MÃÆ'Â © niÃÆ'¨re disease ( MD ) is an inner ear disorder characterized by episodes of feelings such as the world turning (vertigo), ringing in the ears (tinnitus), disorders hearing, and fullness in the ear. Usually only one ear is affected, at least initially; however, over time, both ears may be involved. Episodes generally last from 20 minutes to several hours. The time between episodes varies. Loss of hearing and ringing in the ear can become constant over time.
The cause of the disease MÃÆ' Â © niÃÆ'¨re is unclear but may involve genetic and environmental factors. A number of theories exist for why it occurs including narrowing in blood vessels, viral infections, and autoimmune reactions. Approximately 10% of cases occur in the family. Symptoms are believed to occur as a result of an increase in fluid accumulating in the labyrinth of the inner ear. The diagnosis is based on symptoms and often a hearing test. Other conditions that can produce similar symptoms include vestibular migraine and transient ischemic attacks.
There is no known cure. Attacks are often treated with medication to help with nausea and anxiety. The steps to prevent an overall attack are less supported by evidence. Low-salt diets, diuretics, and corticosteroids can be tried. Physical therapy can help balance and counseling can help anxiety. Injections to the ear or surgery can also be attempted if other measures are not effective but are associated with risk. The use of the tympanostomy tube, although popular, is not supported.
Disease MÃÆ'Ã… © niÃÆ'¨re was first identified in the early 1800s by Prosper MÃÆ' Â © niÃÆ'¨re. It affects between 0.3 and 1.9 per 1,000 people. Most often it starts in people aged 40 to 60 years. Women are more often affected than men. After 5 to 15 years of symptoms, the episodes of the spinning world generally stop and people are left with a mild loss of balance, poor hearing on the affected ear, and ringing in their ears.
Video Ménière's disease
Video Disease MÃÆ' Â © niÃÆ'¨re
Maps Ménière's disease
Signs and symptoms
MÃÆ'Ã… © niÃÆ'¨re is characterized by repeated episodes of vertigo, hearing loss and tinnitus; episodes may be accompanied by headaches and feelings of satiety in the ear.
People may also experience additional symptoms associated with irregular reactions of the autonomic nervous system. These symptoms are not symptoms of Meniere's disease per se, but rather a side effect resulting from hearing organ failure and balance, and include nausea, vomiting, and sweating - which are usually symptoms of vertigo, and not from MÃÆ'Â Â © niÃÆ'¨re. This includes a sharply pushed sensation to the floor from the back.
Suddenly falling without loss of consciousness (drop attack) may be experienced by some people.
Maps Disease MÃÆ'Â © niÃÆ'¨re
Cause
The cause of the disease MÃÆ' Â © niÃÆ'¨re is unclear but may involve genetic and environmental factors. A number of theories exist including constriction in blood vessels, viral infections, autoimmune reactions.
Mechanism
The early trigger of MÃÆ' Â © niÃÆ'¨re disease is not fully understood, with various potential inflammatory causes leading to endolymphatic hydrops (EH), an endolymphatic space distention in the inner ear. EH, in turn, is strongly associated with MD development, but not everyone with EH develops MD: "The relationship between endolymphatic hydrops and Meniere's disease is not a simple, ideal correlation."
In addition, in the MD developed a balance system (vestibular system) and the hearing system (cochlea) of the inner ear is affected, but there are cases where EH affects only one of two systems strong enough to cause symptoms. The corresponding MD subtype is called vestibular MD , showing symptoms of vertigo, and cochlear MD , showing symptoms of hearing loss and tinnitus.
The MD mechanism is not fully explained by EH, but fully developed EH can mechanically and chemically interfere with sensory cells for balance and hearing, which can lead to temporary dysfunction and even death of sensory cells, which in turn can lead to typical symptoms of MD: vertigo , hearing loss, and tinnitus.
