Meniere's disease
Introduction
Introduction to Meniere's disease Ménièresdisease is an idiopathic inner ear disease that was first proposed by the French physician Prosper Ménière in 1861. The main pathological change of the disease is hydrocephalus, and the clinical manifestations are recurrent spine vertigo, fluctuating hearing loss, tinnitus and ear swell. The disease occurs mostly in middle and young people between the ages of 30 and 50, and children are rare. There is no significant difference between men and women. About 8-10% of patients with binaural disease. basic knowledge The proportion of the disease: the incidence rate is about 0.001% -0.003%, more common in women Susceptible people: Most of the young people who are 30 to 50 years old Mode of infection: non-infectious Complications: tinnitus, deafness, nausea and vomiting, diarrhea, headache
Cause
Cause of Meniere's disease
The exact cause is still unclear, probably due to labyrinthine spasm, local hypoxia, increased capillary wall permeability, resulting in excessive endolymphatic production, or due to endolymphatic sac absorption disorder, causing membrane lost water. Pathological changes include cochlear and balloon swelling, and the water in the elliptical capsule and semicircular canal is lighter. The endolymphatic pressure is further increased, which may cause rupture of the vestibular, basement membrane or balloon wall.
Prevention
Meniere disease prevention
When you have a seizure, you should lie down, quit, and enter a light and low-salt diet. Limit the amount of water, avoid smoking, alcohol, and tea. In the intermittent period, encourage patients to exercise, enhance physical fitness, and pay attention to work and rest.
Complication
Meniere's disease complications Complications, tinnitus, deafness, nausea and vomiting, diarrhea, headache
About 25% of the tinnitus or deafness gradually appeared after the attack. The deafness is neurotic. The tinnitus is also aggravated when the attack is severe. The patient is often accompanied by dare to blink, nausea, vomiting, pale, sweating, even diarrhea, blood pressure. Most of the patients have a series of symptoms, some patients have headaches; the general patient is conscious.
Symptom
Symptoms of Meniere's disease Common symptoms Dysphagia, nausea, rehabilitation, drug poisoning, tinnitus, ataxia, nystagmus, deafness, dizziness, dysarthria
Typical Meniere's disease has the following four symptoms: dizziness, deafness, tinnitus, and numbness in the ear.
dizziness
Mostly a sudden onset of vertigo. The patient often feels that the surrounding objects rotate around themselves in a certain direction, and the symptoms can be alleviated when the eyes are closed. Often accompanied by nausea, vomiting, pale, cold sweat, blood pressure and other autonomic reflex symptoms. Any movement of the head can make the vertigo worse. The patient's consciousness is always clear, and individual patients remain awake even if they suddenly fall.
The duration of vertigo is usually 10 minutes or hours, and the longest is no more than 24 hours. After the onset of vertigo, it can be transferred to the intermittent period, the symptoms disappear, and the length of the interval varies from person to person, ranging from several days to several years. Dizziness can be repeated, and the duration and severity of each episode of the same patient are not the same, and the patients are different. And the more the number of stun episodes, the longer each episode lasts and the shorter the interval.
deaf
In the early stage, the sensorineural hearing loss, which is mostly low frequency (125-500 Hz), may be volatility, and the hearing loss during the attack period may be partially or completely recovered. As the disease progresses, the hearing loss can gradually increase, and the high frequency (2-8 kHz) hearing loss gradually appears. There is also a special phenomenon of hearing change in this disease: the phenomenon of diplacusis, that is, the sound of the ear and the ear can be heard into two different tones and timbres for the same pure tone. Or when you hear the sound, you have a tail.
tinnitus
Tinnitus may be the earliest symptom of this disease. It can be expressed as a continuous low-key hair sample at the beginning, and a variety of tonic sounds such as ringing, humming, wind blowing, etc. can appear in the late stage. Tinnitus can suddenly appear or worsen before the onset of vertigo. Intermittent tinnitus disappeared, and tinnitus in patients with chronic disease persisted. A small number of patients may have bilateral tinnitus.
Ear swell
During the episode of vertigo, the affected ear may have a feeling of fullness, pressure, and weight in the ear. A small number of patients complained of mild ear pain and itching.
Examine
Meniere's disease check
(1) Cold and heat test: the early vestibular function of the affected side may be normal or mildly declining. After multiple episodes, the dominant side of the healthy side may appear, and the semicircular canal dislocation or loss of function may occur in the late stage.
(2) vestibular evoked myogenic potentials (VEMP): amplitude and threshold abnormalities may occur.
(3) Hennebert sign: When the tibial foot plate is adhered to the inflated balloon, vertigo and nystagmus can be induced when the external auditory canal pressure is increased or decreased. Menener's disease patients with Henenbert's sign can be positive.
2. Cochlear electrogram: Using the characteristics of the cochlear action potential (AP) response threshold close to the hearing threshold to objectively evaluate the hearing threshold of difficult partners, is the most accurate method to identify the location of deafness (conduction, cochlear or sinus).
3. Hearing examination: It is to observe the response caused by acoustic stimulation to understand the state of auditory function and to diagnose the diagnosis of auditory diseases. The purpose is to understand the extent, nature of the hearing loss and the location of the lesion.
4. Imaging examination: CT examination of the tibia can show stenosis of the vestibular aqueduct. The inner eardrum labyrinth MRI under special contrast can show the lymphatic thinning in some patients.
5. Immunological examination: Raoch (1995) reported that 47% of patients with Meniere's disease had HSP70 antibody, and both sides were 58.8%. Gottschlich (1995) used Western blotting to detect antibodies to bovine inner ear antigen in patients with Meniere's disease, showing that 30% of patients have 68 kD antigen antibodies.
Diagnosis
Diagnosis and identification of Meniere's disease
diagnosis
The exact diagnosis of Meniere's disease is almost impossible due to the inability to perform pathological examination of the ear tissue in vivo. At present, the diagnosis of Meniere's disease is mainly based on medical history, comprehensive examination and careful differential diagnosis. After excluding other diseases that may cause dizziness, clinical diagnosis can be made.
According to the criteria of the 2006 Guiyang Conference of the Chinese Academy of Otolaryngology and the Chinese Academy of Otorhinolaryngology Head and Neck Surgery, the diagnosis basis for Meniere's disease in China is:
1. Paroxysmal vertigo 2 or more times, each lasting 20 minutes to several hours. Often accompanied by autonomic dysfunction and balance disorders. Unconscious loss.
2. Volatility hearing loss, mostly low-frequency hearing loss in the early stage, the hearing loss gradually increases with the progress of the disease. At least one pure tone audiometry is a sensorineural hearing loss, and auditory resilience may occur.
3. Accompanied by tinnitus and/or fullness of ear swelling.
4. Exclude vertigo caused by other diseases, such as benign paroxysmal positional vertigo, labyrinthitis, vestibular neuronitis, drug-induced vertigo, sudden deafness, vertebral basilar artery insufficiency and intracranial space-occupying lesions.
