| Ménière's disease is a recurrent (episodic) disease typically characterized by fluctuating hearing loss, fluctuating sense of pressure in the middle ear, fluctuating ringing in the ear (tinnitus), and a fluctuating sensation of spinning or movement (vertigo). Although there are many theories on why the disease occurs, the cause is unknown. Many experts believe that the disease results from endolymphatic fluid (one of two inner ear fluids) leaking through a separating membrane into perilymphatic fluid (the other inner ear fluid). The two fluids mixing together, they believe, causes the symptoms. Others believe the condition may be linked to factors such as injury, infection, herpes simplex virus, autoimmune disorders, genetics, or metabolic processes. Still others are investigating links between Ménière's and environmental factors, such as noise pollution. None of these theories have been scientifically proven.
There are two atypical types of Ménière's disease: In "cochlear" Ménière's disease (also called cochlear hydrops), symptoms involve fluctuating hearing loss, tinnitus, and a sense of pressure but no vertigo. In "vestibular" Ménière's disease (also called vestibular hydrops), symptoms include fluctuating vertigo, tinnitus, and a sense of fullness but no hearing loss. Some individuals who start out with one of these atypical forms will eventually develop the fourth symptom, and the disease then becomes "classic" Ménière's.
The condition is episodic, which means that attacks may be followed by symptom-free periods. Symptoms vary widely from person to person. Each episode (of vertigo, sense of pressure, tinnitus, or hearing loss) may last minutes or hours; hearing loss may be gradual or progressive; tinnitus may sound different to different individuals. Some individuals have the condition in one ear, but it may or may not progress to both ears. Approximately 30% of individuals with the condition have it in both ears (AAFP).Risk: Men and women develop Ménière's disease, which usually starts between the ages of 20 and 50, in equal numbers (AAO-HNS). Incidence and Prevalence: There are an estimated 615,000 individuals in the US with Ménière's disease, and another 45,000 new cases are diagnosed each year (NIDCD). |
Source: Medical Disability Advisor
| History: In the initial stages of Ménière's disease, the individual may first complain of fullness in the ear and/or tinnitus, a loss of hearing, followed by vertigo. As the symptoms progress, the vertigo may become debilitating, causing nausea, vomiting, and sweating and forcing the individual to lie down. The symptoms may range in severity from a brief episode of impaired balance to an intense, extended illusion of spinning that can last several hours. The individual may also describe tinnitus as the sound of roaring or buzzing in the ear. Symptoms typically subside completely after the attack, but the individual may report a continuing sense of unsteadiness. Hearing loss may recover between attacks but worsen as time goes on. The attacks may occur at any time and waken the individual from sleep. Other symptoms may include headaches, abdominal pain, and diarrhea. Physical exam: The exam is generally normal. Tests: Hearing (audiometry) tests may be conducted to identify the extent and type of auditory losses associated with Ménière's disease. The pattern of hearing loss is described as a low-frequency upsloping hearing loss of neural type. Test results in combination with other symptoms may help confirm the diagnosis. More detailed analysis includes measurements of the function of the auditory nerve (transtympanic electrocochleography) and other interior structures. An electronystagmography (ENT) test may be conducted to determine if something is wrong with the vestibular portion of the inner ear. Part of that procedure includes a caloric test, which produces nystagmus, or rapid eye movements, that determines if there is a balance disorder. Brain stem–evoked response audiometry helps pinpoint the location within the nervous system of the hearing problem. Blood tests (serology) or imaging of internal structures of the body (MRI) may be conducted to rule out other possible causes of symptoms such as infections, tumors, or metabolic disorders. |
Source: Medical Disability Advisor
| There is no cure for the condition. Medications such as those aimed at reducing fluids in the body (diuretics) are usually given to help relieve fluctuations of fluids in the inner ear. A low-salt diet helps avoid fluid retention in the body. Other medications may be prescribed to relieve symptoms of vertigo and accompanying nausea and vomiting. The individual may be advised to avoid consumption of caffeine, nicotine, and alcohol, which can cause symptoms to worsen. Regular exercise may promote good circulation within the inner ear. Sedatives may be prescribed to relieve severe anxiety caused by serious attacks. In some instances, oral steroids help relieve underlying autoimmune disorders that may cause Ménière's disease. Antibiotics may also be needed to treat possible underlying infections.
