Could it be Meniere’s disease?

Buzzing in the ear: could it be Meniere’s disease?

Buzzing in the ear: could it be Meniere’s disease?

Many people experience a momentary ringing in the ear or tinnitus after a loud bang or shout close to the ear. Defined as a buzzing, hissing or roaring sound in one or both ears, tinnitus may indicate Meniere’s disease, a curious disorder affecting two to six per 1,000 people. The disease takes its name from Prosper Meniere, a former physician-in-chief at the Imperial Institute for Deaf Mutes in Paris. In 1861 he proposed that the common triad of symptoms — vertigo (giddy “room-spinning”), tinnitus (ringing in the ear) and transient hearing loss — be designated a definite inner ear disorder. Contrary to the prevailing medical view, which ascribed such symptoms to a brain disorder — Meniere attributed them to some dysfunction in the inner ear’s balancing system (SEE DIAGRAM). Unfortunately, Meniere died a year later and never saw his theory proved true or his name given to the disease he’d so accurately described.

What is Meniere’s disease?

Despite many theories about this strange affliction, its precise cause remains obscure. It generally strikes in mid-adulthood, most often between the ages of 30 and 50, infrequently in people under 25, or the elderly, with a slight preponderance in males. Meniere’s disease classically begins with one or more hours of vertigo — a precipitous sensation that the world is spinning around, or a feeling of somersaulting helplessly through space.

A typical case is Boris, a radio engineer in his mid-30s, who suddenly felt the room begin to circle dramatically. Nauseous and faint, he sat down, gripping the chair to steady himself and banish the spinning sensation. Once the vertigo subsided, he noticed a loud, persistent roaring in his left ear and felt somewhat hard of hearing in that ear. Boris “slept off” the attack and was back at work the next day, but rather apprehensive because the buzzing in his ear went on for about two weeks. When the same thing happened twice more within the year, Boris began to worry that he had a brain tumour or some other serious illness. Obsessed and fearful that an attack would start at some awkward moment, perhaps endanger his life, he became an anxious, overwrought person, quite different from his former confident self. Boris’ case illustrates the three identifying hallmarks of Meniere’s:

1. episodic vertigo — typically one or more attacks a year, singly or in clusters, lasting minutes to hours;

2. tinnitus — an incessant buzzing, hissing or roaring in one ear that’s often very loud during an attack, may persist at a lower level, change in loudness and pitch, or disappear.

3. fluctuating hearing loss — improving between attacks at first, but often worsening with time, sometimes progressing to affct both ears (becoming bilateral), in a certain proportion of cases. The hearing loss typically distorts music and voices, diminishing the ability to distinguish words clearly. The good news is that the hearing loss in Meniere’s may become permanent but is never total. It usually begins with low-tone deafness, only later progressing to include higher frequencies.

Acute Meniere’s spells are sometimes accompanied by headaches, sweating, pallor, a slow pulse, nausea and vomiting, which can lead sufferers to suspect a stomach upset — until they get to know illness better. Although the disorder generally includes vertigo, ear-ringing and hearing loss, all three symptoms are not necessarily present together. For example, with a severe attack, the slight hearing loss often goes unnoticed until the vertigo subsidies. Between hours, the disorder usually leaves few or no lingering signs of its presence and hearing often returns to near-normal. Remissions can last for years or rarely, forever. Very often the disorder reaches a plateau around age 55 to 60, with no further worsening or deterioration in hearing.

Meniere’s vertigo different from ordinary dizziness

The vertigo may strike out of the blue, several times a month or as infrequently as once every two or three years. It makes the person feel weak, unbalanced and out of control, vanishing as mysteriously as it appears, only to recur days, weeks, or years later. Meniere’s vertigo has certain features that distinguish it from ordinary dizziness, such as:

* a rotatory sensation: the room seems to whirl around when the eyes are open, but the person feels as if being rotated when the eyes are closed;

* a definite feeling of unsteadiness and a tendency to stagger from side to side;

* a to-and-fro motion, like being on a ship in stormy seas;

* occasionally a spinnong so violent that the person is thrown to the ground as though struck on the head. Known as drug attacks, utricular crises or Tumarkin spells (after the doctor who first described them), such episodes occur because the ear’s gravity sensors (utricle and saccule) are damaged.

