Meniere's treatment

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Meniere's syndrome: causes, symptoms, treatment

Meniere's disease was described by its discoverer back in the 19th century. But, as it later turned out, the causes of the disease, which causes attacks of severe dizziness, accompanied by nausea, vomiting and irreversible hearing loss, do not lie, as Meniere assumed, in the presence of hemorrhage in the labyrinth.

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Therefore, despite the fact that the concept of “Meniere's disease or syndrome” still exists today, the idea of ​​this pathology has changed greatly. And we will try to understand in more detail the features of its course and methods of treatment.

Meniere's syndrome: what kind of disease?

Our vestibular apparatus, located in the inner ear, is controlled by the so-called semicircular canals, which, by the way, are only the size of a grain of rice.

Microliths floating inside them in the endolymph irritate the nerve endings with each change in the position of the human body, doing this in three planes symmetrically in both the right and left ears. And the brain, thanks to such irritations, receives a signal about what position the body has taken.

If something disrupts signal transmission, a person cannot return to a state of equilibrium. One of the reasons for such a failure may be a very severe pathology called Meniere's syndrome.

Experts have been trying to figure out what kind of disease deprives us of the ability to keep our balance for many years, but so far they have not been able to get answers to all the questions.

Signs of Meniere's disease

The main symptoms of Meniere's disease were once described by the discoverer of this disease, a French audiologist, after whom it was named.

  1. Hearing loss (often not pronounced). Typically, a patient's ear is affected in one ear, and the person's perception of low frequencies suffers the most. However, researchers claim that in 20% of cases of this disease, both ears are affected.
  2. Sudden attacks of severe dizziness, which can last from one to twenty-four hours (and occasionally up to several days). Moreover, it should be noted that these dizzinesses are systemic in nature. That is, the patient feels either the rotation of objects around him or his own rotation in one direction.
  3. Dizziness is usually accompanied by nausea and vomiting, which does not bring relief.

Let's clarify the difference between the syndrome and Meniere's disease

In modern medicine, a distinction is made between Meniere's disease and Meniere's syndrome. A disease is a self-occurring pathology, and a syndrome is one of the symptoms of a pre-existing disease. This could be, for example, labyrinthitis (inflammation of the labyrinth), arachnoiditis (inflammation of the lining of the brain) or a brain tumor. In the syndrome, pressure in the labyrinth is a secondary phenomenon, and treatment, as a rule, is aimed at correcting the underlying pathology.

According to recent studies, in the modern world manifestations of Meniere's syndrome are becoming more and more common, and the disease is becoming a rare occurrence.

Once again about the signs of an acute form of the disease

Doctors distinguish two forms of this pathology. In its acute form, Meniere's syndrome, the causes and treatment of which we are considering, bursts into the patient's life suddenly, in the form of an attack in the midst of normal health, sometimes even in a dream.

  • The sick person feels it like a blow to the head and falls, frantically trying to grab onto some kind of support.
  • There is noise in the ear and severe dizziness begins. As a rule, it forces the patient to close his eyes and take a forced position, always different, but always with his head raised.
  • Any attempt to change the position leads to an intensification of the attack.
  • The patient breaks out in a cold sweat and is tormented by nausea and vomiting.
  • The temperature drops below normal.
  • Often all of the above is accompanied by involuntary urination, diarrhea and stomach pain.

The attack, as already mentioned, lasts several hours, rarely – a day. Then the symptoms subside and after a couple of days the patient becomes able to work again. Seizures can recur regularly, but at different time intervals: weekly, monthly, or even once every few years.

What does the chronic form of the disease look like?

The second form of pathology, chronic, is characterized by moderate or rare attacks. It must be said that dizziness in this case is of a more prolonged nature, although it is less pronounced, as, indeed, are all other symptoms of the disease.

Some patients have warning signs of an attack. This may be increased noise in the ear, gait disturbance (the patient finds it difficult to maintain balance when turning his head).

For each new seizure that characterizes Meniere's syndrome, the causes are usually the same: smoking and drinking alcohol, eating in moderation, overwork, any infections, staying in rooms with loud noise, intense fixation of the gaze, or disturbances in bowel function.

Features of the syndrome

The true causes of this disease, as well as why the patient suffers from only one ear, are still not known. What can be said with certainty is that Meniere's syndrome is always accompanied by an excess of endolymph, which is produced by the semicircular canals. Sometimes the channels produce too much of this fluid, and sometimes its outflow is disrupted, but both lead to equally sad results.

By the way, according to statistics, this syndrome is most often observed in women (it is also unclear why). Fortunately, it does not occur very often: only two people out of a thousand are susceptible to this disease.

How is the disease diagnosed?

The diagnosis carried out to confirm the diagnosis of Meniere's syndrome usually consists of examining the patient by an otolaryngologist and always a neurologist. These surveys should be carried out in several directions:

  • tone and speech audiometry (helps to clarify hearing acuity and determine the sensitivity of the ear to sound waves of different frequencies - the disease being described has a specific pattern on the audiogram that allows it to be identified in the early stages);
  • tympanometry (helps assess the condition of the middle ear);
  • acoustic reflexometry;
  • X-ray of the cervical spine;
  • magnetic resonance and computed tomography, which helps to identify possible tumors that provoke the development of a pathological condition;
  • rheovasography (determines the state of blood circulation in the vessels of the arms and legs);
  • Doppleroscopy (one of the types of ultrasound) of cerebral vessels.

