FitSugar

Are You at Risk For Meniere's Disease?

FitSugar — Tue, 02 Dec 2008 11:00:00 -0800

If you've ever had a little too much to drink, you probably experienced that dizzy sensation where you feel like the room is spinning, know as vertigo in medical-ese. Unfortunately, people diagnosed with Meniere's disease don't have to drink in order to experience such debilitating dizzy spells. Vertigo episodes occur out of the blue, with no apparent cause, in some cases lasting up to eight hours. Aside from dizziness, this disease may also cause ringing in the ear (tinnitus), hearing loss, sweating, uncontrollable eye movements, and vomiting.

Sounds unbearable. To find out if you're at risk for Meniere's disease read more.

Meniere's is a disorder of the inner ear that usually occurs in men and women in their 30s. Scientists aren't sure what causes this disease, but it may be related to any of these reasons: middle ear or respiratory infections, stress, fatigue, syphilis, Lyme disease, a history of allergies, smoking, alcohol use, or head injury. Although Meniere's is not contagious, it may be genetic.

Unfortunately, there's no known cure for Meniere's disease, but a person can help prevent dizzy episodes by lowering the endolymphatic pressure in her inner ear. To do this, medication may help, as well as stress reduction and a low-sodium, no caffeine, no alcohol diet. If symptoms become severe and the person can't work or drive, surgery may be necessary. If these symptoms sound familiar, it's best to get tested by your doctor.

Source

Vertigo-associated disorders

admin — Wed, 03 Sep 2008 17:56:28 -0700

Illustrations

Tympanic membrane

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Vertigo is a sensation of motion or spinning that leads to dizziness and discomfort.

Vertigo is not the same as light-headedness. People with vertigo feel as though they are actually spinning or moving, or that the environment itself is spinning.

Causes, incidence, and risk factors

There are two types of vertigo:

Peripheral vertigo occurs if there is a problem with the part of the inner ear that controls balance (vestibular labyrinth or semicircular canals) or with the vestibular nerve, which connects the inner ear to the brainstem.
Central vertigo occurs if there is a problem in the brain, particularly in the brainstem or the cerebellum (back part of the brain).

Vertigo related to the inner ear may be caused by:

Benign positional vertigo (recurrent attacks of vertigo, especially when the head is in certain positions)
Drugs called aminoglycoside antibiotics
Ménière's disease
Labyrinthitis
Injury

Vertigo related to the vestibular nerve may be caused by:

Inflammation (neuronitis)
Nerve compression (usually a benign tumor such as a meningioma or schwannoma)

Vertigo related to the brainstem may be caused by:

Multiple sclerosis
Blood vessel disease
Migraine
Drugs (anticonvulsants, aspirin, alcohol)

Symptoms

The primary symptom is a sensation that you or the room is moving or spinning. With central vertigo, there are usually other symptoms associated with the condition that is causing the vertigo. Associated symptoms include the following:

Double vision
Difficulty swallowing
Facial paralysis
Slurred speech
Weakness of the limbs

The spinning sensation may cause nausea and vomiting in some people.

Signs and tests

A physical exam may reveal eye movement problems, lack of coordination and balance, weakness, or sensory loss. These signs may suggest a central cause.

Nystagmus (involuntary eye movements) and hearing loss may be present in both central and peripheral vertigo.

Tests to determine the cause of vertigo may include:

Head CT
MRI scan of head and MRA scan of blood vessels of the brain
Caloric stimulation (tests eye reflexes)
Electronystagmography
EEG, evoked auditory potential studies
Lumbar puncture
Blood tests

Treatment

Medications to treat peripheral vertigo may include:

Antihistamines (such as meclizine)
Anticholinergics
Benzodiazepines
Promethazine (to treat nausea and vomiting)

The cause of central vertigo should be identified and treated as appropriate.

Try to avoid head positions that cause vertigo. Use caution in situations such as driving, walking, or operating heavy equipment. Even short episodes of vertigo may be dangerous.

