Menière’s disease (Morbus Menière) is a disorder of the inner ear that is characterized by attacks of rotatory vertigo, one-sided hearing loss and tinnitus. If these three symptoms occur simultaneously we speak of Menière’s Triad. The disease usually occurs between the ages of 40 to 60 and affects more men than women.
Vertigo (Morbus Menière) – symptoms
Attacks of Menière’s come in bouts and are usually repeat themselves after varying intervals. There can be an interval of several years between the respective attacks. It is also possible that only one or two episodes occur in a patient’s lifetime. The disease often begins without a complete Menière’s Triad. This means that the disorder can start with just hearing loss and tinnitus or vertigo while the classic attack of Menière’s occurs only later. In average the disorder develops during the course of one year, progressing from the first symptoms of rotatory vertigo and impaired hearing to the complete syndrome.
Vertigo
Typical of an attack of Menière’s is severe rotatory vertigo combined with nausea and vomiting. The rotatory vertigo may continue for minutes or even hours and can be so violent that the patients are unable to stand upright. The vertigo is worsened by movement but is also present when the patients remain completely immobile. The patients, therefore, try to hold their head absolutely still. Usually no disturbance of balance is experienced between the attacks.
Hearing loss
During the attack the hearing ability of the affected ear decreases, combined with a tinnitus and a sensation of pressure. Hearing dysfunctions and tinnitus may disappear again after the first attacks. After frequent episodes though the hearing loss and often also the tinnitus continue and become progressively worse. A hearing impairment can precede the complete clinical picture of Morbus Menière by years. The hearing loss usually affects low frequencies. Affected patients will noticeably often also complain of distorted hearing. In the majority of cases the extent of the hearing dysfunction has no correlation to the severity and/or frequency of the attacks. In rare cases an improvement of a pre-existing partial hearing loss can occur during an attack of Menière’s. This is then called Lermoyez Syndrom.
Tinnitus
The hearing deterioration which occurs during the attacks concurs with the onset or the increase in volume of a tinnitus. The typical tinnitus associated with Morbus Menière is of a low frequency. The impairment caused by the tinnitus in this case is often only moderate or even minor.
Aura
Preceding the attacks patients frequently experience a sensation of pressure in the affected ear as well as an intensification of the tinnitus, symptoms which may announce the onset of a new attack to the patient.
Vertigo (Morbus Menière) – causes
The presumed cause of this illness is a disease of the inner ear (endolymphatic hydrops). This condition describes a congestion of excess fluid in the inner ear which exudes pressure on the thin membrane (Reissner membrane) of the endolymphatic tube separating the cochlea duct filled with perilymph from the vestibular canal filled with endolymph. The exact cause of this endolymphatic congestion is not yet known. A number of studies suggest that an endolymphatic congestion can have several causes. However, a chronic or recurrent endolymphatic congestion probably has a single, specific cause. This means that not every hydrops cochleae automatically leads to Menière’s disease. On the other hand it can be presumed that Morbus Menière is always accompanied by a fluctuation of the endolymphatic fluid.
Too much pressure on the Reissner membrane leads to a ruptur or an increased permeability of the endolymphatic tube. As a result the endolymph (rich in potassium) and the perilymph (rich in sodium) are mixed. The ion separation, however, is important for electric processes on the nerve and cell level in the inner ear as it maintains a difference of electric potentials. This difference of electric potentials is essential for the correct transmission of sensory signals to the brain. By mixing the two fluids and, thus, disturbing the electric potentials an incorrect signal transmission to the brain occurs. The patient experiences this as long-lasting rotatory vertigo. Self-healing processes close the Reissner membrane and, thereby, re-establish the difference in electric potentials. Due to scars on the Reissner membrane caused by these episodes the patients’ hearing ability further deteriorates which can ultimately lead to complete deafness.
Vertigo (Morbus Menière) – first aid
The excruciating vertigo itself, the primary symptom of the overstrained organ of balance, automatically causes us to behave biologically correctly. The rotatory vertigo, often combined with nausea and vomiting (Morbus Menière), immobilizes the patient. Immobilization, lying down and closing ones eyes are measures that relieve the organ of balance (which assesses our movement in space) – measures which it, therefore, forces upon us. The relief of stimuli gives the overtaxed organ of balance the opportunity to avoid further excessive strain and enables the much demanded regeneration. You can support this process by not resisting the immobilization forced upon you but accepting it and by further reducing avoidable strain in your everyday life. This means that you should avoid fairs and amusement parks, travelling by ship or bus or large crowds (department stores etc.), and instead spend a lot of time outdoors in the peaceful, quiet nature. As the organs of hearing and balance are connected by a common fluid system (peri- and endolymphatic system), an active protection against noise is also highly advisable and sensible in the case of vertigo (Morbus Menière).