The diagnosis is made based on the results of these examinations. Treatment is carried out both during attacks and in the period between them.

How to remove the symptoms accompanying Meniere's syndrome? Treatment

From all that has been said above, it becomes clear that relief of the patient’s condition can occur if the excess fluid accumulating in the semicircular canals can be somehow removed.

Therefore, most often the symptoms accompanying Meniere's syndrome are alleviated by the administration of diuretics. By the way, a reduction in fluid also leads to a decrease in salt in the body, which can retain it.

There are also drugs that dilate blood vessels in the inner ear. And this also improves the outflow of fluid that interferes with balance.

In severe cases that cannot be treated with medication, they also resort to surgical intervention to help create an outflow channel and get rid of excess fluid in the vestibular apparatus.

In particularly severe cases, when attacks lead to severe disability, the semicircular canals have to be removed. This operation is called labyrinthectomy and, unfortunately, deprives the patient of hearing, but returns him the ability to move normally.

A little more about the treatment of the syndrome

Unfortunately, the described disease cannot be completely cured. When a patient is admitted to a hospital, doctors first of all try to stop the next attack, and after some time Meniere’s syndrome, the causes and treatment of which we describe, turns into a milder form.

But the disease lasts for many years. Therefore, in the period between attacks, the patient has to remember about his illness and maintain his condition with the help of a complex of vitamins, as well as drugs that improve microcirculation and act on choline-reactive systems.

If the patient does not change anything according to his understanding in the medication regimen and takes all medical prescriptions responsibly, then obvious relief of the condition and return to work will be achieved.

How to help a patient during an attack of dizziness

It happens that before your eyes, a patient diagnosed with Meniere's syndrome suddenly begins an attack of dizziness. What should a witness do in this case? First of all, don't panic or fuss!

  • Help the patient lie more comfortably on the bed and support his head.
  • Advise the patient to remain still and lie still until the attack is over.
  • Ensure peace and quiet by removing all noise and light stimuli: turn off bright lights, as well as the TV or radio.
  • It is best to apply a heating pad with warm water to the patient’s feet (a bottle will do if you don’t have a heating pad), and put mustard plasters on the back of the head. In these cases, you can also use the “Golden Star” balm, which has a warming effect: it is rubbed with gentle movements into the collar area and behind the ears.
  • Call an ambulance.

Is it possible to cure Meniere's disease with folk remedies?

Please note that treatment with folk remedies does not imply Meniere's syndrome, since in folk medicine there are no effective methods that can significantly improve the condition of a patient with this disease.

Herbal remedies offered as a panacea for Meniere's disease are not such. They can only alleviate the symptoms and somewhat delay the onset of a new attack.

Herbs that are recommended for use in the described syndrome include diuretics and diaphoretics, which help reduce the amount of fluid in the body, which, in turn, will reduce the pressure in the labyrinth.

In addition to these, regular exercise, reducing the amount of salt consumed and avoiding allergens also help reduce the intensity of attacks and increase the intervals between them.

Several herbal recipes

Here you will find recipes for herbal remedies that help with the diagnosis of Meniere's syndrome. Treatment with them should be carried out only in consultation with the attending physician and in no case should these herbs replace the medications prescribed to them!

Mix the crushed herbs of sweet clover, edelweiss, wormwood and tricolor violet in equal parts with the root of kopeck, flowers of calendula, tansy, clover and birch buds. Pour two tablespoons of this mixture with hot boiled water (the volume of a half-liter jar) and leave in a thermos overnight. The strained infusion should be taken 3 times a day, 80 ml for two months. If necessary, you can take a break for two weeks and repeat the course again.

An infusion is also made from a collection containing equal parts of mint, geranium, crowberry, tricolor violet, adonis, motherwort, calamus root and skullcap. It is taken according to the previous scheme.

A few more tips

Patients with Meniere's syndrome will have to slightly adjust their diet. You need to exclude everything spicy and salty from it and enrich it with juices, as well as fresh vegetables and fruits. Soups will have to be cooked in vegetable broth or milk. And three times a week replace them with fresh vegetable salads.

Potassium-rich foods should be included in your daily diet: dried apricots, cottage cheese and baked potatoes. And arrange fasting days twice a week to cleanse the body of accumulated toxins.

This diet, along with regular vestibular exercise, will also help alleviate your condition. Be healthy!

Source: http://www.syl.ru/article/152651/new_sindrom-menera-prichinyi-simptomyi-lechenie

Meniere's disease (Meniere's syndrome). Treatment and prognosis

Treatment of Meniere's disease

Which doctor treats Meniere's disease?

  • neurologist;
  • physiotherapist;
  • general practitioner (general practitioner);
  • rheumatologist;
  • traumatologist (if characteristic symptoms developed after injury);
  • family doctor (monitors the patient during remission, for a long time).

