Mnire's disease is a condition of the inner ear. About 1 in a 1,000 people develops Mnire's disease.

It can affect anyone at any age, but it most commonly begins between the ages of 20 and 50. Generally, this condition starts in one ear only. The other ear is also affected at some stage in about 4 in 10 cases. The disease is named after a French doctor called Prosper Mnire who first described the disease in the 1860s.

Causes The inner ear has fluid-filled tubes called semicircular canals, or labyrinths. The canals, along with a nerve in your skull, help interpret your body's position and maintain your balance. Meniere's disease occurs when a part of the canal, called the endolymphatic sac, becomes swollen. This sac helps filter and remove fluid in the semicircular canals.

The exact cause of Meniere's disease is unknown. It may be related to: Head injury Middle ear infection Syphilis Other risk factors include: Allergies Alcohol use Fatigue Recent viral illness Respiratory infection Smoking Stress Use of certain medications, including aspirin

Pathophysiology It may result from overproduction or decreased absorption of endolymph- the fluid contained in the labyrinth of the ear. Accumulated endolymph dilates the semicircular canals, urticle, and saccule and causes degeneration of the vestibular and cochlear hair cells. Over stimulation of the vestibular branch of cranial nerve VIII impairs postural reflexes and stimulates the vomiting reflex. Perception of sound is impaired as a result of this excessive cranial nerve stimulation, and injury to sensory receptors for hearing may affect auditory acuity. This condition may stem from autonomic nervous system dysfunction that produces a temporary constriction of blood vessels supplying the inner ear. Complications include continued tinnitus and hearing loss.

Symptoms Abnormal sensations of movement (vertigo) Gets worse with sudden movement Lasts for a few minutes to several hours May come and go Dizziness Hearing loss in one or both ears Low frequency noises lost first Extent of hearing loss may change Noises or ringing in the ear (tinnitus) Sudden episodes of complete disorientation that causes the person to fall down Sweating (may be heavy) Uncontrollable eye movements Vomiting and nausea

Exams and Tests A neurological examination may show problems with hearing, balance, or eye movement. A procedure called caloric stimulation tests eye reflexes by warming and cooling the inner ear with water. Abnormal results on this test can be a sign of Meniere's disease. Additional tests done to distinguish Meniere's disease from other causes of vertigo may include: Evoked potential studies Electronystagmography Head CT scan or head MRI scan Hearing tests (audiology/audiometry)

Treatment There is no known cure for Meniere's disease. The goal of treatment is to reduce pressure in the inner ear and relieve symptoms. Medications such as antihistamines, anticholinergics, are used but are rarely effective. Water pills (diuretics) may help relieve fluid pressure in the inner ear. A low-salt diet to reduce fluid retention may also help Medicines called antiemetics may be prescribed for nausea and vomiting. Symptoms such as dizziness, and vertigo may respond to sedative/hypnotics and benzodiazepines such as diazepam. Ear surgery may be required if symptoms are severe and do not respond to other treatment. Hearing aids may be needed for severe hearing loss. Avoid sudden movements that may aggravate symptoms. You may need help walking due to loss of balance during attacks. Avoid bright lights, TV, and reading during attacks, which may make symptoms worse. Rest during severe episodes, and gradually increase activity. Avoid hazardous activities such as driving, operating heavy machinery, climbing, and similar activities until 1 week after symptoms disappear.