Expectations (prognosis)

The outcome depends on the cause.

Complications

Persistent, unrelieved vertigo can interfere with driving, work, and lifestyle. It can also cause falls which can in turn lead to hip fractures.

Calling your health care provider

Call for an appointment with your health care provider if vertigo is persistent or troublesome.

References

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St. Louis, Mo: Mosby; 2005:3226.

Rakel P, ed. Conn’s Current Therapy 2005. 57th ed. Philadelphia, PA: WB Saunders; 2005:226-227.

Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, PA: WB Saunders; 2004:240-241.

Review Date: 11/21/2006

Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

Source Doc: 1_001432

Benign positional vertigo

admin — Wed, 03 Sep 2008 17:56:23 -0700

Overview

Definition
Alternative Names
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Expectations (prognosis)
Complications
Calling your health care provider
Prevention
References

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Benign positional vertigo causes sudden sensations of spinning, typically provoked by head movement.

Alternative Names

Vertigo - positional

Causes, incidence, and risk factors

Benign positional vertigo is the most common cause of vertigo. It is caused by a disturbance within the balance organs of the inner ear. The inner ear has tiny stones that move as you change position, allowing your brain to interpret your body's position and maintain your balance. In benign positional vertigo, these stones break off and float free within the semicircular canals of the inner ear. This may happen in one ear more than another, sending the brain confusing messages about your body's position. The result is vertigo.

There are no major risk factors that make you more likely to get benign positional vertigo, although it may be partly hereditary. Also, a prior head injury or an infection of the balance organs (labyrinthitis) may make some people more likely to get benign positional vertigo.

Symptoms

Vertigo, or a spinning sensation, is the main symptom. The sensation often starts suddenly and can be triggered by head movement. Most often, affected patients complain of the inability to roll in bed or to look up high at something. When severe, the vertigo is often accompanied by vomiting. Patients may also have visual complaints, such as a perception that things are jumping or moving.

Signs and tests

To make a diagnosis, the doctor will often have you perform a test called the Dix-Hallpike maneuver. In this procedure, the doctor holds your head in a certain position and asks you to lie quickly backward over a table. As you do this, the doctor will look for abnormal eye movements and ask if you experience vertigo. The doctor may use various methods to help evaluate your eye movements.

The results of the rest of the physical exam are otherwise normal. In some cases, differentiation from other causes of vertigo may be needed. In this case, tests may include:

Head CT
Head MRI
Head MRA
Caloric stimulation (tests eye reflexes)
Electronystagmography
EEG
Evoked auditory potential studies

Treatment

The most effective treatment is a procedure called "Epley's maneuver", which can reposition the stones inside your inner ear. There are other exercises that can readjust your response to head movements. Occasionally, medications such as antihistamines, anticholinergics, and sedative-hypnotics may be prescribed to reduce the symptoms of vertigo, although these are often minimally effective.

Expectations (prognosis)

Benign positional vertigo is uncomfortable, but it is not medically dangerous, and usually improves with time. This condition may re-occur unpredictably.

Complications

Patients with severe vertigo may get dehydrated due to frequent vomiting.

Calling your health care provider

Call your health care provider if vertigo develops that has not been evaluated or if treatment is ineffective. Also call if you develop any associated symptoms (such as weakness, slurred speech, visual problems) that may indicate a more serious condition.

Prevention

Avoid head positions that trigger positional vertigo.

References

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo: Mosby; 2005:3226.

Rakel P. Conn’s Current Therapy 2005. 57th ed. Philadelphia, Pa: WB Saunders; 2005:226-227.

Goldman L, Ausiello D. Cecil Textbook of Medicine. 22nd ed. Philadelphia, Pa: WB Saunders; 2004:240-241.