Drug treatment of Meniere's disease

  • Antiemetics. This group of drugs is necessary in the treatment (relief) of attacks of the disease. Drugs in this group affect the smooth muscles of the gastrointestinal tract or the nervous system, relieving nausea, dizziness, and stopping vomiting. During the period of remission their use is not required.
  • Diuretics (diuretics). They are used both during attacks and during remission (in courses). The purpose of their use is to remove excess fluid from the body. This reduces the likelihood of fluid accumulation in the inner ear (the speed and volume of endolymph produced decreases). However, some experts question the effectiveness of this group of drugs.
  • Vasodilators (vasodilators). Vascular tone has a great influence on the formation of endolymph. Therefore, in some cases, the use of vasodilators is recommended. Among other things, it relieves headaches (if any) and often improves overall health. This group of drugs is not prescribed to all patients.
  • Drugs that improve cerebral circulation (nootropic drugs). This group of drugs normalizes metabolism in brain tissue, regulating vascular tone in this area. Nootropic drugs can be taken in courses during remission.
  • Antispasmodics. This group of drugs affects the tone of smooth muscles (including blood vessels). It is used for certain indications to improve the general well-being of patients during an attack.

In different situations, they may resort to other groups of means. Most often this happens with Meniere's syndrome, when there is another pathology that needs to be dealt with. In this case, treatment of the pathology is prescribed by a specialized specialist. If successful, the frequency and intensity of attacks of nausea and dizziness will also decrease.

Medicines and drugs for Meniere's disease

Composition and release form

Dosage and regimen

Dimenhydrinate (Dramine, Ciel)

50 mg tablets

50 mg per day.

Tablets 50 mg, solution 10 mg/1 ml

1 tablet per day or tablet intramuscularly or intravenously 1 time per day.

50 mg tablets

50 mg per day, maximum dose 200 mg per day.

25 mg tablets and chewable tablets

12.mg per day.

Dragee 25 mg, solution 50 mg/2 ml

1 dragerase per day or pomol intramuscularly or intravenously 2 times a day.

Apply to healthy skin without hair, in the area behind the ear, for a maximum of 72 hours.

Of the antiemetic drugs in practice, the most commonly used is metoclopramide (cerucal) in tablets of 10 mg three times a day or in intramuscular injections of 10 mg of the drug in 2 ml of solution 1 - 2 times a day. In a hospital setting, where the patient is under constant medical supervision, it is possible to use stronger drugs. To stop an attack, atropine sulfate 0.1% (intramuscular 1 ml) and platiphylline 0.2% (subcutaneous 1 ml) are also used. In severe cases, novocaine 5% (10 ml intravenously), glucose 40% (10 ml intravenously) or aminazine 2.5% (1 - 2 ml intramuscularly) sometimes help relieve an attack.

  • vinpocetine (Cavinton) tablets 5 and 10 mg per day;
  • cinnarizine (stugeron) tablets 25 mg 3 times a day.

These medications belong to the group of nootropic drugs and stabilize cerebral circulation, reducing symptoms of the nervous system. Betahistine (Betaserc, Vestibo) is considered one of the most successful drugs both during remission and during attacks. Its use makes it possible to influence the permeability of the capillaries of the inner ear, which most often reduces the pressure in the labyrinth. The course of treatment lasts 2–3 months, during which the patient receives 8–16 mg of the drug three times a day. As a rule, the use of betahistine also reduces tinnitus and improves hearing.

Steroids for Meniere's syndrome

  • during a post-traumatic attack of illness to quickly suppress inflammation;
  • with concomitant inflammatory diseases of the middle ear;
  • with Meniere's syndrome against the background of systemic inflammatory diseases of connective tissue or blood vessels;
  • during exacerbations of the disease against the background of an allergic reaction (to suppress the allergic component);
  • as a trial course of treatment if other pharmacological agents do not help.

The most common drugs in this group are dexamethasone and prednisolone. The dosage and regimen are selected individually by the attending physician. They are usually taken for a fairly short period of time (1 - 2 weeks) to relieve the acute symptoms of an attack. But if Meniere's syndrome has developed against the background of chronic pathologies, these drugs are taken for months, and they are prescribed by a rheumatologist.

Diuretics for Meniere's syndrome

  • acetazolamide (diacarb) tablets 250 mg per day;
  • furosemide (Lasix) tablets 40 mg once a day.

To prevent side effects during long-term use, it is advisable to combine these diuretics with potassium preparations (asparkam, panangin), 1 tablet 3 times a day.

Physiotherapy for Meniere's disease

  • Ultraviolet irradiation of the collar area. The procedure begins with two biodoses, increasing by one biodose for subsequent irradiations. It is carried out 5 times per course with a frequency of every other day.
  • Darsonvalization of the collar zone. Procedures lasting 3 minutes are used. They are repeated time and again.
  • Electrophoresis of novocaine, sodium bromide, diazepam, magnesium sulfate (according to indications, sometimes for Meniere's syndrome). It has a calming effect, antispasmodic (relaxing), local anesthetic (pain reliever). The duration of the course is minute by minute for 10 days.
  • Baths - iodine-bromine, pine, sea. The water is heated to degrees, with a procedure duration of 10 minutes, sessions.
  • Massage of the collar area and head in courses of sessions.

