[Popular Science in China]-Meniere's Syndrome

Meniere's syndrome, also known as labyrinthal hydrops, is a disease caused by hydrops in the membranous labyrinth of the inner ear, which results in paroxysmal vertigo, tinnitus, deafness, and headache. Meniere's syndrome is common in middle-aged people. It is usually unilateral in the early stage. As the disease progresses, 9-14% of patients may develop bilateral vertigo. It was first discovered by Dr. Meniere in 1861, and since then this vertigo has been called Meniere's syndrome.

There are many theories about the cause of the disease, but no consensus has been reached. For example, allergic reactions, endocrine disorders, vitamin deficiency, and psychoneurological factors can cause autonomic dysfunction, which in turn causes vascular and nerve dysfunction, increased capillary permeability, and water accumulation in the labyrinth, swelling of the cochlear duct and saccule, and stimulation of the cochlear and vestibular receptors, causing a series of clinical symptoms such as tinnitus, deafness, and vertigo. There is no significant difference in the incidence of Meniere's syndrome between men and women. Most patients are young and middle-aged people, and the disease is rare in people over 60 years old. In recent years, there have also been reports of children, and the course of the disease is usually several days or more than a week.

Clinical manifestations 1. Vertigo

Severe rotational vertigo often occurs suddenly without any warning, often waking up from sleep or in the morning. Patients report that objects around them rotate around them, and they feel that they are rotating in space when they close their eyes. Patients often have a forced posture and dare not move, as movement can aggravate the vertigo symptoms. During the onset, they are conscious. During the attack, there are symptoms such as nausea, vomiting, cold sweats, pale face and low blood pressure. After a few hours or days, the vertigo symptoms gradually disappear.

2. Hearing impairment

Hearing loss is a type of fluctuating sensorineural hearing loss. After the early vertigo symptoms are relieved, hearing can be largely or completely restored. Repeated attacks may lead to total deafness. Some patients are also hypersensitive to high-pitched sounds.

3. Tinnitus

It is a possible precursor to the onset of symptoms. Tinnitus is high-pitched and may vary in severity. Before an attack, the patient's tinnitus may worsen, and when the attack stops, the tinnitus may gradually disappear.

4. Stuffy feeling in the head and ear on the same side

Most patients have this symptom, or feel heavy-headed and light-footed.

Examination 1. Otoscope examination of the tympanic membrane is normal

The tympanogram of the acoustic impedance test was normal. The Eustachian tube function was good.

2. Temporal bone X-ray shows no abnormality

The vestibular aqueduct may occasionally show poor gasification around it and be short and straight in the tomographic film.

3. Vestibular function test

During the attack, regular rhythms, different intensities, horizontal or rotational spontaneous nystagmus and positional nystagmus can be observed or recorded by electronystagmography. The results of dynamic and static balance tests are abnormal. During the interval, the results of various spontaneous and induced tests may be normal.

4. Hearing test

The patient suffers from sensorineural hearing loss. Tuning fork test: Weber test is biased to the healthy side, Rinne test is positive, and Schwabach test shows bone conduction shortening. Pure tone audiometry: The air-bone conduction thresholds of the affected ear are both elevated, and the audiogram is ascending or flat in the early stage, and may be descending in the late stage. The hearing threshold fluctuates significantly in repeated tests. Suprathreshold function test, binaural alternating loudness test, and short increment sensitivity index test prove the presence of re-excitation phenomenon; the sound attenuation test is normal; the self-drawing audiometry curve is mostly type II. The difference between the stapedius muscle acoustic reflex threshold and the pure tone hearing threshold is reduced. The SP-AP complex wave of the cochlear electrogram is widened; the SP-AP increases abnormally; the amplitude-intensity function curve of the AP is abnormally steep.

5. Glycerol test

Drink 1.2-1.5g/kg of glycerol with an equal amount of saline on an empty stomach, and perform electrical audiometry once every hour before and after taking it, for a total of 3 times. If the hearing of the affected ear increases by 15 decibels or more after taking glycerol, it is positive. Most patients with this disease are positive, but they are negative during the intermittent period, dehydration and other drug treatment periods. If there is no fluctuation in hearing damage, the test result may also be negative. After using glycerol in the eye, the SP value in the cochlear electrogram decreases, and the otoacoustic emission increases from nothing to something, which can be used as an objective basis for a positive result. Urea and acetazolamide have been used in similar tests.

