meniere

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Offline Alec

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Prof Alec Salt's excellent description of MD.
« on: Jun 24 2003, 12:09 AM »
The following information is reproduced with the kind permission of Professor Alec Salt, a researcher in Menieres Disease.  It may be copied as required.
 
Symptoms and Incidence of Ménière's disease
Symptoms
Ménière's disease is usually characterized 4 symptoms.
1) Periodic episodes of rotatory vertigo or dizziness.
2) Fluctuating, progressive, low-frequency hearing loss
3) Tinnitus
4) A sensation of "fullness" or pressure in the ear.

Detailed description of symptoms
1) Periodic episodes of rotatory vertigo or dizziness.
Periodic attacks of vertigo ( the so-called Ménière's "attack") is the most disruptive of the symptoms to the patient. It is usually the vertigo attack which causes the patient to seek medical treatment. Typically, vertigo occurs in the form of a series of attacks over a period of weeks or months, interspersed by periods of remission of variable duration. The attack consists of a period of dizziness or vertigo (dizziness may include a feeling of unsteadiness; the term vertigo is normally reserved for the perception of spinning). The sensation of spinning may produce nystagmus (a beating of the eyes from side to side), nausea, vomiting, sweating and all the symptoms normally associated with extreme motion sickness. The onset of vertigo may be preceded by a sensation of fullness or pressure in the ear, increased hearing loss and tinnitus, as described below. The onset is frequently sudden, reaching peak intensity within minutes and lasting for an hour or more before subsiding. Unsteadiness may persist for the following hours or days.
Vertigo must be one of the worst chronic afflictions to affect the body. The vertigo patient perceives either that the world is spinning around them or that they themselves are spinning. With many other disabilities, some portion of a normal life can be continued. Vertigo disrupts virtually every aspect of life, since the patient loses the ability to do anything normally, especially when movement is involved. In addition to the obvious hazard of falling, moving around is hampered by the fact that even small head movements often make the spinning sensation worse. The resulting nausea, sweating and vomiting combine to make the patient subjectively very "ill". Vertigo can totally incapacitate the individual, so they cannot function. Often the patient will confine themselves to bed until the symptoms subside.

Most normal individuals probably cannot appreciate the devastating impact of this condition. Most of us are familiar with mild forms of vertigo or dizziness (from fair rides, excessive alcohol consumption, etc.). If you haven't recently experienced vertigo, try the following experiment (in a large open space, on a soft surface such as grass). Take hold of a heavy object at arms length (my son recommends a school backpack full of books) and spin around, leaning slightly backwards to balance the bag. Spin around 10-20 times at a rate of about 2 revolutions /second. Alternatively, if you don't want to injure yourself by falling over, sit in an "executive" swivel chair and have someone spin you around as fast as they can without the chair becoming unstable, for 20-30 seconds. In both these cases, you will experience rotatory vertigo for a few seconds when you stop rotating. You will have the sensation you are still spinning, your eyes will exhibit nystagmus (a beating from side to side) and if you continue, you may experience nausea. Based on this experience, you now partially understand the problem. There are additional factors which the patient must deal with. One is that their vertigo may last from hours to days, compared with the few seconds you experienced. With the brief episode you experienced, the vertigo declined quickly with time. For a patient, the vertigo may be sustained, or even increase in intensity over a few hours. Another difficulty the patient may have is that the vertigo can be made worse by "external" stimuli, such as head movements or loud sounds. Even TVs and radios may have to be avoided. It should also be considered that in this exercise, you had control over your situation and you knew you could stop when you wanted. You also knew that you would be fine tomorrow. The Meniere's patient has to deal with a lack of control of their situation, except for the limited control provided by taking anti-vertiginous drugs. Even when the symptoms have passed, they must face the stress and uncertainty of when the next episode will occur, and whether it will be more or less severe than previous ones. It is generally true that most people underestimate how disruptive episodic rotatory vertigo can be to an individual's life.

2) Fluctuating, progressive, low-frequency hearing loss
The hearing loss usually affects one ear, which typically loses sensitivity to low-frequency (bass) sounds the most. As well as being harder to hear, sounds may appear "tinny" or distorted. Loud sounds may cause more discomfort than normal (loudness intolerance). The hearing loss fluctuates over time. Sometimes the hearing may recover to some extent, but then on other days hearing may be difficult. In addition, the degree of hearing loss may get progressively worse with time, eventually affecting all sound frequencies and hearing may be completely lost in the affected ear.

3) Tinnitus
Tinnitus is sustained, loud "ringing" in the ears. Many normal individuals experience brief episodes of tinnitus, such as a loud "ping" which declines over a period of seconds to minutes. The tinnitus experienced by Ménière's patients is continual and does not abate with time, although its intensity may vary. The tinnitus is generally nonpulsatile. In addition, it may be heard more as a load roaring or buzzing sensation, rather than a whistling.

4) Aural fullness
The feeling of "fullness" in the ear is similar to that experienced by barometric pressure changes (such as when riding up or down a hill, or ascending or descending in an airplane). However, this fullness cannot be cleared by swallowing, as in the case of pressure changes.

For more information visit the following website:

http://oto.wustl.edu/men/mn1.htm

Alec N. Salt, Professor
Department of Otolaryngology, Box 8115
Washington University School of Medicine
660 South Euclid
St. Louis, MO, 63110
Alec (forum Moderator)

Whenever I hear the term, 'let's go for a spin', it makes me cringe.