Surgery for Meniere's disease

  • Chemical labyrinthectomy. Attacks of dizziness with this treatment method are reduced in% of patients suffering from this pathology, and hearing is preserved in% of cases. The essence of the operation is that gentamicin is injected into the tympanic cavity, which, by damaging the neuroepithelial cells of the inner ear, suppresses the function of the labyrinth. Gentamicin has high vestibulotoxicity (toxic to the cells of the vestibule of the inner ear), while having minimal nephrotoxicity (does not damage the kidneys). A course of three injections of 12 mg of gentamicin is given on the affected side. This intervention is most often used due to its relatively high effectiveness, low cost of treatment and minimal complexity. Unfortunately, there are also disadvantages to this treatment. It is not always possible to predict the possible effect on hearing of the administered dose of the drug, as well as the development of allergic reactions.
  • Vestibular neurectomy. Refers to destructive operations in which the vestibular apparatus is completely destroyed; hearing is partially preserved during such an operation. There are side effects, as coordination of movements worsens. This operation is performed only in severe cases of the disease, when the expected benefit outweighs the possible disadvantages.
  • Endolymphatic sac bypass. The essence of the operation is to reduce endolymphatic pressure by performing decompression on the endolymphatic sac. It is recommended to perform such an operation at the second stage of the disease. As a result, the causes of vestibular disorders are eliminated and hearing is preserved. Attacks of dizziness are reduced by 95%, tinnitus is reduced by up to 60%. The problem is that after some time (usually years) the disease may return as the pressure gradually increases again.

The main purpose of these operations is to relieve dizziness and, if possible, preserve hearing. This allows some patients to regain their ability to work (albeit partially) and improve their quality of life. The advisability of surgical intervention is discussed with the doctor in each specific case. There are no uniform indications for its implementation, and the final choice remains with the patient.

Traditional treatment for Meniere's disease

  • Seaweed. Dry and crush the seaweed. Eat a teaspoon of the resulting powder before lunch.
  • Hawthorn fruits. Wash the hawthorn fruits, dry them and crush them. Pour 2 tablespoons of the resulting product with boiling water ml. You can use a thermos for storage and drink it before meals throughout the day.
  • Calendula inflorescences. Calendula flowers are good at removing excess fluid from dizziness, which can be used in the treatment of the disease. Take 10 grams of dried flowers, brew 200 ml of hot water (degrees) in a thermos. Can be used long-term by drinking a tablespoon three times a day.
  • Inflorescences of meadow clover. You can make a vodka tincture from meadow clover. Pour 2 tablespoons of dry clover with 500 ml of vodka. Infuse in a dark place, in a glass container, for 10 days. Drink a teaspoon of the prepared tincture before meals. Take long-term, for 3 months, at intervals of 10 days.
  • Elecampane root. An infusion is prepared from the root of elecampane. Boil 200 ml of water and let it cool (to degrees), pour 1 teaspoon of dried root into the water. Let it brew for 10 minutes. Strain the resulting solution and drink 50 ml throughout the day.

How to prevent an attack of Meniere's syndrome?

  • Stressful situations. Emotional stress leads to the release of so-called stress hormones. On the one hand, they protect the body, on the other, they can provoke a vascular reaction with increased pressure in the inner ear.
  • Smoking. Nicotine has a direct effect on vascular tone. Therefore, smokers usually have attacks more often and their intensity is stronger. However, on the other hand, the body gets used to smoking. In a heavy smoker, abruptly stopping smoking can also trigger an attack. It is still recommended to quit smoking, but to do this you need to consult a narcologist.
  • Sharp sounds. Loud sounds (over 80 dB) or very high frequency sounds can also trigger an attack. This limits career choices for patients. They also do better living in rural areas, which are generally quieter than in the city.
  • Vibration. Powerful operating mechanisms (for example, in factories) produce mechanical vibrations. This vibration is also picked up and recognized in the inner ear. Its constant exposure or high intensity (amplitude or frequency) also contributes to the development of an attack.
  • Excessive load on the vestibular apparatus. We are talking about movements that require good coordination (standing on one leg, simultaneous asymmetrical movements of different parts of the body, etc.), motion sickness and motion sickness.
  • Pressure changes. Weather changes are often accompanied by changes in atmospheric pressure. Since the middle ear cavity is connected to the external environment (through the nasopharynx and the Eustachian tube), the ear becomes blocked or pain occurs. In normal people this is temporary, but in people with Meniere's syndrome it often causes an attack. Flights are strictly contraindicated, since pressure differences are very noticeable during takeoff and landing.
  • Ear, nose or throat infections. Since the ear is connected to the nasopharyngeal cavity, all infections in this area can spread to neighboring organs. The most dangerous infections for people with Meniere's disease are middle ear infections (acute and chronic otitis media). This simultaneously increases fluid production in the inner ear, further impairs hearing and interferes with the normalization of pressure through the Eustachian tube. As a result, the patient not only has an attack, but his condition greatly worsens. You should avoid hypothermia and strengthen your immune system to avoid colds.

A proper diet also plays a significant role in the prevention of attacks, which will be discussed in detail below. With Meniere's syndrome, the dependence of attacks on the course of the underlying disease, which affects the production of endolymph, is expressed. Regular treatment of the underlying pathology can also be considered preventive measures against attacks.