Review Date: 8/6/2007

Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_001420

Vertigo

admin — Thu, 04 Sep 2008 19:31:25 -0700

Back

HEALTH GUIDE REFERENCE FROM A.D.A.M

Rotational head movements cause the fluid in the cupula of the semicircular canal to "bend" the hair cells. The hair cells, in turn, send a signal to your brain that you are experiencing "motion".

Vertigo can occur when these hair cells are still sending signals of motion, even though you may be perfectly still, giving you the "illusion of movement".

Review Date: 5/3/2006

Reviewed By: A.D.A.M. Medical Illustration Team

A.D.A.M. Copyright

adam.com

Source Doc: 2_19706

Dizziness

admin — Thu, 04 Sep 2008 19:05:12 -0700

Overview

Definition
Alternative Names
Common Causes
Home Care
Call your health care provider if
What to expect at your health care provider's office
Prevention
References

Illustrations

Carotid stenosis, X-ray of the left artery

Carotid stenosis, X-ray of the right artery

Vertigo

Balance receptors

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Dizziness is lightheadedness, feeling like you might faint, being unsteady, loss of balance, or vertigo (a feeling that you or the room is spinning or moving).

Most causes of dizziness are not serious and either quickly resolve on their own or are easily treated.

Alternative Names

Lightheadedness - dizzy; Loss of balance; Vertigo

Common Causes

Lightheadedness happens when there is not enough blood getting to the brain. This can happen if there is a sudden drop in your blood pressure or you are dehydrated from vomiting, diarrhea, fever, or other causes. Many people, especially as they get older, experience lightheadedness if they get up too quickly from a lying or seated position. Lightheadedness often accompanies the flu, hypoglycemia, common cold, or allergies.

More serious conditions that can lead to lightheadedness include heart problems (such as abnormal heart rhythm or heart attack), stroke, and severe drop in blood pressure (shock). If any of these serious disorders is present, you will usually have additional symptoms like chest pain, a feeling of a racing heart, loss of speech, change in vision, or other symptoms.

The most common causes of vertigo are benign positional vertigo and labyrinthitis. Benign positional vertigo is vertigo that happens when you change the position of your head. Labyrinthitis usually follows a cold or flu and is caused by a viral infection of the inner ear. Meniere's disease is another common inner ear problem. It causes vertigo, loss of balance, and ringing in the ears.

Much less commonly, vertigo or feeling unsteady is a sign of stroke, multiple sclerosis, seizures, a brain tumor, or a bleed in your brain. In such conditions, other symptoms usually accompany the vertigo or imbalance.

Home Care

If you tend to get lightheaded when you stand up, avoid sudden changes in posture.

If you are thirsty or lightheaded, drink fluids. If you are unable to keep fluids down from nausea or vomiting, you may need intravenous fluids. These are delivered to you at the hospital.

Most times, benign positional vertigo and labyrinthitis go away on their own within a few weeks. During attacks of vertigo from any cause, try to rest and lie still. Avoid sudden changes in your position as well as bright lights. Be cautious about driving or using machinery.

Some vertigo can be reduced by working with a physical therapist. Medications from your doctor may help you feel better.

Such medications include antihistamines, sedatives, or pills for nausea. For Meniere's disease, surgery may be necessary.

Call your health care provider if

Call 911 or go to an emergency room if someone with dizziness also has:

A head injury
Fever over 101°F, headache, or very stiff neck
Convulsions or ongoing vomiting
Chest pain, heart palpitations, shortness of breath, weakness, inability to move an arm or leg, or change in vision or speech
Fainting and losing consciousness for more than a few minutes

Call your doctor if:

You have never had dizziness before.
Symptoms you have had in the past are different (for example, last longer than usual, are worse than before, or are interfering with your daily activities).
Medication is the suspected cause. Talk to your health care provider before making any changes to your medication.
You have any hearing loss.

What to expect at your health care provider's office

Your doctor will perform a physical exam, focusing on your heart, head, ears, and nervous system, and ask question such as:

Does your dizziness feel like lightheadedness, vertigo, or imbalance?
Does your dizziness occur with a change in body position?
What other symptoms occur when you feel dizzy?
When did your dizziness begin?
Are you always dizzy or does the dizziness come and go?
How long does the dizziness last (minutes, hours)?
Did another illness develop before or after the dizziness began? How much later?
Have you had any nausea and vomiting?
Do you have a significant amount of stress or anxiety?

Diagnostic tests that may be performed include:

Blood pressure measurements and tests
ECG
Hearing tests
Neurological tests
Balance testing (ENG) may be required.
MRI

Prevention

Promptly treat ear infections, colds, flus, sinus congestion, and other respiratory infections. This may help prevent labyrinthitis and Meniere's disease.

If you have a cold, the flu, or other viral illness, drink plenty of fluids to prevent getting dehydrated.

References

da Costa SS. Meniere's disease: overview, epidemiology, and natural history. Otolaryngol Clin North Am. 2002; 35(3): 455-495.

Tusa RJ. Dizziness. Med Clin North Am. 2003; 87(3): 609-641, vii.

Swartz R. Treatment of vertigo. Am Fam Physician. 2005; 71(6): 1115-1122.

Review Date: 4/3/2007

Reviewed By: A.D.A.M. Editorial Team: Greg Juhn, M.T.P.W., David R. Eltz, Kelli A. Stacy. Previously reviewed by Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network (5/16/2006).

A.D.A.M. Copyright

adam.com

Source Doc: 1_003093

Caloric stimulation

admin — Thu, 04 Sep 2008 19:10:12 -0700

Overview

Definition
Alternative Names
How the test is performed
How to prepare for the test
How the test will feel
Why the test is performed
Normal Values
What abnormal results mean
What the risks are
Special considerations
References

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Caloric stimulation is a test which uses differences in temperature to diagnose ear nerve damage.

Alternative Names

Caloric test

How the test is performed

This test stimulates the inner ear and nearby nerves by delivering cold and warm water to the ear canal at different times. Sometimes, the test is done using air instead of water.

One ear is tested at a time.

When cold water enters the ear, it should cause rapid, side-to-side eye movements called nystagmus. The eyes should move away from the cold water and slowly back.

Next, warm water is placed into the ear. The eyes should now move towards the warm water then slowly away.

Patches called electrodes, placed around the eyes, detect the movements. A computer records all the results.

Ice cold water may be used if there are no responses.

How to prepare for the test

Do not eat a heavy meal before the test. Avoid caffeine, alcohol, allergy medications, and sedatives at least 24 hours prior to the test, as these can affect the results. (However, do not stop taking medicines without first talking to your doctor.)

How the test will feel

Some people find cold water in the ear uncomfortable. Brief, but severe vertigo may occur during the test.

Why the test is performed

Caloric stimulation is done to check the acoustic nerve, which provides hearing and helps with balance.

This test may be recommended if you have:

Dizziness or vertigo
Hearing loss that may be due to certain antibiotics
Certain types of anemia
Possible psychological causes of vertigo

It may also be done to look for brain damage in persons in a coma.

Normal Values

Rapid, side-to-side eye movements should occur when cold or warm water is placed into the ear. The eye movements should be similar on both sides.

What abnormal results mean

Abnormal results mean there may be damage to the nerve of the inner ear, which controls balance. If the rapid, side-to-side eye movements do not occur even after ice cold water is given, permanent damage to the nerve has probably occurred.

Abnormal results may suggest:

Congenital disorders (present at birth)
Trauma
Rubella
Blood vessel disorders with hemorrhage (bleeding)
Blood clots
Atherosclerosis of the blood supply of the ear
Cholesteatoma and other ear tumors
Certain types of poisonings
Damage to the ear nerves due to ceratin antibiotics, antimalarial drugs, diuretics, and salicylates

The test may also be done to diagnose or rule out:

What the risks are

Excessive water pressure can injure a previously damaged eardrum, but this rarely occurs since the amount of water to be used is measured in advance. Caloric stimulation should not be performed if the eardrum is perforated because of the risk of causing ear infection. Caloric testing should not be performed during an acute vertigo episode as it can make symptoms worse.

