Dizziness "first reaction": Is it Meniere's?

For many friends who suddenly feel dizzy, their first reaction is often to wonder if they have Meniere's disease. This shows that the idea that dizziness is equivalent to Meniere's disease is somewhat deeply rooted in the minds of many ordinary people. Although they don't know what Meniere's disease is, they have heard of the name.

Today I will talk to you about this well-known Meniere's disease.

The time goes back to France in 1861. At this time, Dr. Meniere was 62 years old. He published his research results at the French Medical Annual Conference and summarized the cases of vertigo he had accumulated over the years. These cases of his all had similar symptoms, namely vertigo, tinnitus, and hearing loss. He believed that this syndrome might belong to a new disease. Among these cases, there was a special case that died shortly after the onset of the disease. Dr. Meniere had the opportunity to dissect the patient's inner ear and found endolymphatic bleeding. Therefore, at that time, he believed that this disease might be related to this. This conclusion conflicted with the view of that era that "vertigo comes from the brain", so it caused a lot of controversy. However, God is jealous of talents. Just when Meniere was preparing to conduct further research to reveal the cause of this disease, he unfortunately died of pneumonia in the second year after the speech. Many years later, French doctor Charcot began to call this disease that causes vertigo, tinnitus, and hearing loss syndrome Meniere's disease, and this name has been used to this day.

Medical experts of that era were often all-rounders. Dr. Menier not only made great achievements in otolaryngology, but was also a historian and writer. He had close contacts with the French literary circle at that time, and his contemporaries, such as Hugo and Balzac, also kept in touch with him. Balzac even wrote Menier into his novel as a good doctor.

It was not until the 1920s and 1930s that the medical community gradually came to believe that Meniere's disease was not caused by endolymphatic hemorrhage, but by endolymphatic hydrops, which is an inner ear disease. The so-called endolymph here refers to an anatomical part of the inner ear, including parts of the vestibule and cochlea. It sounds difficult to understand, and indeed, in fact, most doctors can't figure it out unless they are specialists, so this part is also called the "membranous labyrinth." We just need to imagine that this thing is like a water sac with a complex branching structure. The current cause of the disease is mainly due to the edema and accumulation of water in this so-called "water sac", but the exact cause of the water accumulation is still unknown.

So how do ordinary people like us identify whether vertigo is Meniere's disease? In fact, it mainly depends on the symptoms. After all, Meniere's disease is a syndrome named after symptoms. This can actually be seen from the definition of Meniere's disease. The so-called Meniere's disease is an inner ear disease characterized by recurrent vertigo, hearing loss, tinnitus and a stuffy feeling in the ear. This definition clearly explains the symptom characteristics of Meniere's disease.

The first is recurrent episodes of vertigo, with the emphasis on recurrence and vertigo. To diagnose Meniere's disease, it cannot be the first attack. The first attack can only be diagnosed as a suspected case, and at least the second attack counts. There is also vertigo. Vertigo refers to a symptom characterized by visual rotation and impaired balance, which is different from dizziness and vertigo. Secondly, there is hearing loss. This hearing loss is fluctuating, obvious during an attack, and will recover after improvement, but hearing will become worse after repeated attacks. There is also generally tinnitus and a stuffy feeling in the ears. Many old patients with recurrent attacks will have a special experience with this stuffy feeling, and often as soon as they feel it, they know it is coming.

As I said earlier, the specific cause of labyrinthal edema is still unknown, but it is generally believed to be related to the imbalance between the production and absorption of endolymph in the labyrinth. The so-called imbalance is like a math problem in childhood. The labyrinth is like a pool, with water being released on one side and leaking on the other. If too much is released or too little is leaked, the pool will overflow. Many factors, including immune response, inner ear ischemia, endolymphatic sac dysfunction, viral infection and genetics, may be related to this. Later, otologists discovered that not all labyrinthal hydrops will lead to Meniere's disease. As a syndrome, Meniere's disease has gradually been defined as a primary, acquired, symptomatic type of labyrinthal hydrops.

It can be seen that the so-called Meniere's disease, one and a half centuries after it was named, is still keeping pace with the times to find its true cause.