For individuals with persistent and severe vertigo, several surgical procedures are available. Removal of the inner ear sense organ (labyrinthectomy) may control vertigo but is only recommended for individuals with nonfunctional hearing in the affected ear as it may cause more hearing loss. Another procedure, vestibular neurectomy, severs a nerve from the affected inner ear organ and usually controls the vertigo while maintaining hearing, but carries surgical risks. In recent years, administering the ototoxic antibiotic gentamycin directly into the middle ear space has been successful for controlling vertigo of Ménière's disease. |
Source: Medical Disability Advisor
| Ménière's disease is generally progressive, although the pace of the disease varies. Some individuals experience spontaneous remission of varying duration for unknown reasons. If the condition affects one ear, the disease may progress, over time, to both ears. Some individuals may become totally or functionally disabled by vertigo, deafness, and/or tinnitus. Others may become totally or functionally deaf.
However, in many cases, symptoms can be treated successfully, and the condition can be managed. |
Source: Medical Disability Advisor
| Although rehabilitation is not generally indicated in this disorder, individuals with frequent bouts of vertigo may benefit from a few physical or occupational therapy sessions to discuss safety issues pertaining to balance, strategies for optimal positioning, and how to remain stationary for greater relief. |
Source: Medical Disability Advisor
| Untreated or unresolved Ménière's disease may result in permanent hearing loss and chronic ringing in the ear (tinnitus). If surgery is needed, individuals may experience hearing loss as a complication of the procedure. Even when more severe symptoms are resolved, the individual may experience an ongoing feeling of unsteadiness for an indefinite time. Some individuals with Ménière's disease experience severe, often debilitating headaches (migraine). Once Ménière's disease occurs in one ear, the chance of the other ear being affected is significant. |
Source: Medical Disability Advisor
| The severity of vertigo and the extent of hearing loss should be considered in possible work situations. In unresolved cases of Ménière's disease, tasks requiring keen hearing or good physical balance may need to be reassigned. As an example, individuals who climb ladders or operate heavy equipment may be unable to continue fulfilling these duties. Some individuals may be unable to continue tasks that involve driving. Workers who must continually change positions (e.g., aerobics instructors) may be severely affected. Individuals with hearing impairment may require accommodations such as telephone adaptations, interpreters, visual aids, video captions, hearing aids, or amplification at workstations. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have hearing loss, pressure in the ear, tinnitus, and spinning or vertigo? Are one or both ears affected?
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Has individual had a hearing test? EMG? Brainstem evoke response? MRI?
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Has individual had any blood tests?
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Have conditions with similar symptoms been ruled out?
Regarding treatment:
- Is individual on diuretic therapy? Have sedatives been prescribed?
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Is individual following a low-salt diet and avoiding caffeine and nicotine?
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Has surgery been necessary?
Regarding prognosis:
- Has individual received training in safety issues?
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Is individual's employer able to accommodate any necessary restrictions?
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Does individual have any conditions that may affect the ability to recover?
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Does individual have any complications such as hearing loss as a complication of the surgical procedure, an ongoing feeling of unsteadiness for an indefinite time, or severe migraine headaches?
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Source: Medical Disability Advisor
| "Meniere's Disease." American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS). 2002. 27 Dec. 2004 <http://www.entnet.org/about/index.cfm>. "Meniere's Disease." familydoctor.org. American Academy of Family Physicians (AAFP). 27 Dec. 2004 <http://familydoctor.org/x1714.xml>. "Meniere's Disease." National Institute on Deafness and Other Communication Disorders. 1 Jul. 2004. National Institutes of Health (NIH). 27 Dec. 2004 <http://www.nidcd.nih.gov/health/balance/meniere.asp>. |
Source: Medical Disability Advisor
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