Meniere's disease


Meniere's disease is a disease of the inner ear, which is probably caused by an overpressure in the inner ear. The three main symptoms are unpredictable attacks of sudden vertigo, tinnitus and a reduction in hearing. Meniere's disease is basically not curable, but the severity and frequency of the attacks can be reduced by medication. Learn about the symptoms and treatment options of Meniere's disease.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. H81Article overviewMorbus Menière

  • description
  • symptoms
  • Causes and risk factors
  • Examinations and diagnosis
  • treatment
  • Disease course and prognosis

Meniere's disease: description

The French doctor Prosper Menière has already described the disease named after him Meniere disease in 1861. In 1938, physicians Hallpike and Yamakawa reported enlarged inner ear spaces in patients with Menière's disease suspected to be associated with the condition.

The inner ear contains the cochlea and the organ of balance, as well as two different fluids - including the so-called endolymph. According to the current state of knowledge, the absorption of this fluid in the inner ear of Meniere's Disease is disturbed. This accumulates too much endolymph. Since the inner ear is lined by a membranous membrane, the liquid can expand only limited. The result is a pressure increase in the inner ear, which damages the cochlea at a certain place (see causes and risk factors).

It is estimated that about ten percent of all dizzy spells are caused by Meniere's disease. Meniere's disease often occurs between the ages of 40 and 60 years. But also people in young adulthood get sick of Meniere's disease. Men are affected more frequently than women. In total, around half a million people in Europe suffer from Meniere's disease.

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Meniere's disease: symptoms

Typical of Meniere's disease is the vertigo occurring in attacks in combination with tinnitus and unilateral hearing loss. In a swindle, those affected feel that the environment is spinning around them very quickly (similar to driving on the carousel). The dizziness can be so strong that those affected have to lie down. Dizziness-related falls and nausea with vomiting can also occur. The vertigo is described by those affected as the most distressing of the Meniere's Disease Symptoms, as this dizziness occurs without warning and can last for hours to days.

There are also tinnitus and deafness, which mainly affects low notes. Often sufferers also feel pressure on the ear during Meniere's attack. While at the beginning of the disease usually only one ear is affected, the Meniere's disease may extend to the second ear in the further course.

In addition to these main characteristics of Ménière's disease, sufferers often become pale and sweat. The eyes can start to shiver (Nytagmus).

The attacks of Meniere's disease come suddenly and abruptly. Mostly between ten and twenty minutes, they can last for hours. Then the attacks usually stop by themselves. Because Meniere's attacks are extremely stressful due to the vertigo and are completely unpredictable, psychological problems such as anxiety disorders and depression can develop. This can create a vicious circle between the attacks and the mental health of the person affected. The resilience in stressful situations is often reduced as a result.

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Meniere's disease: causes and risk factors

The cause of Meniere's Disease, according to current knowledge, is a disorder of the inner ear. This assumption is based on the fact that the majority of those affected have enlarged spaces in the inner ear. Nevertheless, it is unclear to this day whether this finding is also causally related to Meniere's disease.

The inner ear is responsible for the sense of hearing and balance. It consists of a complicated duct system filled with two different fluids (endolymph and perilymph). These are in a sensitive balance and are essential for the function of the organ.

Doctors assume that Ménière's disease is caused by a fluid excess (hydrops) of the endolymph. The surplus can arise from disturbed discharge or inflow. The increased endolymph creates a high pressure in the inner ear, which causes the so-called Reissner membrane to break down again and again - the suspected trigger for Meniere's disease. The Reissner membrane is a thin cell membrane inside the cochlea. It is equipped with sensory cells for hearing and balance and separates the endo- and perilymph from each other. Cracks in the membrane mix the two fluids (endo- and periplymphe), which disturbs the fine balance of the salts (electrolytes) in these fluids. The crack also leads to a sudden change in pressure conditions. Overall, this results in a malfunction of the sensory cells, which could explain the symptoms of Meniere's disease.

Among other things, the rare inflammation of the inner ear (labyrinthitis) or a concussion may be the cause of the excess fluid. In most cases, the cause remains unclear.

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Meniere's disease: examinations and diagnosis

The first contact for suspected Menière's disease is the family doctor. Depending on the symptoms, this person will refer the affected person to the ENT specialist or neurologist if necessary. Many clinics also have special "vertigo centers", which are the contact persons, especially in severe cases.

At the doctor's talk, the doctor will first inquire about your complaints and any pre-existing conditions. Possible questions from the doctor could be:

  • Could you describe to me how the vertigo attack works for you?
  • Is the dizziness accompanied by tinnitus and deafness in this ear?
  • How long does the dizziness attack last?
  • Can the vertigo attack be provoked by a certain movement, for example, by a twisting of the neck? (This would speak against Meniere's disease.)
  • Do you take any medicine?

Physical examination

During the physical examination, the doctor sees with a so-called otoscope on the eardrum in the ear. Although the injury in Meniere's disease is located in the inner ear and is therefore not visible from the outside, yet existing diseases of the eardrum and the middle ear should be excluded by inspection with the otoscope.

Standard examinations in ear, nose and throat medicine include the Weber and Rinne tuning fork test. An oscillating tuning fork is placed on the vertex or behind the ear. The patient must specify when he can no longer hear the tone of the tuning fork, or whether he can hear him again when the tuning fork is held in front of the ear (gutter test). He should also indicate whether the sound of the attached on the crown tuning fork appears louder in one of the two ears (Weber test). Through these tests, conclusions can be drawn as to whether the discomfort caused by an inner ear or middle ear damage.

As part of the clarification of Meniere's disease is also checked whether the patient may have involuntary eye movements ("nystagmus"). Typical for a Meniere's disease are twitching eye movements to one side (horizontal nystagmus), which usually only occur during the seizure.

Further investigations

In order to estimate an existing deafness more accurately, a hearing test (threshold audiometry) must be performed. In Meniere's Disease, hearing in one ear is significantly reduced. In addition, in particular, the hearing performance for low frequencies is reduced. The hearing recovers in many cases after the attack, but sometimes there remains a permanent hearing loss.

In addition, brain waves that occur after a sound signal (= auditory evoked potentials) can be analyzed to check the connections of the auditory pathway in the brain. These compounds are not affected in Meniere's disease.

Symptoms, such as Meniere's disease, can also be found in other diseases. These alternative causes of Meniere's Disease Symptoms must be ruled out. For example, the auditory nerve is examined to ensure that it is not damaged. To make pictures of the head and inner ear, computed tomography (CT) and magnetic resonance imaging (MRI) can be used. Thus, for example, tumor and inflammatory processes can be excluded.

Diagnosis of Meniere's disease:

Menière's diagnosis can be made on the basis of four criteria established by an American specialist association of specialists. If all four of these criteria apply, Meniere's disease can be assumed: