Is Meniere’s Disease Hereditary
General

What Is Meniere’s Disease? And Is It Hereditary?

Before explaining what Meniere’s disease is and if Meniere’s disease is hereditary, it is important to understand how the ear is responsible for the sense of hearing. For the convenience of understanding, the ear is divided into 3 parts

1. Outer Ear – From The Ear Flap To The Auditory Canal

This part conducts sound to the eardrum. The outer ear is rich in sebaceous glands and hairy sweat glands which work to form ear wax.

2. Middle Ear – Auditory Canal to Stirrup

This portion is of the ear is an air-filled space. Here, the ear connects to the nasopharynx by means of a Eustachian Tube. This tube helps to maintainair pressuree within the ear. This part of the ear also contains the smallest bones in the body. These bones convey sound impulses from ear drum to inner ear.

3. Inner Ear – Stirrup to Cochlea Including the Eustachian Tube
The inner ear contains cochlea. Cochlea is surrounded by fluid. This portion of ear converts sound vibrations to nerve impulses.

All these specific functions of the ear allow a patient to hear effectively. Any breach in the integrity or continuity of the ear, due to any cause leads to signs and symptoms.

The ear is the center of balance of our body. This is the reason why any infections of the ear, nose and throat or any trauma to the ear or near the ear like a blow or a slap causes a person to lose balance or become dizzy. The function of maintaining air pressure also explains why certain people experience sickness in flights, cars or high altitudes.

What is Meniere’s Disease and How is it Caused?

Meniere’s disease is a chronic disorder of the inner ear characterized by recurrent and sudden attacks of vertigo or dizziness. Meniere’s disease is considered as a form of endolymphatic hydrops – an excessive accumulation of endolymph fluid.

The basic mechanism that works in the development of tinnitus is gross distension of lymphatics within the ear. The lymphatic system is responsible for drainage of microbes and toxins. Some causes for an accumulation of endolymph are:

  1. Trauma
  2. Sodium Retention
  3. Edema From Allergies
  4. Mechanical Block
  5. Dehydration
  6. Infections – Bacterial or Viral
  7. Ischemia – Restricted Blood Supply to the Inner Ear
  8. Idiopathic – No Identifiable Cause

Some environmental factors which trigger an attack of Meniere’s disease are regular exposure to noise pollution (occupational), stress, fatigue, emotional disturbances, and prolonged illnesses, changes in pressure like high altitudes, certain food and drugs and excess salt in the diet.

Signs and Symptoms of Meniere’s Disease:

  1. It is usually affects one ear but may involve both ears as the disease progresses.
  2. Meniere’s disease can affect anyone. But it commonly affects persons in 40-60 years of age.
  3. Sensation of fullness inside the ear with dizziness
  4. Nausea and Vomiting
  5. Tinnitus (ringing or buzzing sounds inside the ear suggests the recent or acute onset of disease. Tinnitus often disables concentration.)
  6. Deafness is fluctuating initially. Deafness increases as the disease progresses.
  7. Sensation of Uneasiness
  8. Palpitations or Rapid Pulse
  9. Trembling with Cold Clammy Skin
  10. Imbalance and Unsteadiness with a tendency to stumble or fall.

In some cases, attacks are recurrent. Recurrent attacks result in a progressive reduction in hearing, tinnitus becomes a usual feature and vertigo subsides. In late stages of the disease, there is vertigo with disturbed vision and balance; tinnitus becomes a strong feature along with hearing loss.

Disease presentation may however vary in different individuals. Duration, intensity and recurrence of attacks are often different even in the same individual. This unpredictability of attacks makes is relatively difficult to study it.

Is Meniere’s Disease Hereditary?

Meniere’s disease is known to occur due to a combination of genetic and environmental factors. Very few cases show a family history of Meniere’s. However, there has been no identification of any specific gene yet.

How to Diagnose Meniere’s Disease?