Special considerations

Caloric stimulation is approximately 80% accurate in differentiating nerve damage as a cause of vertigo. Other tests may be required to confirm the diagnosis.

References

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo; Mosby; 2005:3179-3189.

Casselbrant ML. Balance disorders in children. Neurol Clin. Aug 2005; 23(3): 807-29, vii.

Review Date: 2/12/2007

Reviewed By: Alden J. Pearl, M.D., Clinical Assistant Professor, Department of Otolaryngology, State University of New York Health Science Center at Brooklyn, Brooklyn, NY. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_003429

Electronystagmography

admin — Thu, 04 Sep 2008 19:10:26 -0700

Overview

Definition
Alternative Names
How the test is performed
How to prepare for the test
How the test will feel
Why the test is performed
Normal Values
What abnormal results mean
What the risks are

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Electronystagmography is a test to look at voluntary and involuntary eye movements. It evaluates the acoustic nerve, which aids with hearing and balance.

Alternative Names

ENG

How the test is performed

Patches called electrodes (similar to those used with ECG, but smaller) are placed to above, below, and to the side of each eye. They may be attached by adhesive or by a band around the head. Another electrode is attached to the forehead.

The electrodes record eye movements when a standard caloric stimulation test is done. This test stimulates the inner ear and nearby nerves by delivering cold and warm water to the ear canal at different times. Sometimes, the test is done using air instead of water. Each ear is tested separately.

When cold water enters the ear, it should cause rapid, side-to-side eye movements. The eyes should move away from the cold water and slowly back. Next, warm water is placed into the ear. The eyes should now move towards the warm water then slowly away.

Patients may also be asked to use their eyes to track objects, such as flashing lights.

The electrodes detect the length and speed of eye movements, and a computer records the results.

The test takes about 90 minutes.

Electronystagmography provides exact measurements of eye movements rather than the objective observation of standard caloric stimulation. It can record behind closed eyelids or with the head in a variety of positions.

How to prepare for the test

No preparation is necessary. Check with your health care provider if you are taking any medications.

How the test will feel

There is minimal discomfort. You may find cold water in the ear uncomfortable. Brief vertigo may occur during the test.

Why the test is performed

The test is used to determine whether a balance or nerve disorder is the cause of dizziness or vertigo.

Your doctor may order this test if you have dizziness or vertigo, impaired hearing, or suspected toxicity from certain antibiotics.

Normal Values

Distinct involuntary eye movements should occur after instillation of cold or hot water into the ear canal.

What abnormal results mean

Abnormal results may be a sign of damage to the nerve of the inner ear or other parts of the brain that control eye movements.

Any disease or injury that damages the acoustic nerve can cause vertigo. This may include:

Congenital disorders
Injury
Rubella
Blood vessel disorders with hemorrhage (bleeding), clots, or atherosclerosis of the blood supply of the ear
Cholesteatoma and other ear tumors
Some poisons
Medications that are toxic to the ear nerves, including aminoglycoside antibiotics, some antimalarial drugs, loop diuretics, and salicylates
Multiple sclerosis
Movement disorders such as progressive supranuclear palsy

Additional conditions under which the test may be performed:

What the risks are

A risk is associated with the caloric stimulation part of the test. Excessive water pressure can injure a previously damaged eardrum, but this rarely occurs. Caloric stimulation should not be performed if your eardrum has been perforated because of the risk of causing ear infection.

Review Date: 4/30/2007

Reviewed By: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_003448

Labyrinthitis

admin — Wed, 03 Sep 2008 17:54:06 -0700

Overview

Definition
Alternative Names
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Expectations (prognosis)
Complications
Calling your health care provider
Prevention

Illustrations

Ear anatomy

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Labyrinthitis is an ear disorder that involves irritation and swelling of the inner ear.

