When the pharmacological approach for the treatment of Ménière’s syndrome does not generate the desired results, surgery can be used.

There are four main options:

  • labyrinthectomy, i.e. removal of the labyrinth of the affected inner ear
  • decompression of the endolymphatic sac, to decrease the pressure of the endolymph within the labyrinth
  • section of the vestibular nerve, with the aim of interrupting the abnormal signaling between the inner ear and the brain
  • micropressure therapy, through the use of an instrument that sends pressure impulses capable of causing the endolymph to flow out from the sites where excessive accumulation has occurred.

The first three surgical solutions are very invasive, while the last mentioned is only moderately invasive.

Also, for hearing loss (permanent or temporary), the use of hearing aids may be helpful.

For tinnitus, a recommended option is sound therapy, in order to distract and relax the patient through listening to music.

The role of physiotherapy

Physiotherapy, on the other hand, can be useful for working on balance and coordination skills.

Each patient is a separate case, therefore it is difficult to express oneself with respect to the evolution of the clinical picture.

Ménière’s disease is to be considered rather a chronic condition with which the affected person must learn to live with.

Fortunately, most of the patients treated (about 80%), without the use of surgery, detect an improvement in their health conditions.

Finally, don’t overlook the usefulness, even for preventive purposes, of some healthy habits such as:

  • not smoking
  • engage in regular physical activity
  • follow a low sodium diet (to keep the pressure of body fluids, including endolymph, low)
  • do not consume excessive amounts of caffeine and alcohol.

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