How Do I Choose the Best Meniere's Disease Treatment?

Meniere's disease is an idiopathic inner ear disease, formerly known as Meniere's disease, which was first proposed by French physician Prosper Ménière in 1861. The main pathological change of the disease is hydrocephalus, and the clinical manifestations are recurrent vertigo, fluctuating hearing loss, tinnitus, and a sense of tinnitus. The disease mostly occurs in middle and young people aged 30 to 50, and children are rare. There was no significant difference between men and women. Patients with both ears account for 10% to 50%.

Basic Information

nickname

Meniere's disease

English name

Meniere disease

Visiting department

ENT

Multiple groups

30-50 years old, middle-aged

Common causes

Still unclear

Common symptoms

Recurrent vertigo, hearing loss, tinnitus and stuffiness

Causes of Meniere's disease

The cause of Meniere's disease is still unknown. In 1938, Hallpike and Cairns reported that the main pathological change of the disease was hydrocephalus, which has been confirmed by many scholars. However, it is difficult to explain how the membrane stray water is generated. The currently known etiology includes the following factors: various infectious factors (bacteria, viruses, etc.), injuries (including mechanical or acoustic injuries), otosclerosis, syphilis, genetic factors, allergies, tumors, leukemias, and autoimmune diseases, etc. .

DeSousa (2002) referred to the vestibular symptoms of membranous labyrinthosis caused by known causes as Meniere's syndrome, and Meniere's disease is considered to be an idiopathic membranous labyrinth.

Clinical manifestations of Meniere's disease

Typical Meniere's disease has the following symptoms:

Dizziness

Most are sudden onset of rotational vertigo. Patients often feel that surrounding objects rotate around themselves in a certain direction, and symptoms can be reduced when the eyes are closed. Often accompanied by symptoms of autonomic reflex such as nausea, vomiting, pale, cold sweats, and decreased blood pressure. Any movement of the head can make vertigo worse. Patients' consciousness is always clear, and individual patients remain awake even if they suddenly fall.

The duration of vertigo is usually 10 minutes or hours, and the longest is no more than 24 hours. After the onset of dizziness, it can be transferred to the intermittent period, and the symptoms disappear. The length of the intermittent period varies from person to person, ranging from days to years. Dizziness can recur, and the duration and severity of each episode vary from patient to patient, and from patient to patient. And the more the number of vertigo attacks, the longer the duration of each attack and the shorter the interval.

Deafness

In the early stage, the sensorineural hearing loss with low frequency (125 ~ 500Hz) decline can be fluctuating, hearing loss during the onset, and partial or complete recovery during the intermittent period. With the development of the disease, hearing loss can gradually increase, and high-frequency (2-8kHz) hearing loss gradually occurs. This disease can also appear a special hearing change phenomenon: rehearing phenomenon, that is, the affected ear and healthy ear can hear the same pure tone into two different tones and tones. Or the ending of the hearing.

3. Tinnitus

Tinnitus may be the earliest symptom of the disease. It may be manifested as a persistent low-key drizzle in the early stage, and a variety of tones such as ringing tones, cicadas, and wind blowing may appear in the later stages. Tinnitus can appear or worsen before the onset of vertigo. Tinnitus disappeared during the intermittent period, and tinnitus persisted in patients with chronic illness. A few patients may have bilateral tinnitus.

4. Ear tightness

During the onset of dizziness, the affected ear may feel fullness, pressure and heaviness in the ear. A few patients complain of mild ear pain and ear itch.

Meniere's disease check

Audiological examination

(1) Pure tone audiometry can understand whether the hearing is reduced, the degree and nature of the hearing loss. In the early stage, most of them are low-frequency sensorineural hearing loss, and the hearing curve is slightly rising. After multiple episodes, high-frequency hearing decreases, and the hearing curve can be flat or falling. Pure tone audiometry can also dynamically observe the continuous changes in the patient's hearing.

(2) Cochlear electrogram This examination can objectively understand whether there is stagnant water in the membrane labyrinth. -SP / AP amplitude ratio> 0.37 is of diagnostic significance and can indirectly indicate the presence of membrane labyrinth.

(3) Otoacoustic emissions can first reflect the cochlear function of patients with early Meniere's disease. When pure tone audiometry in the early stage of the disease does not reveal abnormalities, transient otoacoustic emissions can be weakened or not induced.

2. Electronystagmogram

During orgasm, spontaneous nystagmus can be seen, and horizontal spontaneous nystagmus and positional nystagmus with regular rhythm, different intensities, and initially turning to the affected side and then to the healthy side can be observed or recorded with electronysmograms. The nystagmus turned to the healthy side. Spontaneous spontaneous nystagmus and various induced test results may be normal.

3.Glycerin experiment

It is mainly used to determine whether there is a membrane stray water. Due to the high osmotic pressure of glycerol, and the molecular diameter is smaller than the diameter of the pores of the cytoplasmic plasma membrane, it can diffuse to the inner ear marginal cells, increase the intracellular osmotic pressure, and allow the water in the endolymph to enter the blood vessels of the vascular vein through the cell pathway, reducing the Pressure effect.

4. Vestibular function experiment

(1) In the early stage of cold and hot tests, the vestibular function of the affected side may be normal or mildly diminished, the dominant side of the healthy side may be biased after multiple attacks, and semi-regular paresis or loss of function may occur in the later stage.

(2) Vestibular evoked myogenic potentials may have abnormal amplitudes and thresholds.

(3) When Hennebert's sacrum foot plate adheres to the inflated balloon, dizziness and nystagmus can be induced when the external ear canal pressure is increased or decreased. Patients with Meniere's disease may develop a positive Henenbert sign.

