Meniere's disease

Meniere's disease - a disease of the inner ear, manifested periodic bouts of dizziness and decreased hearing.
The cause of Meniere's disease are not well understood. The main factor is, apparently, a violation of vegetative innervation receptacles inner ear; as a result, the resulting increased permeability of vascular walls increases the number labyrinth liquid (endolymph) and increases vnutrisosudistoe pressure.
The clinical picture of the disease Meniere's highly distinctive symptoms and over. Typical symptoms are: sudden severe dizziness, nausea and vomiting, noise in the ear and the lowering of hearing in one ear. The attack is accompanied by nystagmus (see), and loss of balance; the patient can't walk, stand or even sit up in bed he takes a forced position. The attack usually lasts a few hours, rarely a few days. In severe cases, seizures happen every 5-6 days, more light - after a year or even less frequently. Between attacks, the patient feels healthy. Balance is restored, nausea, vomiting, noise in the ears stopped. The decrease in hearing usually remains, and with repeated attacks progresses, sometimes reaching up to complete deafness in one ear. The total duration of Meniere's disease is different; sometimes it is limited to one or two attacks, and sometimes lasts for decades.
The diagnosis is made on the basis described above are typical symptoms. Some diseases of the inner ear (labyrinthitis, toxic affection) and Central nervous system tumors, hemorrhage) can provide similar to Meniere's disease picture.
The prognosis is relatively good.
Treatment. During the attack - strict bed rest. Inside Aeron 1 tablet 2 times a day, atropine sulphate, vitamins C, B1. Limiting the intake of fluids and salt, intravenously inject 40% glucose 5% solution of ascorbic acid. Smoking and drinking of alcohol in Meniere's disease must be excluded completely.
Rebalancing and liquidation of the vegetative nervous system (dizziness, nausea) upon Meniere's disease contributes to a special complex of exercises therapeutic physical training (turns and bends of the head and body in a horizontal, sagittal and frontal planes with open and closed eyes in the first position of lying down, then sitting and standing; squats, jumps, walking, running at a different pace). Recommended Cycling, skiing, skating.
Surgical treatment - transection drum strings, destruction drum nerve plexus, complete or partial removal of the lower plate of the stirrup.

Meniere's disease (P. Meniere) is the most common form of labirintovaya, manifested by recurrent bouts of dizziness and decreased hearing.
The etiology and pathogenesis. In the etiology of the disease Meniere's important atherosclerosis, hypertension, autonomic and endocrine disorders, allergies and focal infection. Bouts of Meniere's disease usually develop on the background of vegetative crises. Violation of vegetative innervation of the inner ear upsets the normal circulation labyrinth of liquids. During attacks M. B. in the cochlea happen point breaks reisleravos membrane, which quickly heal. It is not known whether this damage membranous labyrinth direct cause seizures M. B. or, on the contrary, the removal of excess endolymph through breaks reisleravos membrane leads to the decrease of pressure in the membranous labyrinth and thereby contribute to the elimination of attack.
Over and symptoms. Attacks M. B. develop unexpectedly: in a patient there is a strong rotational dizziness - illusion rotation own body or surrounding objects. Dizziness (see) increases with the movements of the head. Completely impaired ability to maintain balance (see Ataxia labyrinth). Pronounced vestibulovegetativnymi reactions (nausea, vomiting). In most cases of Meniere's disease is affected only one maze. During the attack always observed spontaneous nystagmus, amplitude and frequency of which change with the change of the head position in space. During the attack patients report stuffy ear (on the side of the affected labyrinth) with reduction hearing and the emergence of strong noise. After the attack the noise usually weakens and hearing partially reversed. This phenomenon is especially pronounced when the syndrome Laraie that many authors consider atypical form M. B. Sick within hours complain of lower impairment and noise in one or both ears. After this, an attack of vertigo, noise disappears and hearing is restored almost to its original level.
Sometimes the first twinges of Meniere's disease occur without noticeable violations of auditory function and only in the late stages of developing typical for this disease reduction hearing. At first, especially reduced perception of the low tones (bass hearing loss), and the thresholds of air conductivity lowers more than thresholds bone conduction ("air-bone gap" in tone audio-gram). Such changes hearing characteristic lesions sound carrying out device. I believe that zvukoprovodnost when M. B. violated in the cochlea ("rocky" hearing loss) due to the stretching of the walls of the cochlear turn. Along with this, when M. B. from the outset, there are signs of defeat sound perceiving device. Especially typical for this disease phenomenon of accelerated growth of the volume and decrease of speech intelligibility. The perception of the frequency of sound: one and the same tone is perceived by means of the healthy and sick ear as different pitch (split hearing - diplacusis). In the later stages M. B. the deterioration in the perception of high tones, disappears "air-bone gap" in tone audiogram. In interictal periods can be observed the improvement of air and bone conduction, improves speech intelligibility, partially normalized function of the volume.
The diagnosis. The differential diagnosis should be aware of these diseases. 1. Other forms of labirintovaya (see) - they do not occur in the form of violent and recurrent attacks, accompanied by nystagmus large amplitude, vomiting, and ataxia. They are not characterized by significant fluctuations audiological indicators.
2. Labirintit. With limited tympanogram the labyrinthitis (see) is usually possible to identify pistolry symptom. Patients suffer from chronic purulent inflammation of the middle ear with caries walls nabraboogo space. When minerogenic labirintit not marked
repeated bouts of dizziness and significant fluctuations in the audiological indicators.
3. "Neck" vestibular syndrome is caused by compression of the vertebral artery (and surrounding nerve plexus) when deformities of the cervical parts of the spine. Short-term, poorly marked dizziness occurs mainly when a sudden head movements without ataxia, and vomiting. There are different neurological symptoms. X-ray examination reveals deformity of the spine.
4. Neurinoma eighth cranial nerve causes a gradual decrease in hearing, usually without severe dizziness. X-ray examination reveals the expansion of the internal acoustic meatus. In later stages of the disease are observed different neurological symptoms.
5. Focal brain called vestibular disorders mainly when they are localized in the posterior cranial fossa in the temporal lobe of the big hemispheres of a brain. Do not cause repeated violent attacks of vertigo with the lowering of the hearing.