Diagnosis
Diagnostic criteria in 2015 determine MD's definitive and possible MDs as follows:
Definitely
- Two or more spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours
- Audiometry documented low to medium-sized sensorineural hearing loss in the affected ear at least 1 time before, during, or after one episode of vertigo
- Fluctuative aural symptoms (hearing, tinnitus, or fullness) in the affected ear
- No better accounted for by other vestibular diagnoses
Possible
- Two or more vertigo or dizziness episodes, each lasting 20 minutes to 24 hours
- Flooding aural symptoms (hearing, tinnitus, or fullness) in the ears reported
- No better accounted for by other vestibular diagnoses
A common and important symptom of MD is hypersensitivity to sound. This hypersensitivity is easily diagnosed by measuring the level of discomfort loudness (LDLs).
MD symptoms overlap with vertigo-related migraine (MAV) in many ways, but when hearing impairment develops in the MAV usually in both ears, and this is uncommon in MD, and hearing loss generally does not develop in MAV as in MD.
People who have had transient ischemic attacks (TIAs) and strokes may present with symptoms similar to MD, and in people at risk for magnetic stroke resonance imaging (MRI) should be done to exclude TIA or stroke, and because TIA often becomes a precursor for a stroke, the risk must be managed.
Other vestibular conditions to be excluded include vestibular paroxysmia, recurrent unilateral vestibulopathy, vestibular schwannoma, or endolymphatic sac tumor.
Management
There is no cure for MÃÆ' Â © niÃÆ'¨re disease but drugs, diet, physical therapy and counseling, and some surgical approaches can be used to manage it.
Drugs
During the episode of MD, drugs to reduce nausea are used, such as drugs to reduce anxiety caused by vertigo.
For long-term treatment to stop progression, evidence base is weak for all treatments.
Although a causal relationship between allergies and illness MÃÆ'Ã… © niÃÆ'¨re is uncertain, a cure for allergic control may be helpful.
Diuretics are widely used to manage MÃÆ' Â © niÃÆ'¨re on theories that reduce the buildup of fluid in the ear. Based on evidence from several small clinical trials, diuretics seem to be useful for reducing the frequency of episodes of dizziness, but do not appear to prevent hearing loss.
In cases where there is significant hearing loss and resume severe vertigo episodes, chemical labyrinthectomy, in which a drug (such as gentamicin) that "kills" part or most of the vestibular apparatus is injected into the middle ear.
Diet
People with MD are often advised to reduce their salt intake for the same reason, but evidence for this is very bad. Based on the assumption that MD has similar properties to migraines, some suggest removing "migraine triggers" such as caffeine. However, the evidence for this is weak.
Physical therapy
While the use of early physical therapy after onset of MD may be useless because the course of the disease fluctuates, physical therapy to help retrain the balance system seems useful in reducing subjective and objective deficits in long-term balance.
Counseling
Psychological disorders caused by vertigo and hearing loss can worsen the condition in some people. Counseling may be useful for managing distress, as well as education and relaxation techniques.
Surgery
If symptoms do not improve with typical treatment, surgery may be considered. Surgery to decompress the endolymphatic sac is one option. A systematic review in 2015 found that three decompression methods have been used: simple decompression, shunt insertion; and the removal of the sac. There is some evidence that the three methods are useful for reducing dizziness, but low evidence levels, because no trial is blinded nor there is no placebo control.
Another review of 2015 found that shunts used in these operations often turned out to be displaced or misplaced in the autopsy, and recommended its use only in cases where the condition was uncontrolled and affected both ears. A systematic review of 2014 found that at least 75% of people with EL pouch decompression effectively controlled vertigo in the short term (& gt; 1 year of follow-up) and long-term (& gt; 24 months).
It is estimated that about 30% of people with Meniere's disease have eustachian tube dysfunction. While a 2005 review found evidence of tympanostomy benefit for tuberculosis for improvement in the imbalances associated with the disease, the 2014 review concluded that they were not supported.