5. Imaging examination

CT examination of the temporal bone can reveal vestibular aqueduct stenosis. MRI of the inner eardrum labyrinth under special angiography can show that the lymphatic vessels in some patients become thinner.

6. Immunological examination

Some patients have HSP70 antibody and 68kD antigen antibody.

Meniere's disease diagnosis

At present, the diagnosis of Meniere's disease is mainly based on medical history, comprehensive examination and careful differential diagnosis. After excluding other diseases that may cause dizziness, clinical diagnosis can be made.

Differential diagnosis of Meniere's disease

Before the diagnosis of Meniere's disease, various diseases such as central system diseases, vestibular system diseases, and other system diseases should be excluded.

Central disease

Auditory neuroma, multiple sclerosis, aneurysm, cerebellar or brainstem tumors, cervical vertigo, Amolk-Chiat malformation, transient paroxysmal cerebral ischemia, cerebrovascular accident, insufficient cerebral blood supply, etc. Should be excluded first neurological emergency, such as dorsal lateral medullary syndrome, posterior circulation ischemia, cerebrovascular disease and so on.

2. Peripheral disease

Benign paroxysmal positional vertigo, vestibular neuritis, vestibular drug poisoning, labyrinthitis, sudden deafness, Hunt syndrome, otosclerosis, autoimmune inner ear disease, external lymphatic fistula, etc.

3. Metabolic disease

Diabetes, hyperthyroidism or hypothyroidism, Cogan syndrome, blood disease, autoimmune disease, etc.

4. Other systemic diseases

Such as heart disease, essential hypertension and so on.

Meniere's disease treatment

Due to the unknown etiology and pathogenesis of Meniere's disease, there is currently no cure for this disease. At present, drug therapy and surgical treatment are mainly used to regulate autonomic nerve function, improve inner ear microcirculation, and relieve labyrinth fluid.

Drug treatment

(1) Vestibular nerve inhibitors are mostly used in the acute phase, which can reduce the activity of the vestibular nucleus and control dizziness. Diazepam, diphenhydramine, difenidol, etc. are commonly used.

(2) Anticholinergic drugs such as anisodamine and scopolamine can alleviate symptoms such as nausea and vomiting.

(3) Vasodilators can change the metabolism of ischemic cells, selectively relax the blood vessels in the ischemic area, and relieve ischemia. Commonly used are flunarizine (sibilin), betahistine, ginkgo leaves and so on.

(4) Diuretics and dehydration drugs can change the inner ear fluid balance, reduce endolymph and control dizziness. Commonly used are dihydrodiuresis, acetazolamide and the like.

(5) Glucocorticoids are based on the theory of immune response and can be treated with dexamethasone and prednisone.

(6) Vitamins can be treated with vitamins if they are caused by metabolic disorders or vitamin deficiency. Vitamins B ₁ , B ₁₂ , and vitamin C are commonly used.

2. Middle ear compression therapy

Experimental studies have shown that changes in middle ear pressure can affect pressure and flow in the inner ear. In 2001, Densert of Sweden reported the use of a portable middle ear pressurizer (Meniett device) to treat Meniere's disease, which can control short-term or long-term vertigo symptoms in patients.

3. chemical labyrinthectomy

Refers to the use of ototoxicity of aminoglycoside antibiotics to destroy the vestibular function of the inner ear and achieve the purpose of treating dizziness. The drugs used are mainly streptomycin and gentamicin. Can be used throughout the body and in the drum.

(1) Systemic medication According to the report by Langman (1990), systemic intravenous infusion of streptomycin can treat bilateral Meniere's disease and relieve symptoms of vertigo.

(2) Injection in the tympanum uses the principle of semi-osmosis of the round window membrane, and the drug injected in the tympanum can enter the inner ear through osmosis to achieve therapeutic purposes. At present, gentamicin intratympanic injection has become a commonly used method, and good clinical results have been achieved. The main complication is hearing loss.

4. Surgery

Meniere's disease can be considered surgical treatment after failed drug therapy. There are many types of surgery, such as endolymphatic sac surgery (endolymphatic sac decompression, endolymphatic shunt); stellate ganglion closure; those who have lost their work and living ability due to dizziness, and those who have hearing loss can choose Labyrinthectomy, vestibular neurotomy, etc.

The choice of the surgical method should be based on the severity of symptoms such as hearing, dizziness, and the age, occupation, and lifestyle of the patient. For example, young people and patients in need of employment are better off than retired elderly. However, after the vestibular disruption surgery, a balance disorder may occur, which is not suitable for patients working at heights.

According to the preservation of vestibular function and hearing, the surgery can be divided into conservative endolymphatic sac surgery, partial destructive surgery and destructive surgery.

Meniere's disease care

Low-salt diet and light diet: The recommended daily intake of salt is <1.0g. Appropriate control of water intake. Avoid fatigue and irregular life. Keep your mood comfortable and avoid depression and other negative emotions. Get plenty of sleep. Bed rest should be used during the onset of the disease. Try to avoid lighting and strong sound stimulation. It is recommended to strengthen exercise and improve physical fitness during the intermittent period of the disease. Avoid tobacco, alcohol, strong tea, coffee, etc. Avoid contact with allergens and control systemic allergic diseases. Actively treat systemic comorbidities.

References

1. Huang Xuanzhao, Wang Baoji, Kong Weijia. Practical Otorhinolaryngology Head and Neck Surgery: People's Medical Publishing House, 2007: 12: 959-963.

2. Zhang Ting, Dai Chunfu. Advances in genetics of Meniere's disease: Chinese Journal of Otolaryngology, 2001: 11 (1): 58-60.

3. Li Xuepei, editor. Neuroaurology: Peking University Medical Press, 2007: 4: 472-493.