Meniere's disease not only causes vertigo, but also deafness

Meniere's disease, once known as "Meniere's syndrome" by most people, is an inner ear disease of unknown cause with labyrinthine hydrops as the main pathological feature. Clinical manifestations include paroxysmal vertigo, fluctuating hearing loss, tinnitus and/or a stuffy feeling in the ears. The cause of Meniere's disease is still unclear. In 1938, Hallpike and Cairns reported that the main pathological change of this disease was labyrinthine hydrops.

Normal inner ear

Meniere's disease: hydrops of the membranous labyrinth

Clinical manifestations

What are the symptoms of Meniere's disease? Meniere's disease has four main clinical manifestations: paroxysmal vertigo, fluctuating hearing loss, tinnitus, and aural fullness.

1. Paroxysmal vertigo: sudden onset, severe vertigo, rotating, that is, feeling oneself or surrounding objects rotating, the vertigo worsens with the slightest movement of the head. Accompanied by nausea, vomiting, pale complexion and other symptoms of autonomic dysfunction. When the patient opens his eyes, he feels that the house or surrounding objects are rotating, and when he closes his eyes, he feels that his body is rotating. If the vertigo is severe, the patient may suddenly fall to the ground.

As shown in the picture above, when the patient has paroxysmal vertigo, it feels like seeing the picture above. Most of them last for 20 minutes to 12 hours, often accompanied by autonomic dysfunction such as nausea and vomiting and balance dysfunction such as unsteady walking, without loss of consciousness; there is no vertigo attack during the intermittent period, but it may be accompanied by balance dysfunction. Patients with bilateral Meniere's disease may show dizziness, instability, shaking or vibration hallucinations.

2. Fluctuating hearing loss: In the early stage, it is mostly sensorineural hearing loss with low-frequency (125-500Hz) loss, which can be fluctuating. Hearing loss occurs during attacks, but can be partially or completely recovered during intervals. As the disease progresses, hearing loss can gradually worsen, and high-frequency (2-8kHz) hearing loss gradually occurs.

Some patients often feel that high-frequency strong sounds are irritating and unbearable. Sometimes the healthy and patient ears can hear the same pure sound as two sounds with completely different pitches and timbres, which is clinically called polyhearing.

3. Tinnitus

Meniere's disease is often accompanied by tinnitus, which is initially a continuous low-pitched sound of wind or running water, and then turns into a high-pitched sound of cicadas, whistles or sirens. Tinnitus intensifies during vertigo attacks and naturally eases during intermittent periods, but often does not disappear.

4. Feeling of fullness in the ears

During an attack of Meniere's disease, there is a feeling of fullness, heaviness or pressure in the affected ear or on the head, and sometimes a burning pain around the ear.

Clinical staging

Some patients often think that Meniere's disease is just dizziness and ignore hearing loss, but most patients' hearing loss gradually worsens with the onset of dizziness. During the interval between attacks, hearing can return to normal, but when the disease worsens, it cannot return to normal levels. By the time it is discovered, hearing has often dropped to the third or fourth level standard.

The standard for staging Meniere's disease is based on the average hearing threshold of 500Hz, 1kHz and 2kHz pure tones during the patient's worst intermittent hearing in the last 6 months. The clinical staging of Meniere's disease is related to the choice of treatment and prognosis. For bilateral Meniere's disease, the clinical staging of both sides needs to be determined separately.

Stage 1: average hearing threshold ≤25 dBHL;
Stage II: average hearing threshold is 26-40 dBHL;
Stage III: Average hearing threshold is 41-70 dBHL;
Stage IV: Average hearing threshold >70 dBHL.

Treatment principles

The treatment principle of Meniere's disease during the acute phase is to control vertigo and treat symptoms. Vestibular inhibitors are commonly used to control acute vertigo attacks, and in principle, they should not be used for more than 72 hours. If the acute phase vertigo symptoms are severe or hearing loss is obvious, glucocorticoids can be given orally or intravenously as appropriate.

The principle of treatment during the intermittent period is to reduce, control or prevent vertigo attacks while protecting the patient's existing inner ear function to the maximum extent. After understanding the process of Meniere's disease, patients do not need to be afraid. Keep a regular schedule and avoid negative emotions, stress and other triggering factors. Patients are advised to reduce salt intake and avoid the intake of caffeine products, tobacco and alcohol products. Oral medications include: betahistine, diuretics.

Specialist treatments include intratympanic injection of glucocorticoids, gentamicin, and intratympanic low-pressure pulse therapy. Surgical treatments include endolymphatic sac surgery, three semicircular canal occlusion, vestibular neurectomy, and labyrinthectomy.

Many patients often ignore hearing loss during vertigo, which will result in deafness and even disability in severe cases. A small number of vertigo patients take drugs such as Vertigo Stop for a long time to control the condition. Vertigo Stop (chemical name: Diphenidol Hydrochloride) will inhibit vestibular function if taken for more than three days. Some serious Meniere's patients will not only fail to control their vertigo due to lack of timely treatment, but also develop into bilateral deafness. Therefore, we would like to remind everyone that patients with vertigo, deafness and tinnitus should go to a professional and regular hospital for treatment as early as possible, rather than taking some motion sickness medicine at home.