  1. Audiometry – This helps in detecting any sensory-neural defects.
  2. Vestibular Function Test – To assess hypo activity on affected side.
  3. CT Scan To visualize and rule out any structural abnormalities.
  4. Glycerol Test – This is the most valuable diagnostic test. 95% glycerin with the same amount of saline per kg body weight is given on a fasting stomach. Speech audiometry and pure tone audiometry are done and results are compared with pre-test results. Improvement in hearing indicates an excess of endolymph.
  5. Electrochochleography – An electrode is placed near the ear canal to detect electrical potentials in the inner ear in response to sound stimulation.

Management of Meniere’s Disease:

There are no specific medications for treating Meniere’s disease. Symptomatic treatment and surgery in complicated cases is generally used.

  1. Identification of triggering factors and avoiding the same.
  2. Drugs to control vertigo or sickness. Medicines are often given as a preventive measure to patients suffering from Meniere’s in order to avoid symptoms.
  3. Diuretic drugs are given when edema and sodium retention are possible causes.
  4. Stellate Ganglion Block – A procedure in which local anesthetic medications are administered to sympathetic tissues of the neck. This procedure blocks sympathetic nerves in the given area.
  5. Vasodilators are helpful when the cause is restricted blood supply.
  6. According to a controlled trial carried out, 14 out 18 patients having Meniere’s disease were benefited from intravenous Magnesium Sulphate.
  7. Surgery is indicated in complicated cases or cases where Meniere’s is due to a mechanical obstruction such as tumors or a foreign body or congenital defects. Some procedures are:
    • Drainage of endolymph sac
    • Selective section of the vestibular nerve
    • Labyrinthectomy
  8. Rehabilitative therapy includes the use of hearing aids in advanced stages of the disease.
  9. Meniett’s Device – It is a small low pressure pulse generating device to apply pressure to the ear canal in order to reduce symptoms. The device can be used 3-5 times a day, as advised by your ENT therapist.
  10. Alternative modes of treatment like ayurveda and homoeopathy too have proven benefits. These therapies use a more holistic approach towards Meniere’s in dealing with either an acute attack of the disease or providing a more constitutional therapy.

Certain researches have even suggested a reduction in intensity, duration and recurrence in symptoms of Meniere’s with the help of Ayurveda and Homoeopathy.

Natural Ways to Manage Meniere’s disease:

  1. A low salt and low fat diet is advised.
  2. Favorable results are obtained by administration of Vitamins D, A and B complex.
  3. Vitamin C supplements or naturally available vitamin C has antioxidant activities.
    In a study conducted in New Jersey, 122 patients of Meniere’s disease were administered Lemon flavonoid and Vitamin C supplements. Out of these 122 patients included in the study, 79% showed marked improvement, 41% experienced an improvement in both hearing and vertigo, and 38% had lesser vertigo but no improvement in hearing.
  4. Drinking plenty of water is imperative in managing any disease. Water helps to flush out toxins from the body. It aids in quicker recovery.
  5. Stress management for patients having stress as their triggering factor.
  6. Complementary therapies like yoga, reflexogy and acupuncture also have beneficial effects.
  7. Essential oils are the most harmless and natural ways of managing symptoms of Meniere’s. Some essential oils which can be used are:
    • Peppermint Oil – For vertigo with nausea and vomiting.
    • Cypress Oil – Specifically to reduce congestions
    • Basil Oil – For motion sickness
    • Clary Sage Oil – For vertigo from anxiety or nervousness
    • Rosemary Oil – To reduce congestion and dizziness.
    • Tangerine Oil – For vertigo with a headache. Helps in eliminating toxins.

Essential oils help in soothing the nerves and in relieving symptoms. These are not a substitute for medications. Essential oils can be used either singly or in combination.

Medically Reviewed By
Dr. Kaushal M. Bhavsar (MBBS, MD)Assistant Professor in Pulmonary Medicine, GMERS Medical College, Ahmedabad

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