A set of exercises and gymnastics for Meniere's syndrome

  • Starting position: sitting on the edge of the bed or chair. Without moving your head, you need to make slow movements only with your eyes up, down, left, right, diagonally. The exercises are repeated several times. In the same position, extend your arm forward, fix your gaze on the palm of your outstretched hand and slowly turn your head in all directions. The exercise is repeated 10 times. Another exercise is to take a pencil in your hand, slowly bring it closer to your eyes and away, fixing your gaze on the pencil (repeat 10 times). After performing these exercises, you first need to get up from the edge of the bed or chair with your eyes open, and the next day with your eyes closed.
  • Starting position: sitting on a swivel chair. Straighten your back, rest your feet on the floor. In this pose, fix your gaze on any object in front. Try to spin in a chair without looking away or changing the position of your legs. You should not perform the exercise at high speed, as this does not play a decisive role here.
  • Starting position – standing. Fix your gaze on the wall, rise on your toes, then slowly lower onto your heels. At first, with your eyes open, and after a day of training, with your eyes closed. Also standing (eyes open), holding the back of a chair or railing, balance on one leg, then on the other. The leg is moved first forward, then back. The exercise is performed slowly. You can also take the ball and try to hold it on the back of your hand. Hands change alternately. Then throw the ball over your head with both hands and catch it. After 2 - 3 days, throw the ball from one hand to the other.
  • Exercises for moving in a straight line. Draw a line on the ground with length meters. Try to walk straight along this line, without losing coordination (at first you can help yourself with your hands for better balance). After this, try to walk along the line backwards. After successful completion, you can add eye and head movements in all directions during the exercise - up, down, left, right, diagonally. After a week, performing all the exercises, walk along the line on your toes. After another week of classes, walk along the line, raising your knees high.
  • Exercises with a partner who stands behind him with his hands on the patient’s shoulders. The patient's eyes should be closed during the entire exercise. The partner leads the patient around the room, asking questions about position in space (for example, are we in front of the door, in front of the window). Of course, the room should be familiar to the patient. After successful execution, the partner adds commands during the movement (for example, lower your head or take a big step forward).

All these exercises improve coordination of movements. The cerebellum and vestibular apparatus are forced to process signals from various receptors in the body. Regular repetition of exercises trains them and helps to achieve stable results. Exercises can be performed constantly (several times a week) or in the form of unique courses - a week or two daily, then a break - a week. If the condition worsens (decreased hearing acuity, episodes of nausea), the exercises are interrupted so as not to provoke a serious attack.

Diet for Meniere's syndrome

  • limited fluid intake (during an attack, no more than 1.5 - 2 liters per day, including liquid food);
  • limiting salt intake to 2–3 g per day (salt retains water in the body);
  • exclusion of fatty, spicy, smoked products;
  • exclusion of strong tea and coffee;
  • abstaining from alcohol consumption.

With Meniere's syndrome, unlike the disease, swelling of the inner ear is not always combined with excess fluid in the body, so a diet is sometimes recommended only during attacks. There are no specific products that will definitely improve the condition. The diet aims to eliminate all nutritional factors that can worsen the patient's condition.

Meniere's disease in children

Meniere's disease during pregnancy

  • attacks usually occur more frequently than in other patients;
  • fluid retention in the body is a natural process (and following a special diet is not always permitted);
  • the disease responds worse to standard methods of drug treatment;
  • some drugs used in the treatment of Meniere's disease are contraindicated during pregnancy, which reduces treatment options;
  • the frequency of attacks decreases noticeably (and sometimes the disease goes away on its own) after childbirth;
  • Meniere's disease itself does not pose a direct threat to the fetus and does not affect the birth process;
  • pregnancy can cause an exacerbation of some chronic diseases, then we will talk about the syndrome, and not about Meniere's disease (this is important to consider during treatment).

In general, changes in the body during pregnancy are a very complex process that can have many features. Therefore, pregnant patients with Meniere's syndrome or disease are often treated as inpatients (admitted to the hospital). Specialists of various profiles are involved in treatment.

Prognosis for Meniere's disease

Is Meniere's disease curable?

Is there a disability group for Meniere's disease?

  • patients with Meniere's syndrome due to chronic incurable diseases;
  • patients with a pronounced and irreversible decrease in hearing acuity;
  • patients who cannot find an effective course of treatment, and attacks occur frequently;
  • patients with severe concomitant diseases.

Considering that with Meniere's disease, a unilateral process often occurs, the majority of patients usually retain their ability to work. The final decision on assigning a disability group is made by a special medical commission. It is necessary to submit to this commission in advance the results of basic examinations and the conclusions of the attending physician over the past few years (so that this period covers several attacks). The commission may advise changing jobs if the patient was influenced by factors that aggravated the course of the disease. The patient may also be declared temporarily disabled and given time for a full course of treatment.

Hearing aids for Meniere's syndrome

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Source: http://www.tiensmed.ru/news/meniera-lecenie1.html

Meniere's disease. Causes, symptoms, diagnosis and treatment of pathology

FAQ

The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor.

Anatomy of the inner ear and vestibular apparatus

Anatomy of the bony labyrinth

Anatomy of the membranous labyrinth

Mechanism of sound transmission and perception

The mechanism of functioning of the vestibular apparatus

Causes and pathogenesis of Meniere's disease

Symptoms (signs) of Meniere's disease

  • systemic dizziness;
  • hearing loss;
  • tinnitus.

In most cases, there is a paroxysmal course with progressive hearing loss. However, the severity of the disease is determined not by hearing impairment, but by the severity of dizziness and the autonomic disorders caused by it.

Dizziness

Hearing impairment

Noise in ears

Clinical forms and stages

  • reversible;
  • stage of pronounced clinical manifestations;
  • final (terminal) stage.

These stages are determined based on the results of the audiogram. In the reversible stage, signs of labyrinthine hydrocele are detected only before the attack.

