Therapy of Meniere's disease

Synonyms in a broader sense

Meniere's disease; Inner ear vertigo, sudden hearing loss, equilibrium organ, dizziness

English: Menière’s disease

definition

Menière's disease is an inner ear disease and was first described impressively by the French doctor Prosper Menière in 1861.
In Menière's disease, there is an increased accumulation of fluid (hydrops) in the membranous labyrinth of the inner ear (see anatomy ear). This results in a pathological increase in pressure in the inner ear. This increase in pressure leads to the typical signs of illness (symptoms / complaints): seizure-like, non-provocable vertigo, one-sided noises in the ears (tinnitus) and one-sided hearing loss or hearing loss. In addition, nausea and vomiting can occur.

Figure ear

1. Outer ear
2. eardrum
3. Balance organ
4. Auditory nerve (nervus acousticus)
5. tube
6. Mastoid process

Alternative causes / differential diagnoses

Of the Sudden hearing loss, the sudden loss of hearing in one ear and one that may occur with it Ringing in the ear (tinnitus), is a differential diagnosis to Meniere's disease.
It is possible that the first attacks of Menière's disease manifest themselves without symptoms of dizziness, which is why observation and continuous care of the patient is necessary in order to be able to differentiate between these two clinical pictures.

Is the cause of the discomfort in the area of Orthopedics or Internal Medicine, are mainly treating the complaints of the Cervical spine or to name the elimination of allergens as common causes of similar symptoms.
Inflammation of the auditory tract or the inner ear are also important diagnoses to be excluded on the way to determining Menières' disease.

Of the psychogenic dizziness is an important differential diagnosis / alternative causes to Menière's disease.
The vertigo attacks are usually accompanied by violent feelings such as insecurity, Panic attack, severe palpitations, sweating and more extreme fear accompanied.
This Attacks of dizziness do not move from Balance organ in the ear and are therefore subject to different therapeutic measures than the Menière attacks. Psychological care to eliminate anxiety plays an important role in the treatment of psychogenic dizziness.

Therapy Meniere's disease

It is a first and important step in ththerapy of Meniere's diseaseto inform those affected about the possibility of dampening an acute attack with effective medication.

If this occurs, the patient should be due to the dizziness bed rest comply or lie down to avoid falling due to dizziness.

Because of the mostly short duration of the attack, the administration is short-term Anti-nausea medication and vomiting (antiemetic) makes sense. These antiemetic drugs include Vomex ® with the active ingredient dimenhydrinate, Paspertin ® with the active ingredient Metoclopramide and Peremesin ® with the active ingredient Meclozin.
In addition to its antiemetic effect, meclozin also has an effect on the organ of equilibrium: Dizziness is reduced because the drug keeps stimuli away from the organ of equilibrium and this is calmed down - the dizziness improves.
in the acute stage the patient receives infusions with substances for Stimulation of blood circulation in the Inner ear.

Other drugs are used in the treatment / therapy of Meinère's disease:

• Betahistine, also called 2- (2-methylaminoethyl) pyridine, is a remedy for nausea, vomiting and dizziness. It is administered orally and is used in Menière's disease and non-specific dizziness. The active ingredient with the trade name Aequamen ® , Vasomotal ® is supposed to improve the blood flow to the inner ear and stabilize the central balance regulation, so that the dizziness attacks are relieved.
• Ginkgo biloba with blood circulation-promoting effect is also used to counteract tinnitus.
  Further information is also available under our topic: Ginkgo biloba
• Cinnarizine, which also has a blood circulation-promoting effect.

In addition, diuretics can be given to flush the fluid out of the inner ear.

Medical care should also be provided for the patient in the interval between the Menière attacks when the patient has no symptoms.

Balance exercises can be integrated into the therapy program of the Menière patient, so that no general stance and gait uncertainty develops. Safety in movement is thus promoted or can be regained.
Read our general article on this Vertigo training.
If the patient's hearing is impaired to the extent that everyday communication and actions are impaired, technical compensation aids such as Hearing aids or Lip reading training up to Cochlear implant (artificial inner ear) should be considered and its use discussed with the patient.

If it is not possible to stop the vertigo attacks despite conservative therapeutic measures, a surgical intervention should be considered, by which the hearing and / or balance organ is switched off (see prophylaxis).

Prognosis and course

As a rule, as the disease persists, hearing loss progresses until Deaf / hearing loss can lead. The Dizzy spells but decrease in strength.

Both inner ears are affected in 10% of patients.

prophylaxis

The patient can be prepared for an attack with the following measures:

• The Carry along from Tablets or Suppositories for use against nausea and vomiting as well as a bag, if vomiting occurs despite taking medication, can be useful; does the patient have one Self-help card in the event of an acute attack (available from the German Tinnitus League), he can identify himself as suffering from Menière, so that he is not mistaken for drunk because of the dizziness; a cell phone provides the security of being able to call for help immediately if a Menière attack occurs.
  
• To avoid further seizures you should psychological stressful situations which can lead to seizure symptoms in the patient (trigger). Problems with coping with illnesses can also arise that require professional psychological support.
  Many patients are frightened and insecure because they cannot foresee the onset of the symptoms.
  Many patients perceive this as an enormous burden and are always accompanied by the fear that an attack might occur. Against this background, many Menière patients withdraw from their social contacts and remain alone in their insecurity. To prevent vertigo attacks caused by the fear and insecurity of the patient, i.e. if they have a psychological cause, can be prevented by psychological care.
  
• The enjoyment of nicotine, caffeine and alcohol promotes the occurrence of seizures, so that on Coffee, smoking and Alcohol consumption should be omitted.
  
• A low-sodium diet can reduce the accumulation of fluid in the membranous labyrinth.
  However, if these measures do not improve the frequency and severity of seizures, a hearing care professional should be consulted surgical intervention to be discussed.
  
• On the surgical side, there are various measures for the Menière treatment.
  When opening the inner ear, the so-called Saccotomy, the endolymophatic sac is opened so that the fluid can be drained to the outside.
  The increase in pressure caused by the accumulation of fluid in the membranous labyrinth (cause of the Meniere's symptoms), to which the endolymphatic sac belongs, is thus counteracted.
  More, definitely rarer ones Interventions performed as part of the surgical therapy of Menière's disease are firstly Elimination of the organ of equilibrium with drugs that damage the inner ear (ototoxic) such as Gentamicin (Antibiotic) that are introduced into the inner ear through the external ear canal and eardrum.
  Second, the procedure is selective Neurectomy of the equilibrium nerve (Vestibular nerve) Application in which the equilibrium nerve is severed and removed.
  These measures are aimed at eliminating dizziness by turning off the balance organ while maintaining the patient's hearing ability.
  Due to the close proximity of the auditory and equilibrium organs, a complication of the operation can be damage to the inner ear, which causes hearing loss.
• The last therapy option is Destruction of the membranous labyrinth in which the inner ear and the organ of equilibrium are removed from the bony environment. This operation is only performed when the patient's hearing is practically extinguished.