Symptoms of Meniere's disease

Despite the complete similarity of symptoms, the causes of endolymphatic hydrops in each individual patient may be different. Meniere's disease is rarely observed in childhood; usually, a fairly long period of time is required for the development of endolymphatic hydrops. At the same time, before endolymphatic hydrops occurs, unfavorable factors must probably have a repeated or chronic effect on the ear. Despite the fact that both ears are exposed to the same factors and pathogenic influences, Meniere's disease usually begins on one side.

Bilateral lesions are observed in approximately 30% of patients, and, as a rule, intracranial hypertension is characteristic. When unilateral changes develop simultaneously, endolymphatic hydrops is characterized as secondary.

Most patients report the onset of the disease without any warning signs. About 60% of patients associate its occurrence with emotional stress. The disease usually begins with an attack of systemic dizziness with pronounced vegetative disorders (nausea, vomiting), which lasts from several minutes to several hours and is usually accompanied by tinnitus and hearing loss. Quite often, such an attack is preceded by a feeling of congestion, fullness in the ear, which lasts for several days. The clinical course of the disease can vary significantly, attacks can recur with different frequency: from once a day to once for several months.

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Lermoyer syndrome

The syndrome is defined as one of the forms of Meniere-like symptom complex that occurs in patients with atherosclerosis and some other common vascular diseases. It is extremely rare. It differs from BM in the sequence of symptoms: first, signs of cochlear damage appear, then symptoms of vestibular dysfunction, after which hearing returns to normal. This gave grounds to the author who described this syndrome to define it as "dizziness that returns hearing."

The causes of the disease are unknown, the pathogenesis is associated with acute hypoxia of the structures of the cochlea, which occurs as a result of spasm of the artery that feeds the ear labyrinth.

The clinical course is strictly regular, passing through two phases. The first phase is characterized by an acute attack of cochlear dysfunction - spasm of the cochlear branch of the labyrinthine artery, manifested by the sudden occurrence of severe tinnitus and rapidly increasing hearing loss of the perceptual type to high tones (difference from an attack of Meniere's disease), sometimes to complete deafness. In rare cases, mild short-term dizziness also occurs during this period. The cochlear period of the attack can last from several days to several weeks. Then, against its background, severe dizziness with nausea and vomiting suddenly occurs (the second phase is vestibular; spasm of the vestibular branch of the labyrinthine artery), which lasts 1-3 hours, after which the signs of vestibular dysfunction suddenly disappear and hearing returns to normal. Some authors note that the crisis may recur several times in one ear, or several times in one and the other ear, or in both ears simultaneously. Other authors claim that the crisis occurs only once and never recurrs. The symptoms of the disease indicate acute hypoxia of the labyrinth of a transient nature. Two questions remain unclear: why do repeated crises not occur in most cases and, if this is a deep angiospasm, why are its consequences in the form of sensorineural hearing loss not observed?

The diagnosis at the onset of a crisis is made with a certain degree of probability based on the occurrence of the first phase of the syndrome; the occurrence of the second phase and the rapid return of hearing to the initial level determine the final diagnosis.

Differential diagnostics are carried out with Meniere's disease and those diseases with which Meniere's disease itself is differentiated.

The prognosis for auditory and vestibular functions is favorable.

Treatment is symptomatic and medicinal, aimed at normalizing hemodynamics in the ear labyrinth and reducing the severity of signs of vestibular dysfunction.

Clinical stages of Meniere's disease

Based on the clinical picture, three stages of development of Meniere's disease are distinguished.

Stage I (initial) is characterized by periodically occurring noise in the ears, a feeling of congestion or pressure, fluctuating sensorineural hearing loss. The patient is bothered by periodic attacks of systemic dizziness or swaying with varying degrees of severity. Systemic dizziness includes dizziness that the patient describes as a sensation of rotation of surrounding objects. Non-systemic dizziness is characterized by a feeling of instability, the appearance of "flies" or darkening in the eyes. Attacks of dizziness are described as a sensation of rotation that lasts from several minutes to several hours. Sometimes such attacks have precursors or a prodromal period, which is manifested by an exacerbation of auditory symptoms: sometimes patients note a feeling of congestion or fullness in the ear for several days. The intensity of dizziness usually reaches its maximum values within a few minutes, while it is accompanied by hearing loss and vegetative symptoms - nausea and vomiting,

After the attack, hearing deterioration is noted, according to the data of tonal threshold audiometry, mainly in the range of low and medium frequencies. During the period of remission, hearing thresholds may be within the normal range. According to the data of suprathreshold audiometry, the phenomenon of accelerated increase in volume can be determined. Ultrasound shows lateralization towards the affected ear. Dehydration tests are positive in a large percentage of cases with hearing changes. Electrocochleography shows signs of labyrinthine hydrops according to one or more criteria. A study of the functional state of the vestibular analyzer reveals hyperreflexia during the attack and in the early post-attack period,

Stage II is characterized by pronounced clinical manifestations. Attacks acquire a typical Meniere's disease character with pronounced vegetative manifestations, their frequency can vary from several times a day to several times a month. Tinnitus is present constantly, often intensifies during an attack. This stage is characterized by the presence of constant congestion in the affected ear: sometimes patients describe a feeling of "pressure" in the head. Tonal threshold audiometry data indicate fluctuating sensorineural hearing loss of grades II-III. There may be a bone-air interval in the low-frequency range. In the interictal period, persistent hearing loss remains. Suprathreshold audiometry reveals the phenomenon of accelerated increase in volume. The presence of permanent hydrops can be determined by all research methods: dehydration tests, electrocochleography, and ultrasound diagnostics. A study of the functional state of the vestibular analyzer reveals hyporeflexia on the side of the worse hearing ear, and during an attack - hyperreflexia.

Stage III, as a rule, typical attacks of dizziness, which are not always systemic, become rarer, a feeling of unsteadiness, instability is disturbing. Decreased hearing of the neurosensory type of varying severity is noted. Fluctuation of hearing is rarely observed,

Ultrasound usually shows lateralization to the better hearing ear or its absence. Hydrops of the inner ear is usually not detected in dehydration. There is marked inhibition or areflexia of the vestibular part of the inner ear on the affected side.

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