What is Meniere’s syndrome?
Meniere’s syndrome, an idiopathic inner ear disease that was once known as Meniere’s disease, was first proposed by the French physician Prosper Ménière in 1861. The main pathological changes of the disease are membrane lacunar hydrops; clinical manifestations are recurrent spine vertigo, fluctuating hearing loss, tinnitus, and stuffy feeling.
The disease occurred in 30 to 50-year-old middle and young people, rare children. There was no significant difference between men and women. The binocular disease accounts for 10% to 50%.
Causes of Meniere’s Disease
The cause of Meniere’s disease is still unknown. In 1938, Hallpike and Cairns reported that the primary pathological change of this disease is membrane, lipidosis, and many scholars have confirmed this discovery.
However, it is difficult to explain precisely how membrane lacunar accumulation occurs. Currently, known causes include the following factors: various infectious factors (bacteria, viruses, etc.), injuries (including mechanical injury  or acoustic damage), otosclerosis, syphilis, genetic factors, allergies, tumours, leukaemia [2 ] and autoimmune diseases.
DeSousa (2002) refers to Meniere’s syndrome as a disease caused by vestibular hydronephrosis caused by a known cause, and Meniere’s disease is considered to be idiopathic membranous hydrocephalus.
Clinical manifestations of Meniere’s disease
Typical Meniere’s disease has the following four symptoms: vertigo, deafness, tinnitus, and bulging sensation in the ear.
Mostly sudden onset of rotating vertigo. The patient often feels that the surrounding objects rotate around themselves in a particular direction and the symptoms can be relieved when the eyes are closed.
Often accompanied by nausea, vomiting, pale, cold sweat, blood pressure, and other autonomic reflex symptoms. Any movement of the head can make vertigo worse. Patient awareness has always been clear, and individual patients are still awake even if they suddenly fall.
The duration of vertigo is often 10 minutes or a few hours, and the longest is not more than 24 hours. After the onset of vertigo, it can be transferred to an intermittent period, the symptoms disappear, and the length of the interval varies from person to person, ranging from several days to several years.
Vertigo can be repeated, and the duration and severity of each episode in the same patient are different, and they are not the same among different patients. The more vertigo attacks occur, the longer the duration of each attack and the shorter the interval.
In the early stage, a sensorineural hearing loss was mostly low frequency (125 to 500 Hz), which may be fluctuating, with hearing loss during the attack, and the rest period may be wholly or partially restored.
With the development of the disease, hearing loss can gradually increase, and progressively high frequency (2 ~ 8kHz) hearing loss. A particular kind of hearing change can also occur in this disease: the re-listening phenomenon, that is, the ear and ear can hear two different tones and timbres for the same pure tone. There is a tail when listening to the sound.
Tinnitus may be the earliest symptoms of the disease, initially as a continuous low-profile hair-like, and late-stage noises such as ringing, squeaking, and wind blowing. Tinnitus can suddenly appear or worsen before the onset of vertigo.
Tinnitus disappears during the intermittent period, and tinnitus persists in patients with chronic diseases. A small number of patients may have bilateral tinnitus.
4. Feeling stuffy
At the onset of vertigo, the affected ear may experience fullness, pressure, and heavy feeling in the ear. A few patients complained of mild ear pain and ear itching.
Examination of Meniere’s disease
1. Audiology examination
(1) Pure tone audiometry can be used to understand whether the hearing loss is declining and the degree and nature of hearing loss. In the early stage, it was mostly a low-frequency sensorineural hearing loss, and the hearing curve showed a slight increase.
After multiple episodes, high-frequency hearing loss decreases, and the hearing curve can be flat or declining. Pure tone audiometry can also dynamically observe the patient’s continuous hearing changes.
(2) Cochlear electrogram The examination can objectively understand whether there is water accumulation in the membrane labyrinth. The ratio of SP/AP amplitude > 0.37 is of diagnostic significance and can indirectly indicate the presence of membrane lacunar accumulation.
(3) The otoacoustic emission can firstly reflect the cochlear function status of patients with early Meniere’s disease. When no abnormality is detected in early pure tone audiometry, transient otoacoustic emission can be weakened or not induced.
At the onset of seizures, spontaneous nystagmus was observed , and spontaneous nystagmus and positional nystagmus with a regular rhythm, different intensity, initial ipsilateral and then contralateral motion were recorded.
In the recovery period, the nystagmus turns to the healthy side. Intermittent spontaneous nystagmus and various evoked results may be typical.
3. Glycerin experiment
It is mainly used to judge whether there is membrane lipidosis. Due to the high osmolality of glycerol, and the molecular diameter smaller than the diameter of cytoplasmic serosa pores, it can diffuse into the cells of the inner ear and increase the intracellular osmotic pressure, so that the water in the endolymphatic fluid enters the blood vessels of the stria vascularis through the cellular pathway and reaches the reduction. Pressure effect.
