 Chapter 1 Meniere’s Disease When I was working in the EarNose and Throat Department of the Singapore General Hospital, every night I was able to see at 1 case of Meniere’s disease coming in from the Emergency Department with complaints of severe dizziness. The main complaint was always dizziness or vertigo but seldom the associated tinnitus or deafness. It was only when you asked them then they would add in the tinnitus or deafness. It was therefore important to treat them for the dizziness. I always gave an injection of Stemetil (prochhlorperazine) which inadvertently will stop their dizziness within 10 minutes. Stemetil unfortunately gave rise to extrapyramidal reactions such as sticking out tongue or oculogyric crises of the eyes (the eyeball rolled upwards), torticollis, opisthotonos, carpopedal spasm, trismus. These patients have reported other side effects such as akathisia and anxiety. These patients with these side effects were rare (may occur in less than 1% of patients receiving prochlorperazine). Normally the best injection to counter the extrapyramidal reactions is diazepam injection which relaxes the nervous system. Unless there were obvious contraindications to stemetil (these include maxolon and promethazine which also gives similar effects) injections of stemetil gave very good results. In my family practice I have not seen a case of confirmed Meniere’s Disease. Maybe the symptoms of Meniere’s disease more frequently at night. What is Meniere's Disease? Meniere's Disease is a disease of the inner ear which is characterized by the triad of episodic vertigo (giddiness), tinnitus (buzzing sound in ear) and progressive hearing loss. It is more common in adults between 30-60years of age and in men more than women. It usually occurs in one ear. What is the cause of Meniere's Disease? No one knows the exact cause of Meniere's Disease. It is believed to be due to distension of the membranous labyrinth with increased pressure and fluid in the endolymph of the inner ear. As a result the balance in one ear is affected leading to dizziness What are the triggers of Meniere's Disease? The possible triggers of this condition may be: 1. Middle ear infection, 2. Head injury 3. Upper respiratory tract infection 4. The effect of aspirin, 5. Smoking 6. Alcohol 7. Caffeine 8. Salt Some investigators believed that there is a link with the herpes zoster virus which is activated when the immune system is low, resulting in inflammation of the eight nerve(hearing). What are the symptoms of Meniere's Disease? Symptoms: The classical triad of symptoms is: 1. Recurrent bouts of vertigo of varying degrees which may last from hours to days. Recurrences may be as often as 1 week to several years. 2. Slow progressive loss of hearing in one ear or rarely in both ears starting at low pitch sounds first. 3. Unilateral tinnitus (buzzing sound in one ear), sometimes in both ears Besides these symptoms, there is also: 4. Feeling of pressure (fullness) in one or both ears. 5. Nausea and vomiting sometimes occur with the vertigo 6. Hypersensitivity to sound 7. Nystagmus (uncontrollable jerky ear movements) 8. Cognitive disturbance 9. Audiometry shows impairment of hearing 10. MRI scan of the head - to exclude a tumor of the eighth cranial nerve (vestibulocochlear nerve) TABLE OF CONTENT Introduction Chapter 1 Meniere’s Disease Chapter 2 Causes Chapter 3 Symptoms Chapter 4 Diagnosis Chapter 5 Treatment Chapter 6 Prognosis Chapter 7 Vertigo Chapter 8 Tinnitus   |
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