Symptoms of Meniere's Disease

Despite the complete similarity of symptoms, the causes of endolymphatic gypsum in each individual patient may be different. Ménière's disease is rarely seen in childhood, usually a fairly long period of time is required for the development of endolymphatic dropsy. In this case, before the endolymphatic hydrops occur, adverse factors are likely to have multiple or chronic effects on the ear. Despite the fact that both ears are affected by the same factors and pathogenic influences, Meniere's disease usually begins with one side.

Bilateral lesion is observed in about 30% of patients, and as a rule, intracranial hypertension is characteristic. With the development of simultaneous unilateral changes, the endolymphatic hydrops is characterized as secondary.

Most patients report the onset of the disease without any precursors. About 60% of patients associate his appearance with emotional stress. Usually, the disease begins with an attack of systemic vertigo with pronounced vegetative disorders (nausea, vomiting), which lasts from several minutes to several hours and is usually accompanied by noise in the ears and hearing loss. Quite often, such a seizure is preceded by a feeling of stuffiness, fullness in the ear, which lasts for several days. The clinical course of the disease can vary significantly, the seizures can be repeated at different intervals: from once a day to one in a few months.

[1], [2], [3], [4]

Lermuage syndrome

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

Causes of the disease are unknown, pathogenesis is associated with acute hypoxia of the cochlear structures resulting from spasm of the artery feeding the ear maze.

The clinical course proceeds strictly according to the law, passing through two phases. The first phase is characterized by an acute onset of cochlear dysfunction - a spasm of the cochlear branch of the labyrinthine artery, manifested by the sudden occurrence of severe ear noise and rapidly increasing hearing impairment by perceptual type to high tones (unlike Meniere's disease attack), sometimes to total deafness. In rare cases, light dizziness occurs during this period. The cochlear period of an attack can last from several days to several weeks. Then, on its background, suddenly there is a strong dizziness with nausea and vomiting (the second phase is the 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 the hearing returns to normal level. Some authors note that the crisis can be repeated several times on one ear, or several times on one and the other ear, or on both ears at the same time. Other authors argue that the crisis only occurs once and never repeats again. Symptoms of the disease testify to the acute emergence of hypoxia of a maze of a transient nature. Two questions remain unclear: why do not repeated crises occur in most cases, and if this is a deep angiospasm, why are there no effects of it in the form of sensorineural deafness?

The diagnosis at the beginning of the crisis with a certain probability is based on the occurrence of the first phase of the syndrome; the emergence of the second phase and the rapid return of hearing to the baseline determine the final diagnosis.

Differential diagnosis is carried out with Meniere's disease and those with which Meniere's disease itself is differentiated.

The prognosis for auditory and vestibular functions is favorable.

Treatment is symptomatic medication, aimed at normalizing hemodynamics in the ear maze and reducing the signs of vestibular dysfunction.

Clinical stages of Meniere's disease

According to the clinical picture, there are three stages in the development of Meniere's disease.

I stage (initial) is characterized by periodically arising noise and ears, a sense of congestion or pressure, fluctuating sensory-hearing loss. The patient is disturbed by periodic attacks of systemic dizziness or swaying with varying degrees of severity. The system includes those dizziness, which the patient describes as a sense of rotation of surrounding objects. For non-systemic dizziness is characterized by a sense of instability, the appearance of "flies" or darkening in the eyes. Dizziness attacks describe as a feeling of rotation, which lasts from several minutes to several hours. Sometimes such attacks are precursors or prodrome period. Which is manifested by exacerbation of auditory symptoms: sometimes patients note a feeling of stuffiness or fullness in the ear for several days. The intensity of dizziness reaches its maximum values usually within a few minutes, while it is accompanied by a decrease in hearing and autonomic symptoms - nausea and vomiting,

After an attack, hearing impairment is noted, according to the tone threshold audiometry, mainly in the range of low and medium frequencies. In the period of remission auditory thresholds can be within the normal range. According to the above-threshold audiometry, the phenomenon of accelerated growth of loudness can be determined. When ultrasound is observed lateralization in the direction of the affected ear. Dehydration tests are positive in a large percentage of cases with hearing changes. With electrochlearography, there are signs of a labyrinth hydrops with one or more criteria. Investigation of the functional state of the vestibular analyzer reveals hyperreflexia during the attack and in the early post-prandial period,

Stage II is characterized by pronounced clinical manifestations. Attacks acquire a typical character of Meniere's disease with pronounced vegetative manifestations, their frequency can vary from several times a day to several times a month. Noise in the ears is present constantly, often amplified at the time of the attack. 8 of this stage is characterized by the presence of a permanent stuffiness in the area of the affected ear: sometimes patients describe the feeling of "pressure" in the head. The data of the tone threshold audiometry indicate a fluctuating neurosensory deafness of the II-III degree. There may be a bone-to-air interval in the low frequency range. In the interictal period there is a persistent hearing loss, With the above-threshold audiometry, the phenomenon of accelerated increase in loudness is revealed. The presence of a permanent hydrops can be determined by all methods of investigation: with dehydration tests, electroschemotherapy, using ultrasound diagnostic method. Investigation of the functional state of the vestibular analyzer reveals hyporeflexia on the side of the hearing ear worse, and during the attack - hyperreflexia.

Neither stage III, like the rules, typical attacks of dizziness, which is not always systemic, become more rare, worried by a sense of precariousness, instability. There is a decrease in hearing by the neurosensory type of varying severity. Fluctuation of hearing is rare,

With ultrasound, as a rule, there is lateralization in the hearing ear or its absence. Hydrops of the inner ear, as a rule, do not appear during dehydration. There is pronounced oppression or areflexia of the vestibular part of the inner ear on the affected side.

[5], [6], [7], [8], [9], [10]