Alternative Names

Bacterial labyrinthitis; Serous labyrinthitis

Causes, incidence, and risk factors

The cause of labyrinthitis is unknown. However, it commonly occurs after otitis media (ear infection) or an upper respiratory infection, so it is thought to be related to infection with a virus or bacteria. It may also follow allergy, cholesteatoma, or after taking certain drugs that are dangerous to the inner ear.

During labyrinthitis, the parts of the inner ear become irritated and inflamed. This interferes with their function, which includes the ability to keep your balance.

The following raise your risk for labyrinthitis:

Recent viral illness, respiratory infection, or ear infection
Use of certain prescription or nonprescription drugs (especially aspirin)
Stress
Fatigue
History of allergies
Smoking
Drinking large amounts of alcohol

Symptoms

Dizziness
Abnormal sensation of movement (vertigo), possibly severe, with nausea and vomiting
Loss of balance, especially falling toward the affected side
Hearing loss in the affected ear
Ringing or other noises in the ears (tinnitus)
Involuntary eye movements (nystagmus)

Signs and tests

An ear examination may not reveal any problems. Tests will be done to rule out other causes of dizziness or vertigo. These may include:

Head CT scan
MRI scan
Hearing testing (audiology/audiometry)
Caloric stimulation (tests reflexes of the eye)
Electronystagmography
EEG
Evoked auditory potential studies

Treatment

Labyrinthitis usually goes away within a few weeks. However, symptoms may need treatment. Your doctor may prescribe an antibiotic to treat the infection. Medications that may reduce symptoms include the following:

Antihistamines
Anticholinergics
Sedative-hypnotics
Anti-emetics (antinausea medications)
Benzodiazepines

To prevent worsening of symptoms during episodes of labyrinthitis, try the following:

Keep still and rest during attacks.
Gradually resume activity.
Avoid sudden position changes.
Do not try to read during attacks.
Avoid bright lights.

You may need help walking during attacks. Avoid hazardous activities such as driving, operating heavy machinery, and climbing until 1 week after symptoms have disappeared.

Expectations (prognosis)

Hearing usually returns to normal.

Complications

Injury to self or others during attacks of vertigo
Permanent hearing loss (rare)
Spread of inflammation to other ear areas or to the brain (rare)

Calling your health care provider

Call your health care provider if dizziness, vertigo, loss of balance, or other symptoms of labyrinthitis are present. Also call if hearing loss occurs.

Urgent or emergency symptoms include convulsions, fainting, persistent vomiting, or vertigo accompanied by fever of more than 101 degrees Fahrenheit.

Prevention

Prompt treatment of respiratory infections and ear infections may help prevent labyrinthitis.

Review Date: 8/3/2006

Reviewed By: Alden J. Pearl, M.D., Clinical Assistant Professor, Department of Otolaryngology, State University of New York Health Science Center atBrooklyn, Brooklyn, NY. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_001054

Meniere’s disease

admin — Wed, 03 Sep 2008 17:51:28 -0700

Overview

Definition
Alternative Names
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Expectations (prognosis)
Complications
Calling your health care provider
Prevention

Illustrations

Ear anatomy

Tympanic membrane

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Meniere's disease is a disorder of the inner ear affecting balance and hearing, characterized by abnormal sensation of movement (vertigo), dizziness, loss of hearing in one or both ears, and noises or ringing in the ear (tinnitus).

Alternative Names

Hydrops; Endolymphatic hydrops

Causes, incidence, and risk factors

The fluid-filled semicircular canals (labyrinths) of the inner ear, in conjunction with the cranial nerve VIII, control balance and sense of body position. Meniere's disease involves a swelling of part of the canal (endolymphatic sac). The endolymphic sac controls the filtration and excretion of the fluid in the semicircular canals.