Diagnosis of Meniere's disease

Audiometry

In the initial stage of the disease during the interictal period, there are no changes in the audiogram, that is, a normal audiogram of a healthy person is recorded. Only some time before the attack and at the beginning of the attack does the threshold of sensitivity to low sounds increase. The air-bone interval is present, which indicates a conductive type of hearing loss. In other words, only airborne sound transmission is affected, while bone conduction and auditory receptors are not affected.

In the stage of advanced clinical manifestations in the interictal period, there is a constant decrease in hearing at low and speech frequencies with air conduction. Bone patency may be normal or slightly reduced. During an attack, hearing deteriorates significantly. The air-bone gap is still present. The condition of the sensory apparatus of the cochlea is normal or slightly deteriorated.

In the terminal stage of the disease, there is a constant decrease in hearing in the interictal period and during an attack with both types of conduction. The air-bone gap disappears. The dehydration test is negative, since at this stage the decrease in endolymph pressure in the inner ear does not improve the perception of sounds due to irreversible damage to the sensory apparatus of the cochlea.

Treatment of Meniere's disease

Treatment during an attack

  • atropine sulfate solution subcutaneously (1 ml - 0.1%);
  • glucose solution intravenously (20 ml - 40%);
  • novocaine solution intravenously (10 ml - 5%);
  • solution of pipolfen (2 ml - 2.5%) or suprastin (20 mg/ml - 1 ml) intramuscularly;
  • solution of promedol (1 ml - 2%) or aminazine (1 ml - 2.5%) intramuscularly.

Intravenous administration of novocaine is allowed only if the patient has not previously experienced an allergy to this drug. To eliminate this risk, an allergy prick test is performed. If the test does not reveal an allergy to novocaine, then its intravenous administration should be carried out extremely slowly due to its arrhythmogenic effect (the ability to cause heart rhythm disturbances).

Treatment during remission

  • betahistine (Vertran, Betaserc, Tagista - 16 mg) orally daily for at least months;
  • rheopolyglucin (100 mg/mlml) intravenously once a week for months;
  • vinpocetine (5 mg) orally daily for months;
  • papaverine (40 mg) orally in short courses with a break of a month;
  • piracetam (800 mg) in higher courses with intervals of several months, etc.

All of the above drugs are serious drugs. Due to the high risks of side effects, you should definitely consult with your doctor (otorhinolaryngologist/ENT specialist) about the need for their use, as well as about your individual dosage and combination regimen.

Surgical methods of treatment

  • dissection of the nerves responsible for regulating pressure in the labyrinth;
  • decompression operations;
  • destructive operations.

Dissection of the nerves responsible for regulating endolymph pressure in the labyrinth

This type of surgical intervention is indicated for the initial stage of the disease, since it usually gives a temporary effect and somewhat delays the progression of the disease. In particular, the chorda tympani is dissected and the nerve plexus of the promontorium (a small structure of the middle ear) is destroyed.

This type of surgical intervention is indicated in the second and third stages of the disease. Their effectiveness is high, and there are few side effects compared to destructive operations. The essence of these operations is to form a hole or small gap in one or more structures in which endolymph circulates (vestibulary sacs, cochlear duct, endolymphatic sac). As a result, excess fluid will constantly be released into the cavity of the skull or middle ear, from where it will be naturally absorbed.

This type of surgical intervention is rarely used, only when other methods of medical and surgical intervention have not brought the desired result. Its essence lies in the unilateral or bilateral destruction of the labyrinth, after which the pathological impulse from it stops and attacks of dizziness disappear. Some time after the operation, the brain partially compensates for the vestibular function of the lost organ due to the joint work of the visual analyzer, cerebellum and cerebral cortex. Unfortunately, hearing is irretrievably lost during these operations, and therefore such operations are recommended only at the third stage of the disease, when hearing is already lost.

Prognosis for Meniere's disease

Is Meniere's disease treated with folk remedies?

What medicine is most effective for Meniere's disease?

Is there any disability for Meniere's disease?

Is a diet necessary for Meniere's disease?

Are there exercises for Meniere's disease?

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Source: http://www.polismed.com/articles-bolezn-menera-prichiny-simptomy-diagnostika-lechenie.html

How to treat Meniere's disease with drugs and folk remedies?

Meniere's disease - the symptoms and treatment of this pathology were first described by the French physician P. Meniere in 1861. The disease is characterized by damage to the middle ear and is accompanied by a triad of symptoms - dizziness, tinnitus and hearing loss. Let us dwell in more detail on the causes of this pathology and modern methods of treating the syndrome.

Meniere's disease: description

Meniere's disease ICD-10 is a non-inflammatory disease accompanied by an increase in the volume of fluid (endolymph) in the cavity of the inner ear. The accumulated fluid puts pressure on the structures responsible for maintaining balance and the ability to navigate in space, which leads to attacks of dizziness and hearing loss.

Most often, the disease is diagnosed in the age group from 30 to 50 years, and is extremely rare in children. In the vast majority of cases, ear damage is unilateral, but as the process progresses, it can become bilateral.

Causes of Meniere's disease

The exact etiology of the disease is still unknown to scientists. Meniere's disease is not a life-threatening pathology, but frequently repeated severe attacks eventually lead to disability of the patient. There are several theories about the causes of the pathology - the most common of them suggests that the disease is caused by a change in intralabyrinthine pressure due to the accumulation of fluid.

