Hydrops

Alternative names
Meniere’s disease; Endolymphatic hydrops

Definition
Meniere’s disease is a disorder of the inner ear affecting balance and hearing, characterized by abnormal sensation of movement (vertigo), dizziness, loss of hearing in one or both ears, and noises or ringing in the ear (tinnitus).

Causes, incidence, and risk factors

The fluid-filled semicircular canals (labyrinths) of the inner ear, in conjuction with the cranial nerve VIII, control balance and sense of body position. Meniere’s disease involves a swelling of part of the canal (endolymphatic sac). The endolymphic sac controls the filtration and excretion of the fluid in the semicircular canals.

The exact cause of Meniere’s disease is unknown. In some cases, it may be related to middle ear infection (otitis media), syphilis, or Head injury. Other risk factors include recent viral illness, respiratory infection, stress, fatigue, use of prescription or nonprescription drugs including aspirin, and a history of allergies, smoking, and alcohol use. There may be genetic risk factors as well.

About 100,000 people per year develop Meniere’s disease.

Symptoms

     
  • Abnormal sensation of movement of self or the environment (vertigo)       o May be episodic       o Lasts from minutes to more than 8 hours       o Worse with sudden movement  
  • Dizziness  
  • Hearing loss in one ear       o Low frequency noises lost first       o Extent of hearing loss may change  
  • Noises or ringing in one ear (tinnitus)  
  • Nausea, vomiting  
  • Sweating (may be profuse)  
  • Uncontrollable eye movements

Signs and tests
A neurologic examination may show an abnormality of cranial nerve VIII that may include abnormalities of hearing, balance, or eye movement.

Tests to distinguish Meniere’s disease from other causes of vertigo may include:

     
  • Head CT scan or head MRI scan  
  • Caloric stimulation (tests reflexes of the eyes) - abnormal results indicate Meniere’s disease  
  • Evoked potential studies (BAER)  
  • Electronystagmography  
  • Audiology/audiometry

Treatment

There is no known cure for Meniere’s disease. Treatment is focused on lowering the pressure within the endolymphatic sac and on treating symptoms, which tend to occur in discrete “attacks.”

MEDICATIONS such as antihistamines, anticholinergics, and diuretics may lower endolymphatic pressure by reducing the amount of endolymphatic fluid. A low-salt diet to reduce fluid retention may also help (see sodium in diet).

Symptoms such as dizziness, vertigo, and associated nausea and vomiting may respond to sedative/hypnotics, benzodiazepines like diazepam, and anti-emetics.

Surgery on the labyrinth, endolymphatic sac, or the vestibular nerve may be required if symptoms are severe and do not respond to other treatment.

Hearing aids may be needed for severe hearing loss.

Avoid sudden movements that may aggravate symptoms. Help may be needed with walking due to loss of balance during attacks. Rest during severe episodes, and gradually increase activity. During episodes, avoid bright lights, TV, and reading, which may make symptoms worse.

Avoid hazardous activities such as driving, operating heavy machinery, climbing, and similar activities until one week after symptoms disappear.

Physical therapy aimed at acclimation to various positions may be useful.

Expectations (prognosis)
The outcome varies. Meniere’s disease can often be controlled with treatment. Recovery may occur spontaneously. However, the disorder may be chronic or disabling.

Complications

     
  • Inability to walk or function due to uncontrollable vertigo  
  • Hearing loss on the affected side

Calling your health care provider
Call for an appointment with your health care provider if symptoms of Meniere’s disease, such as hearing loss, ringing in the ears, or dizziness, occur or worsen.

Prevention
There is no known prevention for Meniere’s disease, but prompt treatment of ear infection and other related disorders may be helpful.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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