HEAD AND NECK

Meniere’s syndrome is characterized by episodes of “fullness” in the ear, buzzing, deterioration of hearing and vertigo.

The episodes last from a few hours up to a few days and their frequency differs among patients.

A Meniere’s attack may not be manifested with all its characteristics from the beginning. In some cases, the symptoms may be related to hearing only, or only to balance disorders. As time passes, however, the syndrome manifests its symptomatology in full.

Also, in the beginning the symptoms may be due to one ear only. As time passes, however, symptoms may appear in the other ear as well. If the syndrome has a bilateral predisposition it will appear within a five-year period after the appearance of the symptoms.

In addition to the main symptoms of the syndrome, such as the deterioration in hearing, the vertigo and the sense of “fullness” in the ear, other secondary symptoms may appear, like intolerance to noises, distortion of the sounds, or even pain around the ear.

The mechanism which causes the syndrome has not been fully understood yet. It seems that, for some reason, the pressure of the liquids in the labyrinth increases (hydrops of the labyrinth) and this is possibly due to disorders in their absorption. In addition, other chemical factors, such as electrolytic disorders, are also held responsible.

The diagnosis of the syndrome is mainly based on the taking of the patient’s history. Any reference to deterioration in hearing attacks, vertigo, or “fullness” in the ear should make the physician suspicious of the Meniere’s syndrome.

Regarding the various examinations which have been suggested, none of them has proved to be diagnostic enough for the syndrome. Of course, as absolutely necessary we consider the examination of the patient’s hearing. Respectively, we could use the electronystagmograph to measure the functionality of the organ of balance. The examination of electrocochleography is also quite promising.

Before one deals with the treatment of the syndrome, one should look for any underlying diseases which may be responsible for the syndrome. For this purpose, the patient is subjected to blood and radiologic exams, in a search for inflammatory or autoimmune diseases, or growth lesions. In those cases where no underlying diseases are found, we speak of an idiopathic syndrome, or a Meniere’s disease.

The ambiguity of the diagnosis, the mechanism and the causes of the syndrome reflect also on the methods of its treatment. Fortunately, in most of the cases, the attacks are infrequent and mild and no therapy may be necessary, or they may require modest medication.

The patient is advised to abstain from salt, caffeine and alcohol, as well as to avoid any stressful activities. If this is not enough, then medication is given. Usually the doctor prescribes moderate diuretics or cortisone. The cortisone is taken through the mouth or it is injected in the ear cavity.

If even this medication has no real effect, then surgical treatment is suggested. We resort to surgery in two cases: When the frequency and the seriousness of the attacks cause problems to the patient’s everyday life and when the consequences for the hearing become permanent and obvious.

Among the surgical methods suggested, the decompression of the endolymphatic sac seems to have the most advantages. The operation aims at the removal of the bone which surrounds the endolymphatic sac, the organ which receives and drains the liquid of the labyrinth.

The decompression of the endolymphatic sac is the operation which comes closer to the etiologic treatment of the disease. As long as it is done correctly, the possible complications are minimal and the postoperative period presents no serious problems. And this is logical if we consider that we deal with a broad mastoidectomy.

Some claim that the operation does not significantly improve the patient’s condition. Others estimate the rate of total remission from the labyrinth’s hydrops attacks to 70% and of significant improvement of the symptoms to 90%.

In addition, it has been observed that up to a rate of 30% the hearing ability is also improved after surgery, as long we operate within a five-year period from the beginning of the symptoms. Thus, the patient not only has nothing to lose from the operation, but, on the contrary, the longer he or she postpones it the more his or her hearing ability is compromised. Nevertheless, there is a rate of 2% of postoperative acute sensorineural hearing loss, of unknown cause.

In the case in which the symptoms reappear, we can re-examine the endolymphatic sac or perform a section in the vestibular nerve.

The vestibular neurectomy has the advantage of the radical treatment of the sense of vertigo. However, the episodes of the labyrinth’s hydrops continue and hearing is progressively compromised. In addition, this operation entails more and potentially more serious complications compared to the decompression of the endolymphatic sac. Also, let us not forget that in many patients the Meniere’s attacks are triggered by both ears, a fact that makes the decompression of the endolymphatic sac more appropriate.

If the symptoms continue and hearing becomes not useful for the patient then we resort to the destruction of the labyrinth. This can be done either pharmaceutically by injecting gentamicin in the ear cavity, or surgically with operations of labyrinthectomy.

Episodes of the Meniere’s type may sometimes become rather unpleasant for the patient. Despite the research done, the syndrome continues to be characterized by an ambiguity in its origin, its mechanism, the diagnostic examinations and the evaluation of therapeutic methods. To some extent, this is also due to the subjective nature of the symptoms. Nevertheless, we can always help the patient, provided that some brave somehow decisions, like surgery, are taken in time.