active cochlear Meniere's disease

Active Cochlear Meniere's Disease

Meniere's disease is characterized by episodes of vertigo, tinnitus, and sensorineural hearing loss. In the setting of active cochlear Meniere's disease, patients experience fluctuating auditory symptoms and vertigo. This phase is marked by unpredictable episodes of dizziness, ringing in the ears (tinnitus), and hearing loss.

• Fluctuating Hearing Loss: Patients with active cochlear Meniere's disease may experience sudden bouts of hearing loss, which can be temporary or persistent [5].
• Vertigo: Unpredictable episodes of vertigo are a hallmark symptom of active cochlear Meniere's disease. This can cause dizziness and a feeling of spinning [2][4].
• Tinnitus: Ringing in the ears (tinnitus) is another common symptom, which can be constant or intermittent [10].

During this phase, patients may also experience a sensation of fullness or pressure in the ear, which can be uncomfortable but not necessarily painful. The symptoms can vary in severity and frequency, making it challenging to predict when an episode will occur.

References:

[2] - This is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss and a feeling of fullness or congestion in the ear. [4] - by JE Alonso · 2021 · Cited by 10 — Meniere's disease is an inner ear disorder characterized with episodic spontaneous rotational vertigo, fluctuating hearing loss, tinnitus, and aural fullness. [5] - by TA Fife · 2014 · Cited by 38 — Ménière's disease (MD) is characterized by cochleovestibular dysfunction that manifests as fluctuating sensorineural hearing loss (SNHL), ... [10] - Meniere disease is an inner ear disorder characterized by tinnitus, vertigo, and hearing loss. This is thought to occur due to the accumulation of endolymphatic fluid in the cochlea and the vestibular organ.

Common Signs and Symptoms of Active Cochlear Meniere's Disease

Meniere's disease is a disorder of the inner ear that can cause vertigo, hearing loss, tinnitus (ear noises), and ear pressure. The symptoms of active cochlear Meniere's disease can vary from person to person, but here are some common signs and symptoms:

• Vertigo: A feeling of spinning or dizziness that can be severe and debilitating [1].
• Hearing Loss: Fluctuating hearing loss in one ear, which can range from mild to profound [2].
• Tinnitus: Ringing, buzzing, whistling, or roaring noises in the affected ear [3].
• Ear Pressure: A feeling of fullness or pressure in the affected ear [4].
• Dizziness or Lightheadedness: Feeling unsteady or dizzy when standing up or changing positions [5].

These symptoms can be unpredictable and may come and go, making it difficult to manage daily activities. In some cases, vertigo attacks can be severe enough to cause falls or trouble driving.

References:

[1] Context 3 [2] Context 7 [3] Context 6 [4] Context 7 [5] Context 9

Diagnostic Tests for Active Cochlear Ménière's Disease

Ménière's disease is a disorder of the inner ear that affects balance and hearing. The diagnostic tests for active cochlear Ménière's disease are aimed at distinguishing it from other conditions and tracking changes in its severity.

• Physical Examination: A physical examination by an otolaryngologist (ENT) may be performed to assess symptoms such as vertigo, hearing loss, tinnitus, and aural fullness. The doctor may ask about the frequency and duration of these episodes.
• Audiological Tests: Various audiological tests can help diagnose Ménière's disease, including:
  • Multi-frequency tympanometry: This test measures the movement of the eardrum and middle ear muscles in response to sound waves.
  • Testing for antibodies against inner ear antigens: This test detects the presence of antibodies that may be associated with Ménière's disease.
• Imaging Studies: Imaging studies such as:
  • High-resolution delayed contrast magnetic resonance imaging (MRI): This test can help evaluate endolymphatic hydrops in vivo, which is a characteristic feature of Ménière's disease.
  • Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans: These tests may be used to rule out other conditions that may cause similar symptoms.
• Electrophysiological Tests: Electrophysiological tests such as:
  • Vestibular evoked myogenic potentials (VEMPs): This test measures the response of the vestibular system to sound stimuli.
  • Electrocochleography (ECochG): This test measures the electrical activity of the cochlea in response to sound stimuli.
  • Otoacoustic emissions (OAEs): This test detects the presence of sounds emitted by the cochlea in response to sound stimuli.

Diagnostic Criteria: A diagnosis of Ménière's disease requires meeting certain criteria, including:

• Two or more episodes of vertigo lasting 20 minutes to 12 hours
• Audiometrically documented low- to medium frequency sensorineural hearing loss in one ear
• Tinnitus or a feeling of fullness or pressure in the ear

These diagnostic tests and criteria can help identify active cochlear Ménière's disease and track changes in its severity.

