Author: Duan Haijing (Ji'an Central People's Hospital)
Ms. Wu, 41 years old, is a long-term office clerk, like to stay up late, the past three years often have tinnitus, many times suddenly appear dizziness, swirling, nausea, vomiting, continuous tinnitus, hearing loss of varying degrees, etc., each time need to go through a long period of treatment to alleviate, and the degree of seizures is gradually aggravating, which causes great trouble to her work and life, and has a great impact on her psychology and spirit.
To this end, Ms. Wu has visited major hospitals many times. I went to the emergency department, the emergency department doctor treated vertigo symptomatically, but later there were still occasional seizures; I also went to the neurology department, and the doctor still treated her with anti-sickness and vasodilation according to vertigo; and even went to the psychiatric department, but there was no significant improvement. Later, she heard from her friend that it might be related to the ear, and finally came to the entolaryngology department.
After a detailed medical history, including a series of tests, including CT, MRI, audimetry, etc., the doctor finally diagnosed Meniere's disease and told her that the disease was not easy to cure and was prone to recurrent attacks.
After a period of symptomatic treatment and improved sleep, Ms. Wu's number of seizures was significantly reduced, and the symptoms at the time of the attack were also significantly reduced.
1. What is Meniere's disease?
Also known as Meniere's syndrome (Meniere's disease), it is an unexplained disease of the inner ear characterized by idiopathic membranous labyrinthosis, which is disordered by imbalances in the production and absorption of endolymphs.
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2. What symptoms may indicate Meniere's disease?
1. Episodic vertigo
The types of "halos" are actually various.
Most of the vertigo in Meniere's disease is sudden, occurring when it feels like the body or surrounding objects rotate in a certain direction and plane, rolling forward or backward.
The patient will feel that he is rotating when he closes his eyes, and when he opens his eyes, his dizziness will be aggravated, and he will be accompanied by nausea, vomiting, cold sweat, pallor, slow heartbeat, blood pressure drop, etc., and the random movement of the head will aggravate the dizziness.
Therefore, patients only dare to lie quietly when they are dizzy, and often find it more comfortable to lie on their sides in one direction, while lying on the other side (the sick side of the inner ear) will aggravate the dizziness. Although he was dizzy, his consciousness was still clear.
The duration of each vertigo is not too long, mostly in tens of minutes to a few hours, rarely more than 24 hours, and generally no second episode within 10 days, about 6 to 11 attacks per year.
But the painful thing is that as the number of seizures increases, the duration of each episode becomes longer and longer.
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2. Hearing loss
Not sudden "deafness", but gradual hearing loss. Hearing loss is not noticeable and is not easy to detect at first, but as the number of episodes increases, hearing loss becomes more pronounced. Generally does not cause total deafness, mostly monoaural hearing loss.
A small number of people may even experience "re-hearing," meaning that both ears hear sounds of two different tones and timbres.
3. Tinnitus
Tinnitus usually precedes dizziness, is exacerbated during the attack, and lessens after remission, but is generally difficult to disappear and is persistent.
4. Full feeling of ear swelling
The attack occurs with a feeling of swelling, heaviness, or pressure in the ear or head on the affected side, and sometimes a burning sensation around the ear, usually without a severe headache.
5. Otolith crisis
"Otolith" is a calcium carbonate crystal on the oval sac and balloon in the inner ear, which is used to feel balance and is also related to vertigo. Onset of the disease occurs an episodic dumping – without any warning, the patient suddenly falls to the ground, but the consciousness is clear, occasionally accompanied by dizziness. Of course, the incidence of this symptom is low.
3. What tests should be done for Meniere's disease to be diagnosed?
The main pathological manifestations of Meniere's disease are labyrinth in the inner eardrum, so there are generally no abnormalities in the outer and middle ears, and otoscopy and acoustic resistance are normal. Hearing tests usually show sensory deafness.
Therefore, Meniere's disease does not have a good and high specificity test for the time being, and its diagnosis mainly relies on detailed medical history inquiries. The main diagnostic basis is:
Episodic rotational vertigo occurs 2 or more times, lasting 20 minutes to several hours each time, but is conscious.
