Description of Ménière's disease, her symptoms of treatment approaches

1 The essence of the pathology of

Earlier this disease was called a labyrinth dropsy. Gradually, deafness develops, initially impermanent( at times), which then becomes irreversible. Hearing loss is accompanied by other unpleasant sensations in the ear: a whistling sound, tinnitus - at first in one, later another is struck. Distinguish a separate nosological unit, called P. Menier's syndrome. An independent nosological unit is the Ménière disease itself. Pathology develops with vestibular dysfunction of various genesis, with a sudden weakening of the ear in one ear and subjective sensations in the other, there are causeless hemorrhages in the inner ear without an inflammatory component.

Meniere's syndrome always has real causes, and the treatment depends on them. Symptoms are secondary, arising from the already existing diseases( labyrinth ischemia, trauma, inflammation, abuse of drugs with ototoxic effect, such as Gentamicin, Aspirin, vascular diseases, CCT), with the syndrome there is no onset of deafness. Meninger's syndrome causes a mixed cause: the etiology of the disease is still debated, various factors are called, some consider it a complication of herpes, others - hormonal failures in autoimmune diseases, do not exclude an allergic background. True causes are not identified, but risk factors are named: viral infections of the inner ear, congenital anomalies, head trauma, syphilis.

The disease has a frequency of 1 per 1000 population, mostly people over 35-40 years old, women 1.5 times more often. In 55% of cases there is a hereditary transmission of the disease in the third generation. This disease was diagnosed in Jonathan Swift( author of books about Gulliver), American astronaut Alan Shepard, American musician Ryan Adams, and others.

2 Classification of the disease

In its development, this disease passes through 3 stages, respectively, the symptoms are different, and the treatment must take them into account:

1. Attacks are irregular and easily tolerated. Hearing does not suffer.
2. Regular manifestations, can be daily. The hearing will be restored.
3. Hearing loss is frequent or permanent, vegetative manifestations subside, but are replaced by periodic fainting.

Ménière's disease has the following forms:

1. Cochlear form. It occurs in 50% of cases, the prevailing and the only symptoms are hearing disorders.
2. Classical form. It takes about 30% of cases. With this form, the name itself indicates that this is a classic manifestation of Ménière's disease and that both auditory and vestibular functions are simultaneously disrupted.
3. Vestibular form. It is registered in 15-20% of cases, characterized exclusively by vestibular disorders.

In addition, Meniere's disease in its development has a certain cyclicity with exacerbations( attacks) and remissions, when the symptoms of the disease are relatively flattened. There are also three degrees of severity: mild degree with full recovery of ability to work after an attack;moderate severity - seizures last up to 5 hours, several days sick are disabled;severe - an attack lasts more than 5 hours, occurs daily or weekly. Work ability at this degree is not restored.

3 Symptoms and signs of the disease

Meniere's disease has the following symptoms: vestibular and cochlear disorders in the form of dizziness attacks, with severe headache, usually nausea, frequent vomiting, sensations of body failure with a sense of fear, illusion of room rotation, objects around and your own body. To reduce dizziness, the patient is forced to lie down.with any change in the position of the symptoms intensify. Coordination is disturbed, there is noise in the ears, a whistling ringing( in the form of the sound of bells or chirping of cicadas), there are signs of ear congestion, hearing loss. In a fit, nystagmus is noted( involuntary jerking of the eyeballs) on the side of the lesion.

Extremely painful vegetative symptoms appear, and treatment is required in case of dyspnea, palpitation, blushing, cold sweats, worsening the already bad state of health. The duration of the attack is usually 2-8 hours, but it can be prolonged for several days. For a long time, the sick often feel the onset of an attack and warn others about it themselves, this phenomenon is called aura( lat. "Aura" - "breeze").In different patients, it is different, but in general it is an aggravation of initial symptoms associated with balance and increased tinnitus.

An attack can be manipulated in the ear, alcohol, hyperthermia, stress. After an attack for a while, the heaviness in the head, the deafness, weakness and unsteadiness of the gait are preserved. The hearing is first restored within 24 hours. With the development of the disease, the described symptoms begin to occupy the entire inter-attack period. Violations concern first only low frequencies, then the range expands, with each attack the hearing decreases more and goes into total deafness. With the onset of deafness, vegetative manifestations in the form of nausea and vomiting cease, but fainting occurs.

4 Diagnostic measures

There is a classic combination of symptoms, the so-called triad, by which the otolaryngologist can, after hearing the patient's complaints, accurately predict the presence of Ménière's disease without error. This is primarily a decrease in hearing in full health, sudden wheezing in the ears and dizziness. But for the final diagnosis it is necessary to conduct additional examinations. When otoscopy in patients with Meniere's disease, inflammatory diseases, changes in the external auditory canal and tympanic membrane are not detected.