Meniere’s vertigo may be disabling enough to force the person to lie down until it fades. Since movements exacerbate it, Meniere’s sufferers tend to lie rigid, eyes closed, gripping the bed to stop the feeling of gyrating through space. Attacks may last from 20 minutes to 24 hours. If they last longer, they’re probably due to another condition, such as a stroke, viral attack on the inner eat, or cerebellar hemorrhage. A few symptoms, such as motion sickness and momentary ataxa (imblance) when changing direction, may persist after a vertigo attack for hours to days. The unsteadiness is generally quite manageable because the brain compensates for the ear’s balancing defect. There’s no ay to predict when or how often attacks will occur.

Diagnosis not always easy

Since the main symptoms of Meniere’s disease may not all come on at the same time, diagnosis can be tricky. If, as sometimes happens, hearing loss in one ear is the first hint of Meniere’s, the condition may go undiagnosed until one or more bouts of vertigo give the telltale clue. Even then, Meniere’s disease is not confirmed unless the person returns to normal health between attacks. Diagnostic procedures include hearing tests (audiograms), a balance test (nystagmogram) and possibly X-rays.

Distinguishing Meniere’s from other ear-buzzing

Occasionally tinnitus is loud enough to be heard objectively by nearby observers (if due to serious vascular/blood vessel disease), but it’s usually subjectively audible only to the individual concerned, not noticeable by others. Ringing in the ears is quite common in the elderly and people regularly exposed to excessive noise, such as airfield workers. Besides Meniere’s disease, a ringing, hissing or buzzing sound in the ear can stem from other conditions — for example middle ear infections, brain tumours, multiple sclerosis, a bad whiplash, migraines, epilepsy and regular exposure to loud noise. But when tinnitus is linked to vertigo and fluctuating, low-tone hearing loss, it’s probably due to Meniere’s disease.

Anxiety an inherent part of the disease

One common problem with Meniere’s disease is the tremendous anxiety it engenders. Since the debilitating vertigo strikes unpredictably, many sufferers constantly fear that an attack may strike at any moment. Patients understandably dread another attack once they’ve experienced a hour or two, and many are afraid to go on with activities, such as driving a car or operating machinery. In severe bouts, some patients even momentarily pass out. Although usually mild, Meniere’s disease can become serious, especially for the few who get the dramatic drop attacks. Reassurance and support are an essential part of therapy. Medical experts encourage Meniere’s sufferers to carry on as usual, and to live, work and drive as normal between episodes. Although attacks come on unexpectedly, there is usually enough warning to allow sufferers to stop driving or put down a dangerous instrument.

Fluid over-drive mainly to blame

The most obvious abnormality in Meniere’s is distension of the ear’s endolymph spaces with increased fluid in the labyrinth chamber of the inner ear (SEE DIAGRAM). Known as endolymphatic hydrops, the fluid accumulation may occur because of excess endolymph production and insufficient absorption. The fluid build-up in the inner ear raptures a bit of membrane from time to time, allowing the endolymph (fluid rich in potassium) to mix with the outside bathing fluid or perilymph (poor in potassium). This mixing of fluids leads to a violent biochemical alteration that transiently paralyses the inner ear’s balance (vestibular) nerve, producing the vertigo. Once the fluid balance normalizes, the vertigo ceases.

Underlying causes unclear

While the precise causes of the fluid overdrive remain unclear, some ascribe it to a genetic or immunological flaw. (A minority of Meniere’s sufferers have a family history of the disease). The disorder can also arise from an ear injury or a blockage in the ear’s delicate canal system (e.g., due to temporal bone fracture, mumps or syphilis). Psychological factors such as tension, anxiety or emotional stress inevitably worsen attacks but do not actually cause them or the disease.

Treatment

Acute Meniere’s episodes are best treated by staying in bed and taking anti-nauseants and sedatives. While nothing reliably stalls an attack, prevents future bouts, or slows the progress of this affliction, suggested therapies range from acupuncture and herbal remedies to diuretics, low-salt diets, vasodilators and electrical stimulation. Most treatments aim to decrease the vertigo and offset the hearing loss. For those who still have some useful hearing in the affected ear, there are various options that are considered after all medical therapy has been exhaustively tried. Surgery is a last resort for the small proportion in whom medical management fails.

Future research may help to uncover the precise causes of this disorder, and permit more accurate treatment targeted to the causes, which may some day help to alleviate the discomfort due to Meniere’s disease.

Self-help groups, such as one at a University of Toronto teaching hospital, are morale boosters that allow patients to share problems, receive expert advice and learn stress management strategies.

COPYRIGHT 1988 Strategic Inc. Communications Ltd.

COPYRIGHT 2008 Gale, Cengage Learning