Meniere's Disease: Symptoms, Diagnosis, and When to See an ENT - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Hello, Miss Hsiao-Hsuan:
A.
Should the above situation warrant a visit to the ENT clinic for further examination?
Q.
Yes.

A.
What examinations should be conducted?
Q.
Hearing and balance tests.

A.
What are the diagnostic criteria for Meniere's disease?
Q.
When the general public mentions dizziness, they often think of "Meniere's," and even general practitioners tend to diagnose it as such.
In reality, there are not as many cases of Meniere's disease; many patients complain of dizziness and are overdiagnosed by physicians.
Therefore, if the number of Meniere's cases is disproportionately high among patients in a neurotology clinic, the medical competence of the physician specializing in dizziness may be called into question.

In simple terms, if a patient experiences dizziness, tinnitus, and hearing loss, the physician will consider this condition.
The renowned Japanese physician Ichiro Chie describes it as a "7 points disease" due to the following characteristics:
1) Severe dizziness: It feels as if the world is spinning, often lasting for several hours, with the first episode being the most intense.

2) Spontaneous dizziness: It occurs without any triggers and can happen suddenly.

3) Recurrent dizziness: Patients with Meniere's disease often experience repeated episodes, rarely having just one occurrence.

4) Reversible dizziness: There are periods of complete normalcy between episodes, and dizziness does not persist for days.

5) Dizziness accompanied by cochlear symptoms: Patients often experience fluctuating hearing, severe tinnitus during acute episodes, and sometimes perceive sounds at different frequencies.

6) Hearing loss is often more pronounced at low frequencies.

7) There is a "reverberation phenomenon," where patients often complain of discomfort in noisy environments, such as markets or train stations.

To date, no laboratory test can definitively diagnose Meniere's disease, making a detailed medical history and basic physical examination crucial.
Patients often experience unforgettable episodes of severe vertigo accompanied by tinnitus, a feeling of ear fullness, and hearing loss.
These episodes do not occur daily, and their duration is not as brief as in "benign paroxysmal positional vertigo" (BPPV), nor as prolonged as in "vestibular neuritis." Most patients experience dizziness for about 3 to 4 hours before gradually improving, but episodes may recur weeks later.

In the clinic, many elderly patients report having recurrent dizziness since their youth, eventually leading to progressive hearing loss and persistent tinnitus.
This condition commonly occurs between the ages of 20 and 40 and has a maternal inheritance pattern.
The underlying cause is endolymphatic hydrops in the inner ear, leading to a sensation of ear fullness.
Treatment primarily involves medical management, including neurotropic agents, vasodilators, and mild sedatives.
If episodes occur once a month, treatment should last at least four months; if they occur every two months, treatment should last at least five months, which is the interval between symptom occurrences plus an additional three months.
If medical treatment is ineffective or the patient cannot tolerate long-term medication, endolymphatic sac decompression surgery may be considered.

Dr.
Da-Wei Yeh, Director of the ENT Department, Shou Hsin Hospital.

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Reply Date: 2009/02/04