Meniere’s disease
This is a very common vertigo disease whose main pathogenesis is the accumulation of water in the ducts of the organ that manages the body’s balance (vestibule) and hearing (cochlea) in the human inner ear, known as membranous vagus fluid. The age of first onset is mostly 30 to 50 years old, but rarely exceeds 50 years. About 85% of the cases are in one ear and 10%-20% are in both ears. This disease accounts for more than 60% of otogenic vertigo.
I: Clinical manifestations
The main manifestations are idiopathic inner ear diseases characterized by episodic vertigo, sensorineural deafness, tinnitus and fullness in the ear.
1. Episodic vertigo.
The onset of vertigo is often sudden, mostly without aura, and is rotational in nature (rotation of visual objects or sensation of one’s own rotation), accompanied by nausea, vomiting, cold sweat, pallor, drop in blood pressure and other vegetative reflex symptoms, without headache, and the brain is always clear. The diagnosis of Meniere’s disease is usually made after at least 2 episodes of vertigo.
2. Sensorineural deafness
Hearing can be mostly recovered after the vertigo stops, but it will gradually become worse as the number of attacks increases. The audiological examination shows that the early stage is low-frequency descending type of sensorineural deafness, and later develops into high-frequency hearing loss. Some patients have the phenomenon of deafness (hearing the same pure tone in both ears with different tones and tones).
3. Tinnitus
It is intermittent or persistent, often appearing before the onset of vertigo, and can be temporarily aggravated during vertigo attacks and then reduced, but the tinnitus can last longer, even up to several weeks. Tinnitus is often low-pitched tinnitus (e.g., cicada, buzzing sound, wind blowing in the ear, etc.)
4. Ear swelling and fullness
It often occurs along with vertigo, or it may occur earlier, presenting a kind of waterlogged swelling-like feeling in the ear; or presenting a feeling of pressure in the ear. It may have a feeling of head fullness or a feeling of head heaviness.
II. Etiology.
The etiology is unknown and is mainly associated with the following factors.
1. Cochlear microcirculation disorders
2. imbalance of endolymphatic fluid production and absorption
3. inflammation or trauma of membrane vagus rupture
4, immune response
5.Disorders of vegetative nerve function
6.Viral infection
7.Endocrine disorder
8.Familial heredity.
III. Differential diagnosis.
1.Benign paroxysmal positional vertigo
2.Sudden deafness
3. Hunt’s syndrome
4.Vestibular neuronitis
5.Drug poisoning
6.Viral vaginitis
7.Auditory neuroma
8.Multiple sclerosis
9.Ectolymphatic fistula
10. Chronic brainstem ischemia
11. Insufficient blood supply to the vertebrobasilar artery
Diagnostic basis
①Recurrent episodes of rotational vertigo lasting from 20 minutes to several hours, with at least 2 episodes; often accompanied by nausea, vomiting, balance disturbance without loss of consciousness; may be accompanied by horizontal or horizontal rotational nystagmus. (ii) At least 1 electrical audiometry showing sensorineural deafness. (iii) Intermittent or persistent tinnitus. ④Sense of fullness in the ear. ⑤ Exclude other diseases that can cause vertigo.
V. Treatment
1.General treatment: low-salt diet, lying down during the attack, quit smoking and alcohol and strong tea.
2.Treatment during seizure: sedation, anti-vertigo, dehydrating agent, vasodilator, glucocorticoid, vitamin, etc.
3.Surgical treatment: If drug treatment is ineffective, surgery can be considered for those who have frequent attacks, heavy symptoms and long duration of illness, and has obvious influence on work and life: endolymphatic sac surgery (decompression or shunt); vagotomy; vestibular nerve severing; cervical sympathetic nerve severing; decompression via vestibular window; stellate ganglion removal, etc.