The exact cause of Meniere's disease is unknown. In some cases, it may be related to middle ear infection (otitis media), syphilis, or head injury. Other risk factors include recent viral illness, respiratory infection, stress, fatigue, use of prescription or nonprescription drugs including aspirin, and a history of allergies, smoking, and alcohol use. There may be genetic risk factors as well.

About 100,000 people per year develop Meniere's disease.

Symptoms

Abnormal sensation of movement of self or the environment (vertigo)
- May be episodic
- Lasts from minutes to more than 8 hours
- Worse with sudden movement
Dizziness
Hearing loss in one ear
- Low frequency noises lost first
- Extent of hearing loss may change
Noises or ringing in one ear (tinnitus)
Nausea, vomiting
Sweating (may be profuse)
Uncontrollable eye movements

Signs and tests

A neurologic examination may show an abnormality of cranial nerve VIII that may include abnormalities of hearing, balance, or eye movement.

Tests to distinguish Meniere's disease from other causes of vertigo may include:

Head CT scan or head MRI scan
Caloric stimulation (tests reflexes of the eyes) -- abnormal results indicate Meniere's disease
Evoked potential studies (BAER)
Electronystagmography
Audiology/audiometry

Treatment

There is no known cure for Meniere's disease. Treatment is focused on lowering the pressure within the endolymphatic sac and on treating symptoms, which tend to occur in discrete "attacks."

Medications such as antihistamines, anticholinergics, and diuretics may lower endolymphatic pressure by reducing the amount of endolymphatic fluid. A low-salt diet to reduce fluid retention may also help (see sodium in diet).

Symptoms such as dizziness, vertigo, and associated nausea and vomiting may respond to sedative/hypnotics, benzodiazepines like diazepam, and anti-emetics.

Surgery on the labyrinth, endolymphatic sac, or the vestibular nerve 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. Help may be needed with walking due to loss of balance during attacks. Rest during severe episodes, and gradually increase activity. During episodes, avoid bright lights, TV, and reading, which may make symptoms worse.

Avoid hazardous activities such as driving, operating heavy machinery, climbing, and similar activities until one week after symptoms disappear.

Physical therapy aimed at acclimation to various positions may be useful.

Expectations (prognosis)

The outcome varies. Meniere's disease can often be controlled with treatment. Recovery may occur spontaneously. However, the disorder may be chronic or disabling.

Complications

Inability to walk or function due to uncontrollable vertigo
Hearing loss on the affected side

Calling your health care provider

Call for an appointment with your health care provider if symptoms of Meniere's disease, such as hearing loss, ringing in the ears, or dizziness, occur or worsen.

Prevention

There is no known prevention for Meniere's disease, but prompt treatment of ear infection and other related disorders may be helpful.

Review Date: 8/7/2006

Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_000702

Acoustic neuroma

admin — Wed, 03 Sep 2008 17:51:56 -0700

Overview

Definition
Alternative Names
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Expectations (prognosis)
Complications
Calling your health care provider
References

Illustrations

Central nervous system

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

An acoustic neuroma is a noncancerous (benign), often slow-growing tumor of the nerve that connects the ear to the brain.

Alternative Names

Vestibular schwannoma; Tumor - acoustic; Cerebellopontine angle tumor; Angle tumor

Causes, incidence, and risk factors

These tumors are thought to occur when there is a defect in a gene that normally prevents tumors from forming. The cause of the genetic defect is not known. However, acoustic neuroma is often linked with the genetic disorder neurofibromatosis type 2 (NF2).

Acoustic neuromas are relatively uncommon, but they are one of the most common types of brain tumors.

The tumor is usually found at the base of the brain.

Symptoms

The symptoms vary based on the size and location of the tumor. Because the tumors grow so slowly, symptoms usually start after the age of 30.