Fluctuating hearing loss, which gradually worsens.
There is tinnitus and a feeling of full ears.
What is the difference between Meniere's disease and other vertigo?
We also commonly cause vertigo in benign paroxysmal positional vertigo (also known as "otolithiasis"). It is due to a shorter period of paroxysmal vertigo induced by head movement to a specific location, which lasts less than 60 seconds, and also has symptoms such as nystagmus, nausea, and vomiting.
Otolithiasis usually occurs when the head position changes posture. The most common is from sitting to lying down, or from lying down to sitting up, lying on the bed and turning over. And the biggest difference between it and Meniere's disease is that there is generally no hearing change.
Diagnosis of otolithiasis relies primarily on history inquiry and diagnostic otolith reduction. If the doctor performs manual reduction and the vertigo improves, the diagnosis of otolithiasis can be diagnosed; if the reduction worsens the vertigo, or the vertigo still does not get better, the otolithia can be ruled out and other diseases can be considered.
On the other hand, vestibular migraine can also cause dizziness, which is generally accompanied by a moderate to severe headache with pulsatile on one side, with photophobia and sound intolerance, so the eyes cannot be opened during the attack, and the duration of the attack can reach 72 hours, while Meniere's disease generally has no headache symptoms.
Can Meniere's disease be cured?
Because the cause and mechanism of the disease are not clear, there is currently no cure for Meniere's disease, and the symptoms can only be improved through multi-faceted comprehensive treatment.
While this answer may disappoint some patients a bit, we still can't afford to give up on treatment. At the very least, treatment can improve your symptoms and get a better quality of life.
The primary goal of treatment is to reduce the frequency of vertigo crises; second, to reduce the severity; at the same time, to minimize the impairment of auditory function, improve hearing, and reduce the symptoms of tinnitus.
6. General treatment methods
Improve your lifestyle and get a good night's sleep. During the attack period, bed rest is required, minimize activities, avoid fatigue, low-salt diet, avoid caffeinated drinks, alcohol, and tobacco, and patients with frequent seizures should be psychologically counseled to avoid psychological burden and mental stress, and change bad living habits.
1. Symptomatic treatment
Diazepam, diazepam, diphenhydramine, scopolamine and scopolamine, betatastine, flumelide, nimodipine, and furosemide can be used, and steroid hormones such as dexamethasone can be injected in the tympanic chamber.
2. Surgical treatment
For patients with long-term frequent seizures, severe seizures, ineffective long-term conservative treatment with drugs, and severe tinnitus and hearing loss, surgery can be considered. The most commonly used surgical modality is endolymphatic sac surgery (endolymphatic sac decompression and shunting), which is a surgical procedure that preserves vestibular function, is less destructive, and preserves hearing.
3. Vestibular rehabilitation training
The main thing is to repeatedly do some movements that may stimulate vertigo, and train the balance ability of the body, such as repeatedly turning the head, picking things up with your head down, throwing the ball around in a circle, and so on. However, to avoid the vertigo attack crisis period, generally in the intermittent period of rehabilitation training, is a safe and effective measure.
4. Destructive treatment
There are drug-destructive treatments, such as gentamicin injections in the tympanic chamber, but there is a risk of hearing impairment; surgical destructive treatments, i.e., surgical labyrinthectomy and vestibular nerve amputation, are a completely destructive treatment.
For some patients who have undergone conservative drug treatment, surgical treatment and other comprehensive treatment are ineffective, seriously affecting life, causing great psychological and mental distress, this method can be considered.
5. Adjuvant therapeutic drugs
In addition, it can also be used in the auxiliary application of some nutrient nerve and vasodilator drugs.
bibliography:
HUANG Xuanzhao, WANG Jibao, KONG Weijia. Practical Otolaryngology Head and Neck Surgery[M]. Beijing: People's Medical Publishing House, 2008, 10.
KONG Weijia,ZHOU Liang. Otolaryngology Head and Neck Surgery (3rd Edition)[M]. Beijing: People's Medical Publishing House, 2015, 05.
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