Destructive surgery can not be altered and involves removing most of the function, if not all, of the affected ear; in 2013, there is almost no evidence that can be used to assess whether the operation is effective. The inner ear itself can be removed through the labyrinthectomy, though hearing is always completely lost in the affected ear with this operation. The surgeon may also cut the nerve into the inner ear balance section within the vestibular neurectomy. Hearing is often mostly preserved; However, surgery involves cutting open to the lining of the brain, and staying in the hospital for several days for monitoring will be necessary.
Not supported properly
- Beginning 2014, betahistine is often used because it is cheap and safe; But the evidence does not justify its use in the disease of MÃÆ'Ã… © niÃÆ'¨re.
- Transtympanic micropressure pulses were investigated in two systematic reviews. There is no evidence to justify this technique.
- Intratympanic steroids are investigated in two systematic reviews. It was concluded that the data were not sufficient to decide whether this therapy had a positive effect.
- Evidence does not support the use of alternative treatments such as acupuncture or herbal supplements.
Prognosis
Disease MÃÆ' Â © niÃÆ'¨re usually begins to be limited to one ear; it appears that it extends to both ears in about 30% of cases.
People may start with just one symptom, but in the MD all three appear over time. Hearing loss usually fluctuates in the early stages and becomes more permanent in later stages. MD has a 5-15 year journey, and people generally end up with mild disequilibrium, tinnitus, and moderate hearing loss in one ear.
Epidemiology
From 3% to 11% of dizziness diagnosed in a neuro-otological clinic is due to Meniere's. The annual incidence rate is estimated to be around 15/100,000 and the prevalence rate is around 218/100,000, and about 15% of people with Meniere's disease are over 65 years old. About 9% of cases of a relative also have MD, suggesting that there may be a genetic predisposition in some cases.
MD opportunities are greater for white ethnic people, with severe obesity, and women. Some conditions are often comorbid with MD, including arthritis, psoriasis, gastroesophageal reflux disease, irritable bowel syndrome, and migraines.
History
This condition is named after the French physician Prosper MÃÆ' Â © niÃÆ'¨re, who in an article from 1861 describes the main symptoms and is the first to show a single disorder for all the symptoms, in the combined organs of balance and hearing on the inside of the ear.
The American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium (AAO HNS CHE) sets the criteria for diagnosing MÃÆ'Â © niÃÆ'¨re, as well as defines two sub categories of MÃÆ'Â © niÃÆ'¨re's: koklea (without vertigo) and vestibular (without deaf).
In 1972, the academy defines the criteria for diagnosing MÃÆ' Â © niÃÆ'¨re disease as:
- sensorineural, progressive, progressive deafness.
- Episodic, the definitive mantra feature of vertigo lasting 20 minutes to 24 hours without unconsciousness, vestibular nystagmus is always present.
- Tinnitus (rang in the ears, from mild to severe) Often tinnitus is accompanied by earache and a feeling of fullness in the affected ear. Usually tinnitus is more severe before the vertigo spell and decreases after vertigo attacks.
- Attacks are marked by remission and exacerbation periods.
In 1985, this list changed to change the words, such as changing "deafness" to "hearing loss associated with tinnitus, typical of low frequency" and requiring more than one vertigo attack to be diagnosed. Finally in 1995, the list was changed again to allow the degree of disease:
- Certain - Definite disease with histopathological confirmation
- Definitely - Requires two or more definitive episodes of vertigo with hearing loss plus tinnitus and/or aural aural
- Possible - Only one definitive episode of vertigo and other signs and symptoms
- Possibility - Definitive Vertigo without associated hearing loss
In 2015 the International Classification for the Vestibular Disorder Committee of the Society Barany publishes a consensus diagnostic criterion in collaboration with the American Academy of Otolaryngology - Head and Neck Surgery, European Academy of Otology & Neuro-Otology, Japan Society for Equilibrium Research, and Korean Balance Society.
References
External links
Sumber artikel: Wikipedia
Source of the article : Wikipedia
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