MENIERE SYNDROME

Meniere syndrome, was first described by Prosper Meniere in 1861. This syndrome consists of recurrent attacks of tinnitus – ringing in ear, gradual hearing loss and vertigo  ( feeling of objects or self rotating ), sense of pressure in the ear, distortion of sounds and sensitivity to noises. These symptoms may not occur at the same time in the same spell. Hearing loss or vertigo may even be absent for several years. The symptoms occur in clusters with periods of remission that may last for several years. Major attacks of vertigo last for 5-30 minutes with nausea and vomiting. Minor spells are characterized by unsteadiness, giddiness or light headedness.

Isolated and recurrent attacks of sudden  and severe vertigo are the cardinal features of this syndrome. Continuous vertigo that lasts for days or weeks is almost never due to meniere syndrome. Most episodes are associated with nausea, vomiting and profuse perspiration, but nausea may occur without vomiting in mild attacks.

Hearing loss begins as a low frequency hearing loss, improving between attacks and in severe cases hearing loss becomes persistent and slowly progressive. Symptoms are unilateral at first, but in 20 to 30% of the cases the other ear is finally affected.

A consistent pathologic feature is an increase in endolymphatic volume with bolloning of the cochlear duct, utricle and saccule – small bones in the inner ear. This is referred as Endolymphatic hydrops. It is not known as to what causes this distention of the endolymph space, nor it is clear that it is the cause of the clinical symptoms.

Mechanical, physiologic and biochemical theories have been advanced to explain the development and symptoms of hydrops. Possibilitis include mechanical blockage of inner ear cochlear and endolympatic ducts, autonomic dysfunction with vasospasm of vessels of the stria vascularis, vitamin deficiency, allergy, altered hypothalamic neurovascular mechanisms and psychosomatic factors.

Diagnosis: The diagnosis in not difficult in most cases with a characteristic history of acute attacks of vertigo associated with tinnitus and hearing loss without any neurological abnormality. There should not be vertigo in between attacks and tinnitus and sensorineural hearing loss are required for a definitive diagnosis. Differential diagnosis include, acute labyrinthitis, tumors of posterior fossa like neuromas of the acoustic nerve,

Multiple sclerosis etc.

Treatment: Acute episodes are self limited and may not require but symptomatic treatment is usually necessary including bedrest but unfortunately there is no definitive medical treatment.

Surgical procedures include selective nerve section of vestibular nerve, labyrinthectomy, cryosurgery and ultrasonic treatment of the semicircular canal. One needs to consult ENT

Specialist with specific training in this highly complex surgical procedures.

Presented by – Lalit Savla M.D.