4. Vestibular function test
(1) The vestibular function of the ipsilateral cold-heat test can be normal or mildly reduced in the early stage, and the dominant side of the contralateral side can occur after multiple episodes, and semi-regular spasm or loss of function occurs in the late stage.
(2) A vestibular evoked myogenic potential may have abnormal amplitude and threshold.
(3) When Hennebert’s sign is attached to the swelling of the balloon and the balloon foot, dizziness and nystagmus can be induced when the external auditory canal pressure is increased or decreased. Menenbert’s sign may appear positive in Meniere’s disease.
5. Imaging examination
CT scan of the sacrum can show stenosis of the vestibular duct. The inner eardrum labyrinthine MRI under special radiography can show the thinning of lymphatic vessels in some patients.
Diagnosis of Meniere’s disease.
Due to the inability to perform a pathological examination of in vivo ear tissue, it is virtually impossible to diagnose Meniere’s disease.
At present, the diagnosis of Meniere’s disease is mainly based on medical history, comprehensive examination, and careful differential diagnosis, and after excluding other diseases that may cause dizziness, clinical diagnosis can be made.
Differential Diagnosis of Meniere’s disease
Before the diagnosis of Meniere’s disease, diseases such as central nervous system diseases, vestibular system diseases, and other system diseases should be excluded.
1. Central disease
Acoustic neuroma, multiple sclerosis, aneurysm, cerebellum or brainstem tumor, cervical vertigo, Amolk-Chiat malformation, transient episodes of cerebral ischemia, cerebrovascular accidents, and cerebral blood supply insufficiency, especially during acute dizziness , should first be excluded from the emergency department of neurology, such as medulla oblongata syndrome, posterior circulation ischemia, cerebrovascular disease and so on.
2. Peripheral disease
Benign paroxysmal positional vertigo, vestibular neuritis, vestibular poisoning, sudden deafness, hunt syndrome otosclerosis, autoimmune inner ear disease, perilymphatic spasm, etc.
3. Metabolic diseases
Diabetes mellitus, hyperthyroidism or low, Cogan syndrome, haematological disease, autoimmune diseases, etc.
Treatment of Meniere’s disease
Due to the unknown aetiology and pathogenesis of Meniere’s disease, there is currently no cure for the disease. At present, many medications such as regulating autonomic function, improving inner ear microcirculation, and releasing labyrinthine fluid are commonly used.
(1) The vestibular nerve inhibitors are mostly used in acute attacks, which can weaken the activity of the vestibular nucleus and control vertigo. Commonly used diazepam, diphenhydramine, diphenidol and so on.
(2) Anticholinergic agents such as anisodamine and scopolamine can relieve symptoms such as nausea and vomiting.
(3) Vasodilators can alter the metabolism of ischemic cells, selectively relax blood vessels in the ischemic region, and relieve ischemia. Commonly used are flunarizine (spirobillon), betahistine, ginkgo leaves and the like.
(4) Diuretic dehydration drugs can change the inner ear fluid balance, reduce the endolymph, control dizziness. Commonly used hydrochlorothiazide, acetazolamide and so on.
(5) Glucocorticoids based on immune response theory can be applied to the treatment of dexamethasone, prednisone.
(6) Vitamins such as metabolic disorders, vitamin deficiency, can be vitamin treatment, commonly used vitamins B1, B12, vitamin C and so on.
2. Middle ear pressure treatment
Experimental studies have shown that changes in pressure in the middle ear can affect the inner ear pressure and flow. In 2001, Sweden reported that the use of a portable Meniett device (Meniett device) in the treatment of Meniere’s disease could control patients’ vertigo symptoms in the short or long term.
3. Chemical labyrinthectomy
Refers to the use of aminoglycoside antibiotic ototoxicity, destroy the vestibular function of the inner ear, to achieve the purpose of treatment of vertigo. The drugs used were mainly streptomycin and gentamicin. Can be used throughout the body and in the tympanum.
(1) Systemic administration According to the report of Langman (1990), systemic intravenous drip streptomycin can treat bilateral Meniere’s disease and relieve vertigo symptoms.
(2) Intratympanic injection uses the semi-permeable principle of the round window membrane. The tympanic injected drug can enter the inner ear through the osmotic effect for therapeutic purposes. At present, gentamicin injection into the tympanic cavity has become a common method and has achieved good clinical results. Its main complication is hearing loss.
4. Surgical treatment
Surgical treatment may be considered for Meniere’s disease after failure of drug therapy. More types of surgery, such as endolymphatic sac surgery (endolymphatic decompression, endolymphatic sac shunt); stellate ganglion closure; loss of work and living ability due to vertigo, hearing loss in children, can choose Labyrinthectomy, vestibular neurotomy, etc.
The choice of surgical approach should be based on the severity of hearing, dizziness, and other symptoms as well as the patient’s age, occupation, lifestyle and other decisions. For example, young people and those in need of employment are more likely to choose surgery than retired people. The destructive vestibular surgery can cause balance disorders and is not suitable for patients working at heights.