Functional hearing tests are conducted: audiometry( determining the degree of deafness), vestibulometry( determination of the degree of deviations in the vestibular apparatus), study with a tuning fork, electrochlear, promontorial test( reveals the pathology of the auditory nerve), impedanceometry( assessment of the mobility of the auditory ossicles and the state of the in-ear muscles).To exclude tumors( neurinomas of the auditory nerve) and CCT, MRI and CT of the brain are performed. Consultation of the ophthalmologist: carrying out of an electrostemagmography, research of a nystagmus( involuntary movements of an eyeball) - for definition of the reasons of fainting, at an attack the nystagmus arises on the party of defeat.

Dehydration test is a dehydration exercise that improves the patient's hearing,with Meniere's disease there is edema of the inner ear, this is a diagnostic sign. Conducting a neurological examination, EchoEG, EEG.The study also includes ultrasound of the thyroid gland, biochemical blood test for the determination of lipid metabolism, serological tests for the presence of syphilis. All the examinations not only reveal the presence of pathology, but also determine the degree of its severity. In the case of Meniere's syndrome it is necessary to collect complete information about previous diseases.

5 Treatment and prognosis for Ménière's disease

Ménière's disease treatment is bi-directional:

1. An arrest( arrest) of an attack.
2. Conservative treatment of interinstrumental period. It is not necessary to speak about the complete cure of the disease due to the unclear etiology.

Various combinations of neuroleptics( triftazine, aminazine, haloperidol and etaperazine), scopolamine preparations, atropine( Bellaspon, Belloid), spasmolytics for the removal of spasms of blood vessels( No-shpa, Nikoshpan, Papaverin), antihistamines( Dimedrol, Pipolphen, Suprastin), diuretics( Lasix, Hypothiazide, Furosemide).Treatment is usually outpatient, without hospitalization. Only with persistent vomiting patient is hospitalized.

Conservative treatment means means that improve the microcirculation of the internal ear structures long-term( Betagistin is the only drug that widens the inner ear vessels, Torekan), medications to reduce the permeability of the vessel walls, diuretics, venotonicks and atropine preparations. Treatment is symptomatic, contributes only to reducing the time and frequency of seizures, reduces their severity, but does not relieve hearing loss.

Treatment is usually supplemented by observing the regime of the day, nutrition with a decrease in salt, excluding caffeine-containing foods and an increase in potassium-containing foods - bananas, spinach, sweet potatoes, apricots, eggplants;refusal from smoking and alcohol, moderate physical activity between attacks, performance of special exercises for coordination and training of the vestibular apparatus. Emotional lability involves the help of a psychologist and a psychiatrist. Patients are forbidden to work in extreme conditions at altitude, under water, earth, in the zone of increased injuries. In the interictal period, Diazepam, Phenobarbital, Meklozin are good. Less commonly prescribed acupuncture, laseropuncture. Necessity is a periodic assessment of the hearing of patients.

In case of ineffectiveness of conservative treatment, three types of surgical methods are used. It is draining( evacuation of the excess fluid - drainage of the endolymphatic sac or labyrinth through the middle ear), destructive( decompression of the endolymphatic sac - during the operation, part of the bone inside the ear is removed and the bag expands, the pressure in it decreases and dizziness passes) and operations on the autonomic nervous systemcervical sympathectomy).

There is also an intracranial intersection of the vestibular branch of the VIII pair of cranial nerves( during the operation the surgeon excises that part of the nerve that is responsible for keeping the balance, and the patient stops coordination disorders), the effect on the labyrinth by laser, ultrasound. Sometimes a complete removal of the entire labyrinth system is performed, but rarely and only if the hearing is already completely lost, then the equilibrium of the patients is restored. Less popular is chemical ablation( Latin "ablatio" - "abstraction") - removal from the surface of a part of tissues by the administration of certain drugs, in this case in the inner ear cavity, in small doses Gentamicin, Streptomycin, having ototoxic effect, cause the death of the cells of the vestibular apparatus. Often, non-steroid hormones( prednisolone, dexamethasone) are also injected into the middle ear cavity to improve the course of the disease and preserve the organ of hearing. With the development of bilateral deafness, hearing aids is recommended. The syndrome requires treatment of the underlying disease.

It is impossible to prevent or completely cure Meniere's disease, but the disease does not pose a threat to life.

Operative methods, although significantly reduce the frequency and strength of attacks, but return of hearing is not guaranteed. If the patient as a result of hearing loss reduces the level of his skills, he is transferred to the disability of the III group. It is encouraging that 80% of patients restore lost functions with an improvement in the quality of life.