Excess endolymph puts pressure on the membranes, makes it difficult to conduct sound waves and worsens the course of trophic processes in sensory cells. With a sharp increase in pressure inside the bony labyrinth of the inner ear, characteristic attacks associated with dysfunction of the vestibular apparatus occur.

Provoking factors that cause fluid accumulation with increased pressure include:

  • excessive production of endolymph;
  • blockage of lymphatic ducts due to congenital malformations, surgery or trauma;
  • an increase in the volume of pathways in the structures of the ear;
  • vascular pathologies;
  • allergic reactions, dysfunction of the immune system;
  • infectious processes or inflammatory diseases of the inner ear.

The theory based on hereditary predisposition is supported by cases where Meniere's disease was diagnosed in members of the same family. Other researchers point to a direct connection of the disease with autonomic disorders, disruptions in the endocrine system, changes in the secretory activity of labyrinthine cells, insufficient estrogen synthesis, or changes in water-salt metabolism.

There is also a viral theory that links the development of the disease with autoimmune disorders, the mechanism of which is triggered under the influence of viral infections (cytomegalovirus or herpes simplex virus).

Other reasons that can presumably provoke the disease include hypovitaminosis, drug, alcohol, nicotine intoxication, prolonged exposure to vibration and noise factors, and atherosclerotic changes.

Symptoms of the disease

The main symptom of Meniere's disease is severe dizziness, with simultaneous attacks of nausea and repeated vomiting. The patient characterizes this condition as a feeling of “sinking,” falling, or rotating surrounding objects, although at this time he continues to remain in an upright position. In this case, the patient becomes so disorientated in space that he cannot stand; when trying to sit down, he falls on his side and closes his eyes. When changing body position, the condition worsens, nausea intensifies, and the urge to vomit returns.

In addition to dizziness, the attack is accompanied by the following symptoms:

  • headache;
  • pale skin;
  • profuse sweating;
  • increased heart rate;
  • ear congestion, feeling of fullness in it;
  • ringing and noise in the ears, sudden hearing loss;
  • blood pressure surges;
  • dyspnea;
  • uncontrolled movement of the eyeballs.

The patient notes ringing in the ears, which is in no way related to the source of the noise. Patients characterize it as “the chirping of cicadas,” “the sound of a bell,” or say that a muffled whistle appears in the ears. Before an attack, there is usually a pressing sensation in the ear due to excess fluid accumulating in the cavity.

An attack can last from a few minutes to 3 hours. Its occurrence can be provoked by a variety of situations - being in a noisy or smoky room, overeating, drinking alcohol, hypothermia or a stressful situation. Sometimes the patient anticipates the next attack by increased noise in the ear or imbalance; in some cases, worsening of the condition is preceded by an exacerbation of hearing.

After the attack

After an attack, the patient feels weakness for a long time, heaviness in the head, noise in the ear, notes instability of gait and impaired coordination of movements. As the disease progresses, these sensations become more pronounced and subsequently do not disappear, but persist in the intervals between attacks.

Meniere's syndrome or disease is progressive and leads to gradual hearing loss. If at the initial stages the patient has difficulty distinguishing low-frequency sounds, then the perception of the entire sound range worsens, up to complete deafness, and at the same time the attacks of dizziness stop.

With mild to moderate severity of the disease, characterized by alternating periods of remission and exacerbations, a person can still work, since when the condition improves, working capacity is completely restored. At a severe stage of the disease, even in the absence of attacks, there are disturbances in balance, coordination of movements, weakness, headaches and a general deterioration in well-being, which over time leads to deafness and disability.

Diagnostics

An experienced otolaryngologist will easily make the correct diagnosis based on the characteristic clinical picture and complaints of the patient. To determine the degree of hearing loss, the patient is referred for additional examination:

  • audiometry;
  • tuning fork examination;
  • electrocochleography;
  • promontorial test.

To exclude damage to the auditory nerve, it is necessary to do an MRI of the brain. If there is a suspicion of inflammatory diseases of the hearing organs, the doctor will perform an otoscopy procedure. Vestibular disorders are detected by vestibulometry or stabilography.

In addition, the patient will need to consult a neurologist. Additionally, he may be referred for examination of cerebral vessels (REG, ultrasound), electroencephalography, ECHO-EG (measurement of intracranial pressure). Such a wide range of diagnostic studies is necessary in order to differentiate Meniere's disease from other diseases with similar symptoms - atherosclerosis, otitis media, eustachitis, acute labyrinthitis, tumor of the auditory nerve or psychogenic disorders.

Treatment

Meniere's syndrome is treated by an otolaryngologist. If necessary, narrow specialists can be involved in the process - a neurologist, therapist, rheumatologist or traumatologist. Today there is no uniform regulation for drug treatment of the disease; the treatment regimen is selected individually, taking into account the main manifestations of the pathology and the severity of the condition.

In medical practice, medications are used that can be divided into two main groups. Medicines of the first group are intended to relieve attacks; the patient should always have them at hand, in a home medicine cabinet, since with this pathology it is impossible to predict when the next exacerbation will begin. Such drugs quickly relieve unpleasant symptoms - nausea, dizziness, loss of orientation.

Patients take the second group of medications throughout their lives; they are intended for long-term therapy and slowing down further progression of the disease.

