The disease was named after the French doctor Prosper Menière, who was the first to attribute such symptoms to the inner ear in 1861. The exact cause of the disease is not yet known. In summary, we assume that Meniere’s disease is a multifactorial disorder of the fluid and electrolyte balance of the inner ear, which can lead to excess pressure in the inner ear fluid that surrounds the sensory cells of the auditory and vestibular organs (so-called “endolamph hydrops”). This triggers the symptoms of Meniere’s triad. Especially in the early stages of the disease, these do not have to occur at the same time.
The disease is characterized by active phases with frequent attacks, followed by quiet phases in which no Menière’s attacks occur for months to years.
In around 10 percent of cases, the disease runs in families. Approximately 30 to 40 percent of those affected develop bilateral disease within 10 years.
Treatment
The treatment of an acute attack depends on the severity and duration of the symptoms. Nausea and dizziness are dampened by medication (so-called antiemetics / antivertiginosa). In cases of severe vomiting, these can also be administered intravenously. In the case of severe and persistent hearing loss, corticosteroids are used in tablet form or as an injection into the middle ear (intratympanic).
Attack prophylaxis, i.e. therapy to prevent further attacks, is complicated by the fact that there are currently only a few measures whose effectiveness has been proven in so-called double-blind, randomized controlled trials. At the USZ, we use a step-by-step scheme based on the current state of research. Initially, measures that do not impair the function of the vestibular system are used, e.g. a therapy trial with betahistine and / or calcium antagonists or intratympanic administration of corticosteroids.
If this does not achieve satisfactory control of the dizziness attacks for the patient, there is the option of low-dose, titrated intratympanic administration of gentamicin. The good therapeutic success here is “bought” by a partial permanent loss of function of the vestibular organ, which is why this method is classified as a “destructive” or “ablative” procedure and must be carefully weighed up with the patient on a case-by-case basis with all the advantages and disadvantages. Fortunately, a complete “deactivation” of the vestibular organ by high-dose intratympanic administration of gentamicin, surgical destruction of the vestibular organ (labyrinthectomy) or transection of the vestibular nerve (neurotomy) is nowadays only necessary in very rare cases.
Why the USZ
The staff at the ORL Clinic at the USZ have many years of clinical and scientific experience in dealing with this clinical picture. The endolymph hydrops can be visualized using special magnetic resonance imaging. The above-mentioned conservative, minimally invasive and surgical procedures are all available at the ORL Clinic and are applied in the sense of participatory decision-making with the patient (“shared decision making”). If the affected ear becomes deaf in the course of the disease, a cochlear implant can be inserted.
Psychological/psychotherapeutic support is also available as part of the interdisciplinary center for dizziness and neurological visual disorders. Vestibular physiotherapy is used for chronic balance problems (physiotherapy and occupational therapy).