References:

[3] Various tests and measurement methods have been employed for the diagnosis of Ménière's disease. These include audiological, vestibular, radiological, clinical ... [5] High-resolution delayed contrast magnetic resonance imaging (MRI) has served to evaluate for endolymphatic hydrops in vivo to diagnose Meniere's disease and ... [9] A videonystagmography (VNG), also referred to as an electronystagmography (ENG). This test measures the response of the vestibular system to sound stimuli. [11] Vestibular evoked myogenic potentials (VEMPs); electrocochleography (ECochG); and otoacoustic emissions (OAEs) are commonly used electrophysiological tests for Ménière's disease.

Treatment Options for Active Cochlear Meniere's Disease

Meniere's disease is a disorder of the inner ear that can cause vertigo, tinnitus, hearing loss, and pressure in the affected ear. While there is no cure for the condition, various drug treatments can help manage its symptoms.

• Betahistine: This medication is often prescribed as a first-line treatment for Meniere's disease. It works by improving blood flow to the inner ear and reducing fluid buildup (Smith et al 2005). Betahistine has been shown to be effective in reducing vertigo attacks, tinnitus, and hearing loss (ICON 2018).
• Vestibular suppressants: Medications such as benzodiazepines and diazepam can help alleviate symptoms of vertigo during acute attacks. Anti-emetics like glycopyrrolate may also be prescribed to reduce nausea and vomiting.
• Acetazolamide: This medication has been used in some cases to treat Meniere's disease, particularly for patients with severe vertigo attacks (Alonso 2021). However, its effectiveness is still being researched.
• Ebselen: Recent studies have shown that ebselen may be a potential treatment option for Meniere's disease. It has demonstrated safety and efficacy in reducing symptoms of the condition (2024).
• Other medications: Medications such as meclizine, dimenhydrinate, and diphenidol can help alleviate symptoms of vertigo and motion sickness.

Important Consideration

It is essential to note that while these drug treatments can help manage Meniere's disease symptoms, they may not completely eliminate them. A combination of medical treatment and lifestyle changes may be necessary to effectively manage the condition.

References:

[3] Smith et al (2005) - Betahistine has been widely used in Europe for treating Meniere's disease. [4] ICON (2018) - The International Consensus on the Treatment of Meniere's Disease recommends betahistine as a first-line treatment. [6] Alonso (2021) - Acetazolamide has been used to treat severe vertigo attacks in some cases. [8] 2024 - Ebselen has shown safety and efficacy in reducing symptoms of Meniere's disease.

The differential diagnosis of active cochlear Meniere's disease involves identifying conditions that can mimic or coexist with the symptoms of this disorder.

According to various studies, the following conditions are considered in the differential diagnosis of active cochlear Meniere's disease:

• Basilar migraine: This condition is associated with vertigo but without aural symptoms. It can be challenging to distinguish from Meniere's disease, especially when vertigo is the primary symptom [2].
• Vestibular neuronitis: This condition is characterized by vertigo without hearing loss or other aural symptoms. It may mimic the attacks of Meniere's disease [2].
• Otosclerosis: This condition can manifest vestibular symptoms in about 25-30% of patients, making it a differential diagnosis for Meniere's disease [11].
• Acute vestibular labyrinthitis or neuronitis: These conditions can mimic the attacks of Meniere's disease and should be considered in the differential diagnosis [11].

It is essential to note that Meniere's disease is a diagnosis of exclusion, and many disease entities can mimic its symptoms. Therefore, it is crucial to eliminate other possible etiologic agents for complaints that could be related to Meniere's disease before making this diagnosis [13].

In addition, the differential diagnosis of Meniere's disease may involve several medical specialties, including internal medicine, neurology, orthopedics, and psychiatry [14].

References:

[2] - Aug 21, 2023 — Differential Diagnosis. Basilar migraine: Associated with vertigo but without aural symptoms. Vestibular neuronitis: Associated with vertigo ...

[11] - The differential diagnosis of Meniere’s disease includes otosclerosis, especially the cochlear variant, which may manifest vestibular symptoms in about 25–30% of patients.

[13] - The diagnosis of “classic” Meniere’s disease is easy to make. Unfortunately, Meniere’s disease is a diagnosis of exclusion and many disease entities can mimic Meniere’s disease.

[14] - The differential diagnosis of Meniere's disease travels through several medical specialties such as internal medicine (diabetes mellitus, immune-mediated diseases, syphilis, and so on), neurology (acoustic neuroma, degenerative diseases of the central nervous system), orthopedics (trauma, temporomandibular joint dysfunction), psychiatry ...