The basis of treatment for Meniere's syndrome is the following drugs:
  • Antiemetics are used during an attack to relieve the condition. Their action is aimed at relaxing the muscles of the gastrointestinal tract and reducing excitation of the autonomic nervous system. In practice, patients are most often prescribed Cerucal (Metoclopramide) in tablets or intramuscular injections.
  • Diuretics (diuretics). The drugs are used both during attacks and during remission of the disease, in order to remove excess fluid from the body. The use of diuretics (Diacarba, Furosemide) reduces the likelihood of endolymph accumulation in the inner ear and helps reduce its production. To reduce the risk of side effects, potassium preparations (Panangin, Asparkam) are prescribed simultaneously with diuretics.
  • Antispasmodics (No-shpu, Drotaverine) and drugs with a vasodilating effect are recommended to relieve headaches and spasms in the intestines. Such remedies relax smooth muscles well and make you feel better during an attack.
  • Nootropic drugs improve cerebral circulation, help normalize metabolism and reduce vascular tone. They are taken in courses during the period of remission of the disease.
  • Antihistamines have a sedative effect and mitigate dysfunction of the vestibular apparatus.

To relieve acute attacks, neuroleptics, Atropine and Scopolamine drugs, antihistamines (Meclozine), and diuretics are prescribed. In case of repeated vomiting, injections of antiemetics are given. In case of exacerbation of the disease against the background of allergic reactions, inflammatory and infectious lesions of the middle ear, steroid drugs with a powerful anti-inflammatory effect (prednisolone, dexamethasone) are prescribed. The dosage and treatment regimen are selected by the doctor.

One of the innovative methods is chemical ablation - the introduction of drugs directly into the middle ear. This technique is an alternative to surgery and allows you to block the influence of the affected structures on the coordination of movements. The drug of choice is the antibiotic Gentamicin, which is administered using local anesthesia. Comprehensive drug treatment helps reduce the manifestations of Meniere's syndrome, reduces the frequency of attacks, dizziness and tinnitus, but, unfortunately, cannot completely stop hearing loss.

Patients are advised to completely change their lifestyle, stop smoking, drinking alcohol and caffeine-containing drinks. Conflict and stressful situations, hypothermia, traumatic brain injuries, colds and other situations that can provoke an attack should be avoided.

Physiotherapy methods

Physiotherapeutic procedures for Meniere's disease are prescribed during the period of remission. Main treatment methods:

  • ultraviolet irradiation;
  • darsonvalization of the collar zone;
  • electrophoresis with novocaine, diazepam or sodium sulfate;
  • massage of the collar area;
  • coniferous, iodine-bromine, sea baths.
Vestibular rehabilitation methods are widely used, which are aimed at improving coordination of movements, fixing the gaze and reducing dizziness with the help of special exercises.

Surgery

If, against the background of complex drug treatment, the symptoms of the disease continue to increase, and the desired therapeutic effect is absent, it is necessary to resort to surgical intervention. For Meniere's syndrome, the following types of operations are performed:

Radial surgery is the complete or partial removal of parts of the auditory system within the affected area (labyrinthectomy). After the intervention, the unpleasant symptoms disappear, but the patient completely loses the ability to perceive sounds from the affected ear.

Drainage operations are performed to ensure the outflow of endolymph. They are carried out in different ways - by draining the labyrinth or endolymphatic sac. After the intervention, the patient notes an improvement in his condition, a decrease in the severity and frequency of dizziness. But this method cannot guarantee a complete cessation of attacks.

Nutrition for Meniere's syndrome

Often, excess endolymph production in the middle ear is associated with high blood pressure or increased fluid intake. Therefore, doctors advise adjusting your drinking regime and sticking to a low-salt diet. When the disease worsens, it is necessary to limit the amount of fluid entering the body. You can drink no more than 1 liter of liquid per day, including water, other drinks and first courses.

Treatment of Meniere's disease with folk remedies

Traditional medicine can only be used as an addition to the main course of treatment. To reduce the severity of attacks, you can use herbal medicine methods and take decoctions and infusions of medicinal herbs:

  1. Calendula decoction. This plant removes fluid from the body well and helps reduce attacks of dizziness. To prepare the decoction, place 10g of dried calendula inflorescences in a thermos, add hot (not boiling) water and leave to infuse overnight. The finished broth is filtered and taken 1 tbsp. before eating.
  2. Clover tincture. The medicine is prepared on an alcohol basis from a ratio of 2 tbsp. l. dry clover per 500 ml of vodka. The composition is infused in a dark place for 10 days, after which 1 tsp is taken for 10 days. before eating. Then they take a break and repeat the course of treatment.
  3. Tincture of elecampane root. Dry elecampane root is crushed into powder, measure out 1 tsp. and pour in 200 ml of hot water. The composition should infuse for 10 minutes, after which it is filtered and drunk during the day, 50 ml at a time.

Reviews about the treatment of Meniere's disease

Now the hearing on the affected ear has significantly decreased. I learned to cope with severe symptoms during an attack, I know what medications to take. I recently had injections in my ear, after which the dizziness almost stopped. My only concern is hearing loss.

Thank you . I have Meniere's disease, group 3 disability. I recently started having dizziness, nausea and vomiting. I will try your advice and report the results or share them with people who also suffer from hearing loss. Sincerely, Alexander

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Before using medications, consult your doctor!

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