Diagnosis: Meniere's syndrome can be divided into eight types, and the classification has important guiding significance for diagnosis and treatment.

1. Ordinary type

The symptoms of dizziness, tinnitus, nausea, vomiting, sweating, etc. appear at the same time, which is also called the common type.

2. First-onset tinnitus

Tinnitus precedes other symptoms by months, weeks, or years.

3. Severe tinnitus

Tinnitus is severe. When tinnitus occurs, vertigo is likely to occur. If vertigo is severe, tinnitus is also severe. If vertigo is cured but tinnitus is not cured, vertigo will recur.

4. No tinnitus type

Vertigo attacks more than 5 times without tinnitus are called the non-tinnitus type.

5. Sudden deafness

During a vertigo attack, due to the extremely high pressure, the membrane pathway ruptures, causing sudden deafness. The deafness is usually unilateral, but can also occur alternately on both sides.

6. Delayed vertigo type

Fluctuating, neurological, progressive tinnitus and hearing loss (vertigo does not occur for a short period of time) and vertigo may recur for several years or even 20 years before it occurs.

7. Hidden tinnitus type

The patient does not show any tinnitus on the outside, but has a feeling of blockage, stuffiness, heat, itching, and slight pain in the ear. This is a hidden type of Meniere's syndrome without tinnitus.

8. Dizziness

If the disease occurs more than three times within a month, the patient is in a state of dizziness, which is called the vertigo state type, also known as severe condition.

Treatment: Because of the different viewpoints on its etiology, there are many clinical treatment methods. Meniere's syndrome can be treated with drugs or surgery. Sometimes the disease can disappear without treatment, but it may also seriously affect the patient's life and even require surgery to destroy the inner ear structure.

1. General treatment

During an attack, patients should lie still, avoid being impatient, eat a light and low-salt diet, limit water intake, and avoid smoking, drinking, and tea. During the interval, patients should be encouraged to exercise, strengthen their physical fitness, and pay attention to proper work and rest.

2. Medication

Infusion is a treatment method. Clinical verification shows that it can relieve symptoms in some patients, but the effect is not good for most patients. If a diuretic drug is added to the liquid, the effect can be better. Infusion can relieve the symptoms of vertigo. It can temporarily reduce the pressure of the labyrinthal lymphatic circulation in the balance organ, so infusion is a palliative treatment.

(1) Keep quiet and lie still.

(2) Symptomatic treatment using sedatives such as diazepam and oryzanol in combination with phenergan.

(3) Vasodilators such as sibelium and scopolamine hydrobromide (654-2) may be used as appropriate.

(4) Use diuretics such as hydrochlorothiazide and alanine.

(5) Local drug blockade: 10 ml of 10% procaine is used for stellate nerve blockade.

3. Surgical treatment

Not all patients with Meniere's syndrome can undergo surgery. Surgery is only suitable for patients who have lost their ability to work and have failed to respond to drug treatment. It is limited to patients with unilateral disease. According to statistics, only 5% of patients with Meniere's syndrome are within the scope of surgical treatment. In addition, patients with diseases of the heart, brain, liver, lung, spleen, and kidneys are excluded, and the number of patients who can undergo surgery is very small. Surgery can be summarized into three types: destructive, semi-destructive, and conservative.

Surgical treatment is suitable for severe cases: endolymphatic sac decompression, balloon fistula, labyrinth destruction, vestibular neurectomy. Most patients do not accept destructive or semi-destructive surgery. Here is a brief introduction to conservative surgery. There are many types of conservative surgery, including endolymphatic sac incision, balloon decompression, sympathetic nerve cut, chorda tympani nerve cut, endolymphatic subarachnoid shunt, stapes footplate fenestration and endolymphatic sac mastoid cavity shunt. Comprehensive analysis shows that most of them are fenestration decompression. The International Vertigo Academic Conference concluded that surgical treatment is not ideal, and short-term fenestration decompression has a certain effect.