Treatment. During the attack of Meniere's disease is prescribed strict bed rest, limits the intake of fluids and sodium chloride. Inside appoint atropine sulfate (0.00025 0.0005 g 2-3 times a day), chlorpromazine (25 mg 2 times daily), bromides, vitamins C, B1 and PP. For high blood pressure - antihypertensives, intramuscularly injected solution of magnesium sulfate. If after the attack, M. b. the patient feels well, notes the attenuation of the noise in the ears and hearing better, you can think that in the near future he would not face a repeat of the attack. In cases where patients after an attack complain about noise and decreased hearing, the instability when walking and sharp turns of the head, a feeling of pressure in the field of the crown of the head and stomach, it is necessary to recommend them for a long time to strictly stick to the diet with restriction of fluid and sodium chloride. Patients continue purpose of atropine and injections of magnesium sulfate; effective protivogistaminne drugs (Dimedrol, suprastin, pipolfen), intravenous or intramuscular injection solution of novocaine procaine blockage of the nasal mucosa (by Ya. S. Temkina) and cervical sympathetic nodes. Special attention should be paid to the identification and elimination of infectious foci in the sinuses and tonsils. Patients ban Smoking is recommended to avoid fatigue and alcohol.
Termination or weakening of attacks can be reached through a surgical interventions. The least traumatic intervention produce endourology cut; they are in the transection drum strings or destruction drum plexus. The next place on the degree of trauma occupy surgical intervention on the stirrup, who also produce endourology incision; these interventions involves partial or total removal of the "pasture plate" stirrup with a change of connective tissue flap in the region oval window. While hearing is usually saved and can be a little bit better. By the same inderalno cut through the oval window produce and other interventions - local coagulation vestibular receptors and complete destruction of the maze. For mechanical damage to the labyrinth of receptors used ultrasound, which act through the wound cavity formed by atticoantral. Most traumatic operations are on the endolymphatic SAC and intracranial transection vestibular fibers of the eighth cranial nerve. Currently with Meniere's disease often require interventions on the stirrup.
Therapeutic exercise for Meniere's disease helps to restore statokinetic and vestibulovegetativnymi sustainability.
Combined with restorative and breathing exercises are recommended with the aim of vestibular training the following exercises. For training the semicircular canal to accomplish in the provisions of lying, sitting, standing and tilt the head and body in front, sagittal, horizontal planes. For training otolith device shown squats, pococi, walking and running at different rates and directions. For training in balance and orientation in space - balance exercises; apply exercises in coordination. For training purposes, part of these exercises are performed with closed eyes. Uses some sports exercises: bicycling, skating and skiing; as an element of passive exercise applies swing on a swing, a rotation of a rotating chair. In the process of training is important to gradually increase the pace and range of motion. The classes shown In the interictal period.