Are You Facing Heaviness in Ear With Reeling of Head? (Exclude Meniere’s Disease)

Meniere is a condition characterized by sudden spontaneous episodes of vertigo, nausea, vomiting and fluctuating hearing loss.

Pathology

• Overproduction or malabsorption of endolymph, results in endolymphatic hypertension. The endolymphatic hypertension further results in gross enlargement of membranous labyrinth called endolymphatic hydrops.  
• Vascular insufficiency may play a role in endolymphatic dysfunction.

Clinical features 

• Hearing Loss: It has 3 Phases.
  • Early reversible hearing loss.
  • Established Fluctuating hearing loss.
  • Late non-fluctuating hearing loss.
• Vagal Stimulation may occur. Patient complains of sweating and pallor. This is seen is acute attacks.
• Recurrent attacks of spontaneous vertigo. Intensity of vertigo increases over a period of minutes and then usually lasts for several hours (20 minutes to 24 hours).
• Tinnitus: It is variable, low pitched, roaring in nature and prominent before an attack. Tinnitus is unilateral and subjective.
• Sensation of heaviness and fullness in the ear.
• Severe anxiety.
• Nystagmus is always present during an attack.

Diagnosis

According to American Academy of Otolaryngology – Head and Neck Surgery, Meniere’s disease is diagnosed as Definite, probable or possible Meniere’s disease.

1. Possible Meniere’s disease-·       
   1. Episodic vertigo without hearing loss.·       
   2. Sensorineural hearing loss, fluctuating or fixed, with disequilibrium but without definitive episodes.·       
   3. Other causes excluded. 
2. Probable Meniere’s disease-·       
   1. One definitive episodes of vertigo.·       
   2. Hearing loss documented by pure-tone audiogram on at least one occasion.·       
   3. Tinnitus or aural fullness on the affected side.·       
   4. Other possible causes excluded.  
3. Definite Meniere’s disease-·       
   1. Two or more spontaneous attacks of vertigo (each lasting 20 minutes or longer).·       
   2. Hearing loss documented by pure-tone audiogram on at least one occasion.·       
   3. Tinnitus or aural fullness on the affected side.·       
   4. Other possible causes excluded.
4. Certain Meniere’s disease-·       
   1. Two or more spontaneous attacks of vertigo (each lasting 20 minutes or longer).·       
   2. Hearing loss documented by pure-tone audiogram on at least one occasion.·       
   3. Tinnitus or aural fullness on the affected side.·      
   4. Other possible causes excluded. ·       
   5. Histopathological confirmation of the disease.

Treatment

• Stop alcohol, Smoking.
• Monitor blood pressure.
• Sound Sleep. 
• Medical:
  • Reduce sodium intake.
  • Diuretics.
  • Vestibular ablation.
  • Vasodilators like Betahistine.
  • Calcium channel blockers: Useful in some patients not responding to the above treatment.
  • Sedatives to relieve anxiety.
  • Labyrinthine sedatives with antiemetics used in acute period.
  • Anti-histaminics: Act as vestibular suppressants. 
• It above treatment is not sufficing then surgical treatment is an option
  • Chemical Labyrinthectomy of inner ear by injection gentamycin.
  • Ultrasonic ablation of the inner ear.
  • Endolymphatic Sac decompression. Helps to prevent the accumulation of the endolymph.
  • Vestibular neurectomy.
  • Labyrinthectomy: It comprises of destruction of the labyrinth to relieve the symptoms.