Signs and Symptoms of Meniere’s Disease
Meniere’s disease is a disorder of the inner ear. It has symptoms of vertigo and dizziness that frequently give no warning. Often, this is accompanied with vomiting, extreme nausea, and sweating. In Meniere’s disease, the symptoms get worse when the patient moves suddenly and the symptoms last for periods ranging from a few minutes to hours. Meniere’s disease may also affect hearing, particularly affecting the ability to detect low frequency sounds. There may also be tinnitus or a sense of pressure in the ear. Other occasional symptoms include diarrhea, headaches, stomach pain, and even uncontrolled eye movements (Schwartz & Zieve, 2010).
Diagnosis of Meniere’s Disease
Diagnosis of Meniere’s disease is complicated by the fact that several other disorders, including benign positional vertigo, also cause dizziness and vertigo. Formal diagnosis may require several neurological tests to identify problems in hearing, balance and eye movements. Specifically, the test may include a caloric stimulation test, which warms and cools the inner ear with water; when coldwater is entered to the ear, the eye movements should show side-to-side motions, moving away from the cold water, then slowly back. When warm water is used, the eye should show the opposite motion, toward the ear and then slowly away from it. Abnormal responses may indicate Meniere’s disease. A CT scan or MRI of the head may also be called for, and there may be hearing tests to determine any hearing abnormalities. (Schwartz & Zieve, 2010).
Distinction between Meniere’s Disease and Benign Positional Vertigo
Bayer et al.(2010) produced a set of indexes that distinguish Meniere’s from other disorders with similar symptoms on a clinical basis. This paper indicates that the most distinguishing features of Meniere’s disease are vertigo, the type of vertigo, the patient’s perception of the environment in an attack, and symptoms such as ear noises, sweating, nausea, and vomiting. In particular, the vertigo coming and going in attacks (as opposed to being constant or near-constant, and feeling like being on a “roundabout” (i.e., merry-go-round) or in an elevator were highly indicative of Meniere’s disease. (Bayer, 2010). In particular, persistence of vertigo beyond a few minutes or the presence of sweating, nausea, and vomiting was generally found to be contraindicative of benign positional vertigo, but indicative of Meniere’s disease. Ear noises similarly tends to rule out benign positional vertigo, while providing a strong indication of Meniere’s disease (Bayer, 2010, Table 2).
In contrast with Meniere’s disease, benign positional vertigo rarely includes symptoms beyond the vertigo. The vertigo is generally sparked from motion of the head, and rarely lasts longer than a few minutes. The most common complaint from benign positional vertigo is that patients have trouble rolling over in bed, or have difficulty tilting their heads. Rarely, there can be problems with vision of objects “jumping” around, and in severe cases, some vomiting from the vertigo.
Treatment Options, Meniere’s Disesase
No cure exists for Meniere’s disease. Treatment includes methods to reduce the water in the body (diuretics and low-salt diet) to relieve pressure in the inner ear. It is also recommended that patients avoid sudden movements, and avoid activities such as being in bright lights, watching television, or reading when experiencing an attack because those may worsen symptoms. It is also important to avoid driving or operating heavy machinery during attacks and for a period after the attack ends. If symptoms are severe and do not respond, surgery may be necessary, but may also involve some hearing loss. (Schwartz & Zieve, 2010).
Treatment Options, Benign Positional Vertigo
Generally, benign positional vertigo may be treated by an exercise called Epley maneuver. The point of the procedure is to reposition small bits of calcium that maybe floating in the inner ear fluid. It is a series of body positions that allows the calcium to reposition in the ear (sit upright, turn head 45 degrees and lie down for 5 minutes; turn head 90 degrees to other side and lie for 5 minutes; roll onto the side facing pointing nose down and lie for 5 minutes; sit up and hold for about a minute). Medications are often not particularly effective for vertigo (Zieve & Schwartz, 2010).