Meniere’s disease is characterized by
tinnitus and ear fundus that is followed by severe spinning attacks that last
hours to days. It is hypothesized that Meniere’s disease is due to an abnormal
increase in fluid within the endolymphatic chamber found within the
inner ear. Here we have the endolymphatic chamber in green and a surrounding perilymphatic chamber in blue. The vestibular membrane separates the endolymphatic
from the perilymphatic chambers. The fluid within each of these chambers are
different and kept in a stable equilibrium. However for unclear reasons
patients with Meniere’s disease will start to suffer from excessive fluid
buildup within the endolymphatic chamber causing the vestibular membrane to start
stretching. When this happens, symptoms of ear
fullness and tinnitus occur. Should enough fluid fill the endolymphatic
chamber, the vestibular membrane will eventually rupture causing the fluids
between the chambers to mix resulting in symptoms of spinning dizziness also
known as vertigo. Over hours to days, the vestibular membrane will slowly heal
back together and the fluid within the endolymphatic and perilymphatic
chambers will revert back to normal resulting in restoration of normal
hearing and balance. In order to prevent fluid from building up in the endolymphatic chamber, patients are often instructed to avoid salt, caffeine, and alcohol.
Diuretics may even be prescribed in order to be help prevent fluid buildup.
Should medical management fail, surgical intervention can be performed with
endolymphatic sac decompression surgery. The bone around the endolymphatic sac is
removed and a shunt placed to physically drain fluid out of the endolymphatic sac
to prevent excessive fluid buildup. In another variation of this surgery
called endolymphatic duct blockage, bone is removed around the duct and a
clip place to prevent fluid that is produced by the sac from building up in
the rest of the inner ear. Finally, if vertigo is still not well
controlled, the nerve going to the inner ear balance system can be cut surgically.
Alternatively, special drugs can be injected into the inner ear to
chemically destroy the balance system.