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Meniere's disease

M�ni�re�s disease (or syndrome, since its cause its unknown) was first
described by French physician Prosper M�ni�re in 1861. It is a disorder of
the inner ear characterized by vertigo (abnormal sensation of movement), a
feeling of fullness or pressure in one or both ears, and possibly loss of
hearing and tinnitus (noises or a sensation of ringing). Moreover, nausea,
vomiting, sweating and nystagmus (uncontrollable rhythmical and jerky eye
movements; usually in horizontal plane with M�ni�re's) may frequently
accompany other symptoms. These complaints and findings occur as episodic
bouts, which may last from minutes to hours and worsen with movements.

The exact cause of M�ni�re's disease is not known, but it is believed to be
caused by the swelling of the endolymphatic sac, part of the vestibular
system of the inner ear, which is responsible for the body's sense of
balance. The symptoms may occur in the presence of a middle ear infection,
head trauma or an upper respiratory tract infection, or by using aspirin,
smoking cigarettes or drinking alcohol. They may be further exacerbated by
excessive consumption of caffeine and even salt in some patients.

The diagnosis is usually established by clinical findings and medical
history. However, a detailed neurologic examination, audiometry and even
head MRI scan can be performed to exclude a tumor of the cranial nerve VIII
(which would cause similar symptoms).

Treatment is aimed at lowering the pressure within the inner ear.
Antihistamines, anticholinergics, steroids, and diuretics may be used for
this purpose. Also, the symptoms may be treated with antiemetics (to relieve
nausea) or benzodiazepines (which control vertigo directly). Some clinicians
may recommend a low salt diet for the same purpose. Surgery of the
semicircular canals or the vestibular nerve is very rarely performed in some
untreatable and most severe cases. Another treatment is chemical
labyrinthectomy, in which a drug (such as Gentamycin) that "kills" the
vestibular apparatus is injected into the inner ear. These radical
treatments eliminate vertigo, but they also eliminate the patient's normal
sense of balance, and so are used only as a last resort. The disease may end
spontaneously and never repeat again, recovery may be managed by using
medications only, and in some limited occasions the symptoms may last
despite any kind of medications.

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