Common symptoms include:

Abnormal sensation of movement (vertigo)
Hearing loss in the affected ear
Ringing (tinnitus) in the affected ear

Less common symptoms include:

Difficulty understanding speech
Dizziness
Headache
- Upon waking up in the morning
- Wakes you from sleep
- Worse when lying down
- Worse when standing up
- Worse when coughing, sneezing, straining, or lifting (Valsalva maneuver)
- With nausea or vomiting
Loss of balance
Numbness in the face or one ear
Pain in the face or one ear
Vision abnormalities that are temporary
Weakness of the face

Signs and tests

The health care provider may diagnose an acoustic neuroma based on your medical history, an examination of your nervous system, or tests. A physical examination may show the following signs:

If the tumor is large, there may also be signs of increased pressure on the brain (increased intracranial pressure), including the following:

Dilated pupil on one side only (see eyes, pupils different size)
Nausea and vomiting
Sleepiness

The most useful test to identify acoustic neuromas is an MRI of the head. Other useful tests used to diagnose acoustic neuroma and to tell it apart from other causes of dizziness or vertigo include:

Head CT
Hearing test (audiology)
Test of equilibrium and balance (electronystagmography)
Test of hearing and brainstem function (brainstem auditory evoked response)
Test for vertigo (caloric stimulation)

Treatment

Surgery
- Goals of surgery are to remove the tumor and prevent paralysis of the face. Preserving hearing is more difficult. If a tumor is removed when it is very small, hearing may be preserved. You cannot get back any hearing that is lost before surgery. Large tumors usually result in total loss of hearing on the affected side.
- Large tumors may also press down on nerves important for movement and feeling in the face. These tumors can typically be safely removed, but the surgery often leads to paralysis of some muscles of the face.
- Extremely large tumors may also press on the brainstem, threatening other nerves and preventing the normal flow of cerebrospinal fluid. This can lead to a build-up of fluid (hydrocephalus), which can increase pressure in the head and can be life-threatening. Goals of surgery in these cases are to treat the hydrocephalus and relieve pressure on the brainstem.
Stereotactic radiosurgery
- The goal of radiation therapy is to slow or stop the tumor growth, not to cure or remove the tumor.
- Radiosurgery is often performed in elderly or sick patients who are unable to tolerate brain surgery.
- Sometimes during brain surgery to treat acoustic neuromas, not all of the tumor can be safely removed, and some of the tumor must be left behind. Radiosurgery is often used after surgery in these cases to treat the tumor that remains.
- Radiosurgery is only appropriate for small tumors, so that radiation damage to surrounding tissues can be minimized.
- Like brain surgery, radiosurgery can sometimes result in paralysis of the face or loss of hearing.
Observation
- Since these tumors usually grow very slowly, small tumors that have few or no symptoms can be safely watched with regular MRI scans and left untreated unless they grow dangerously.
- Very often elderly patients will die of other natural causes before small, slow growing tumors show symptoms.

Expectations (prognosis)

Acoustic neuromas are not cancer. They do not spread (metastasize) to other body systems, but they may continue to grow and press down on important structures in the skull.

Complications

Brain surgery can completely remove the tumor in most cases.
Most people with small tumors will have no permanent paralysis of the face after surgery. However, about two-thirds of patients with large tumors will have some permanent facial weakness after surgery.
Approximately one-half of patients with small tumors will get back useful hearing in the affected ear after surgery.
There may be delayed radiation effects after radiosurgery, including nerve damage, loss of hearing, and paralysis of the face.

Calling your health care provider

Call your health care provider if you experience new or worsening hearing loss or vertigo (dizziness).

References

Abram S, Rosenblatt P, Holcomb S. Stereotactic radiation techniques in the treatment of acoustic schwannomas. Otolaryngol Clin North Am. 2007;40:571-588.

Bennett M, Haynes DS. Surgical approaches and complications in the removal of vestibular schwannomas. Otolaryngol Clin North Am. 2007;40:589-609.

Backous DD, Pham HT. Guiding patients through the choices for treating vestibular schwannomas: balancing options and ensuring informed consent. Otolaryngol Clin North Am. 2007;40:521-540.

Review Date: 4/23/2008

Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery and Gene Therapeutics Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

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