1. What is Ménière’s disease?
Meniere’s disease is an idiopathic inner ear disease with symptoms such as vertigo, deafness, tinnitus and a feeling of stuffiness in the ear. The cause is unknown, and there is no significant difference in the incidence between men and women. There are many theories about the cause of the disease, but there is no definite conclusion yet, such as autonomic dysfunction caused by metabolic reactions, endocrine disorders, vitamin deficiency and psychoneurological factors, which leads to vascular nerve dysfunction and increased capillary permeability, resulting in fluid accumulation in the membranous vagus, cochlea and balloon expansion, and stimulation of the cochlea and vestibular receptors, causing a series of clinical symptoms such as tinnitus, deafness and vertigo. This disease can be relieved without treatment, or it can recur, with variable intervals between attacks, but there are also attacks that do not recur.
2. How did the name of Meniere’s disease originate?
Meniere’s disease was first described in 1861 by the French physician Prosper
Meniere’s disease is a disease of the inner ear of unknown origin, characterized by the accumulation of fluid in the membrane vagus. Clinical manifestations include recurrent episodes of vertigo, sensorineural deafness, tinnitus, and may include a feeling of fullness in the ear. First-episode Ménière’s disease usually presents with low-frequency tinnitus and hearing loss, accompanied by a feeling of stuffiness or pressure in the affected ear. The duration of vertigo in Ménière’s disease is usually tens of minutes to 24 hours.
3.What is the diagnosis of Ménière’s disease based on?
History is the most important in the diagnosis of Ménière’s disease. Auxiliary examinations such as pure tone audiometry, cochlea electrogram, cold and heat test, VEMP and glycerol test have diagnostic value for Ménière’s disease, among which glycerol test has the greatest value and is the gold standard for the diagnosis of Ménière’s disease.
4.What are the typical symptoms of Ménière’s disease during an attack?
The symptoms of Ménière’s disease vary from person to person. The main symptoms of the attack period are: the attack is sudden and can occur at any time, even after falling asleep. The most common symptoms are: when the patient opens his eyes, he feels that the house or the surrounding objects are turning, and when he closes his eyes, he feels that his body is spinning. Most of the patients lie still with their eyes closed and are afraid to turn their head and body if they open their eyes or turn their head during the attack. Most patients have unilateral tinnitus and deafness during the attack, but a few have bilateral attacks. About 25% of the patients have tinnitus and deafness before the attack, and they get worse after the attack.
The remaining approximately 75% develop tinnitus or deafness gradually after the attack. The tinnitus/deafness is neurological in nature, and the tinnitus is aggravated when the attack is intense. The attack is often accompanied by a series of symptoms such as not daring to open the eyes, nausea, vomiting, pallor, sweating, and even diarrhea. Some patients have headache; the patient is conscious.
There are two forms of intermittent periods: one in which the vertigo and accompanying symptoms suddenly disappear, and one in which the vertigo gradually changes to dizziness. The length of intervals in Meniere’s disease varies from months to years, and the degree of each attack varies. Hearing power gradually decreases with the number of attacks, eventually leading to deafness.
5. Is a violent attack of Ménière’s disease life-threatening?
This does not happen. Although the symptoms are severe, the lesions are concentrated in the inner ear system and the patient is conscious during the attack, so there is no risk to life. However, the following issues should be noted.
①If vertigo is accompanied by prolonged and violent vomiting, prompt medical consultation and appropriate fluid supplementation should be made.
②If the patient has arteriosclerosis or cerebral artery blood supply deficiency with vertigo, the original disease should be treated early to avoid aggravation and cerebral infarction.
6. What tests should be done for Meniere’s disease?
In acute attacks, the patient is seen to be bedridden, pale, nervous and with a fearful expression. The examination reveals.
(1) Nystagmus Spontaneous nystagmus is seen at the climax of the attack.
(2) Audiological examination including: pure tone hearing threshold test, acoustic conductance test, cochlear electrogram test.
(3)
Glycerol test, the patient is asked to take glycerol reagent orally and measure the pure tone audiometry every hour for three times, this is to use the property of glycerol dehydration to temporarily reduce the membrane vagal fluid accumulation, if the hearing is improved after taking the drug, the existence of membrane vagal fluid accumulation is confirmed.
(4) Vestibular function examination: cold and heat test is the main test, most patients examined have one side of the horizontal semicircular canal function is reduced.
7.How to treat Ménière’s disease effectively?
Ménière’s disease can be treated with drugs or surgery.
(1) General treatment
During an attack, the patient should lie still, refrain from anxiety, eat a light and low-salt diet, limit the amount of water intake, and avoid using tobacco, alcohol and coffee. During the interval, encourage the patient to exercise, strengthen the body and pay attention to the combination of work and rest.
(2) Drug treatment
The principle of treatment during the attack is to reduce the vagal effusion and relieve the symptoms. 20% mannitol 250ml can be used as a rapid intravenous drip twice a day, and the recent clinical effect is relatively obvious; for severe vomiting, vertigo and palpitations, sedation and antiemetic treatment can be given.
① Keep quiet and lie still.
②Treat symptomatically with sedatives: such as Valium, lidocaine, etc., which can be combined with finasteride.
③Apply diuretics: hydrochlorothiazide, aminoglutethimide.
④Apply vasodilators as appropriate: flunarizine, betahistine mesylate tablets, etc.
(3) Surgical treatment
Surgery is only applicable to patients who have failed medication and have severe hearing loss. It is limited to patients with unilateral disease. According to statistics, only 5% of patients with Ménière’s disease require surgery. Surgery is summarized in 3 types: destructive, semi-destructive, and conservative.
Surgical treatment includes: endolymphatic bursa decompression, balloon fistula, vagotomy, and vestibular nerve dissection. Most patients in general do not undergo destructive and semi-destructive surgery.
(4) Meniett treatment.
Meniett low-pressure pulse therapy instrument mainly uses low-pressure pulse pressure waves to conduct to the inner ear membrane vagus to improve the circulation of endolymph and reduce the water accumulation in the inner ear membrane vagus so as to achieve the therapeutic effect. The treatment instrument is simple to use, and patients can treat themselves at any time and place; it is non-invasive, without complications, safe and effective, and does not require additional rehabilitation and medication after treatment.
8.What are the precautions for patients with Meniere’s disease during the attack period?
(1) Diet: The membrane vagus of such patients is mostly in a waterlogged state, and the physicochemical characteristics of endolymph are mostly high sodium and low potassium, therefore, in terms of diet, a diet with “two high and two low” characteristics should be used, i.e. high protein, high vitamin, low fat and low salt diet, such as lean meat, fresh fish, live poultry and other stews served frequently, and also more fruits, leeks, carrots, celery and other high vitamin diets. Carrots, celery and other high vitamin vegetables and fruits.
(2) Life and living: pay attention to bed rest during the attack period, the room should be slightly dark, avoid noisy and noisy environment, it is desirable to quietly rest. After the symptoms have subsided, it is advisable to gradually get out of bed and avoid long-term bed rest.
(3) For those who have been ill for a long time, have frequent seizures and suffer from neurasthenia, explain the condition to the patient and relieve their mental tension and fear. Pay attention to the regularity of life and prohibit stimulating products such as tobacco, alcohol and coffee.
(4) After the seizure period, the symptoms are relieved, and those who were engaged in driving, gymnastics, dancing, etc. should not rush to resume their original work and training. However, you should always take vestibular depressant drugs such as Valium and vertigo stop to prevent sudden attacks of vertigo.