Meniere’s Disease
Martin Salazar
PIMA Medical Institute
Pathology
Table of Contents
Introduction 3
Etiology 3
Pathophysiology 4
Signs and Symptoms 4
Diagnosis 4
Prognosis 5
Treatment 5
Physical Therapy Problem List 6
Physical Therapy Interventions 6
References 6
Introduction
Meniere’s disease is a disorder of the inner ear. It was first identified in the early 1800s by Prosper Meniere. There is no known cure for Meniere’s disease. It is believed that Meniere’s disease run’s in about 10% of cases in families. The inner ear is responsible for hearing and balance. Experts do not know what causes Meniere’s Disease. Experts believe that changes in the fluid (endolymph) within the ear contributes to Meniere’s Disease. There is no cure for Meniere’s disease. However, medications, diet, physical therapy and counseling can be used to manage MD. Surgery is also another alternative that can be explored. It was found that three methods (simple decompression, insertion of a shunt and sac removal) of decompression of the endolymphatic sac were useful in reducing dizziness.
Etiology
The associated symptoms with Meniere’s disease include: the feeling of dizziness, ringing within the ear(s), loss of hearing and plugged ears. It is typical for only one ear to be affected but both ears may become involved. The cause of Meniere’s disease is unclear but environmental and genetic factors may play a significant role. Other factors include viral infections, blood vessel constriction and autoimmune reactions. The ear has two main sections within the inner ear. Those two main sections are the cochlear and vestibular systems. The cochlear system is responsible for hearing. The cochlea converts sound waves into electrochemical impulses which are passed on to the brain via the auditory nerve also known as the cochlear nerve. The vestibular system is responsible for balance. The vestibular system has a bony labyrinth which contain semicircular canals. There are three semicircular canals that are responsible for spatial orientation. Those three semicircular canals are the horizontal, superior and posterior semicircular canals. The ampullae is located within each of these three semicircular canals. The ampullae is the area within the semicircular canal that detects changes in movement by the cupula. As movement occurs, endolymph fluid pushes against the cupula which in turns bend the cilia hair cells which transmits the stimulated signal to the brain via the vestibulocochlear nerve.
Pathophysiology
The pathophysiology of Meniere’s disease is not well understood. It is theorized that there is an abnormality (hydrops) of endolymph fluid within the inner ear. Endolymphatic hydrops causes changes to endolymph which to become over produced which results in expansion of the vestibular system followed by rupture of the vestibular membrane. The vestibular membrane is responsible for separation of perilymph and endolymph in the vestibular system. Once the vestibular membrane is ruptured, perilymph and endolymph mix which then leads to tinnitus, pressure, and vertigo. There are other various factors such as allergies, viral infection, head trauma, improper fluid drainage and migraines that could trigger Meniere’s disease. Other factors that could contribute to Meniere’s Disease are blood vessel constrictions and autoimmune reactions.
Signs and Symptoms
The signs and symptoms of Meniere’s disease problems are associated with balance, hearing and dizziness. Dizziness is known as vertigo which can be caused by viral infection (labyrinthitis), benign paroxysmal positional vertigo (BPPV) in which dislodged otoliths or otoconia migrate into one of the semicircular canals causing dizziness. Tinnitus is also another symptom in which one will experience problems associated with hearing such as a ringing sound.
Diagnosis
The diagnosis of Meniere’s disease is defined by a certain criterion that one must exhibit. One must have two or more episodes of vertigo lasting 20minutes to 12 hours. Hearing loss in the affected ear either before, during or after an episode of vertigo must occur. Hearing issues such as tinnitus, fullness and fluctuating aural symptoms in the affected ear. Hypersensitivity to sounds is also an important symptom. The criteria system that is used is as follows:
Definite
1. Two or more spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours.
2. Audiometrically documented low- to medium-frequency sensorineural hearing loss in the affected ear on at least 1 occasion before, during, or after one of the episodes of vertigo.
3. Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear.
4. Not better accounted for by another vestibular diagnosis.
Probable
1. Two or more episodes of vertigo or dizziness, each lasting 20 minutes to 24 hours.
2. Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the reported ear.
3. Not better accounted for by another vestibular diagnosis.
Prognosis
Many individuals with MD may only initially start out with one symptom of the disease. However, in MD all 3 triad symptoms appear over time. Hearing loss usually occurs in the beginning stages with a timeframe of 5-15 years in which people end up with mild disequilibrium, tinnitus and hearing loss. In about 30% of cases both ears are affected. MD is not directly tied to mortality. Once an MD episode occurs, it is the effect on the individual that can lead to injury when the episode occurs such as in driving a vehicle and causing a car accident.
Treatment
There are different alternatives to treat MD based on symptoms that one is experiencing. There are medications to reduce nausea and medications to reduce anxiety associated with MD. Salt intake is also another method in which an individual will reduce the amount of sodium chloride that is ingested. Physical therapy can also be helpful with retraining of the balance system over the long term. Counseling is also another method to help individuals deal with the hearing loss and vertigo. This can also help one to benefit from relaxation techniques. Surgery is also another alternative to decompress the endolymphatic sac.
Physical Therapy Problem List
• Balance issues associated with vertigo
• Stiff neck
• Issues related to ADL’s and vertigo
• Patient education to explore other alternative prior to surgery
Physical Therapy Interventions
• Patient education
• Exercise to help brain correct differences with inner ears
• Massage
• Strength and flexibility to improve blood flow circulation
References
Zhang, Endolymphatic Sac Surgery, 2015
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4656865/
NIDCD, Meniere’s Disease, 2017
https://www.nidcd.nih.gov/health/menieres-disease
Mirza, Pathophysiology of Meniere’s Disease 2016,
https://www.intechopen.com/books/up-to-date-on-meniere-s-disease/pathophysiology-of-meniere-s-disease