Menyer's disease

Description:

Menyer's disease (Menyer's syndrome) — the disease of an inner ear causing increase in amount of liquid in his cavity. This symptom complex was described in 1861 by the French doctor Prosper Menyer and was soon recognized an independent nosological form.
Disease attacks, as a rule, repeatedly repeat, and hearing slowly goes down from an attack to an attack though, despite it, there can be a long time satisfactory. It was noted that attacks of dizziness accompany sometimes a number of diseases, in particular a nervous system, a metabolism, closed glands, various pathology of a middle ear, an injury, etc. External similarity gave a reason to call such dizzinesses the term - "Menyer's syndrome". However the speech in such cases goes about absolutely other nature of diseases which are often designated as a vestibulopathy or a kokhleovestibulopatiya.

Symptoms of the Disease of Menyer:

Menyer's disease is characterized by a classical triad:
    * the attacks of a rotatory vertigo which are followed by disorder of balance, nausea, vomiting and other various vegetative manifestations;
    * the progressing decrease in hearing on one or both ears;
    * noise in one or both ears.
At long observation of patients the bilateral hearing disorder, as a rule, is defined at Menyer's disease. The typical onset of the illness, with simultaneous disturbance of acoustical and vestibular functions, occurs approximately at 1/3 patients. At a half of patients the disease begins with acoustical frustration, at some, on the contrary, the vestibular symptomatology originally develops. Emergence of acoustical and vestibular symptoms can differ on time.
The most burdensome symptom of a disease of Menyer - dizziness attacks. Frequency of attacks can be various - 1-2 times in week or in month (frequent), 1-2 times in a year (rare), 1 times in several years (incidental). Attack duration from several minutes to several days, but is more often than 2-6 h. Attacks happen at any time, but is more often at night or in the morning. The physical or mental overstrain can be the provocative moment. Sometimes the patient feels approach of an attack in several hours or even days, but it can arise also at absolutely healthy person. Dizziness at the time of an attack is more often shown by feeling of rotation or shift of surrounding objects; weight of a condition of the patient at the time of an attack substantially is defined by expressiveness of vegetative symptoms (nausea, vomiting, the strengthened sweating, increase or lowering of arterial pressure, etc.). As a rule, at the time of an attack noise in a sore ear amplifies, there is a feeling of a congestion and devocalization. An objective sign of an attack is the spontaneous nystagmus which disappears soon after the termination of an attack. At the time of an attack balance is broken, quite often considerably so the patient is not capable to keep standing, aims to accept horizontal position, more often blindly. Any turn of the head, attempt to change a pose leads to an aggravation of symptoms and strengthening of nausea and vomiting. After an attack for some time (6-48 h) the patient feels weakness, the lowered working capacity. During the remission continuing within several months or even years, the state remains satisfactory.

Menyer etiologies:

The disease etiology Menyera is unknown. The following reasons of its emergence are most often mentioned: angioneurosis, vegetative dystonia, disturbance of exchange of an endolymph and ionic balance of intra-labyrinth liquids; vasculomotor and neurotrophical frustration; infection and allergy; disturbance of food, vitamin and water exchange.
All these theories do not explain either a long unilaterality of a disease, or frequency of attacks, or their symptomatology. Along with the specified probable causes it is necessary to allow possible existence and other contributing factors. Now, explaining essence of a disease, consider the final cause of a disease intra labyrinth hypostasis. On autopsy the typical picture of an endolymphatic edema (hydrodog) of a labyrinth is morphologically confirmed.
The point of view according to which development of pathological symptoms at Menyer's disease is connected with increase in amount of labyrinth liquid (endolymph) that leads to labyrinth hypertensia is most widespread. The mechanism of development of an endolim-fatichesky hydrodog and labyrinth hypertensia at the same time comes down to three highlights: hyperproduction of an endolymph, decrease in its resorption and disturbance of permeability of membrane structures of an inner ear. Increase in intra labyrinth pressure leads to protrusion of the basis of a stirrup and membrane of a window of a snail in a drum cavity. It creates the conditions complicating carrying out a sound wave on liquid systems of an inner ear and also breaks a trophicity of receptor cells of a snail, a threshold and semicircular channels.
The known data on a disease allow to think that endolymph supertension at Menyer's disease violates conditions of life activity of vestibular receptor cells of one party, than irritates them and creates an imbalance on the other hand. After a certain period of such irritation receptors are discharged by vestibular crisis - a dizziness attack. Tension in receptors is dumped.

Treatment of the Disease of Menyer:

Though full treatment from Menyer's disease is impossible, treatment can help to reduce manifestations and to reduce the frequency of their emergence. During an exacerbation of a disease of Menyer drug treatment can stop manifestations of a sudden attack of dizziness, reducing symptoms of nausea and vomiting. Unfortunately, treatment of a disease of Menyer does not help to stop gradual decrease in hearing. Treatment of a disease of Menyer consists in monitoring symptoms, especially dizziness and reduction of frequency of emergence of attacks of disease. First of all treatment of this disease begins with the corresponding diet. It allows to reduce number of attacks of disease in the future.
Treatment is most often directed to reduction of frequency of attacks and weight of an exacerbation of a disease of Menyer, at the same time it includes:
    * Reception of diuretics (diuretics) for the purpose of reduction of accumulation in an inner ear of liquid (endolymph).
    * Restriction of alcohol intake, smoking of tobacco and reception of caffeine, and also the stresses and any states provoking attacks.
    * Administration of drugs, having overwhelming effect on a vestibular mechanism (antihistaminic or sedative) to calm an inner ear.
    * Observance of a diet with the low content of salt to reduce accumulation of liquid in an inner ear.
Also for treatment appoint the means improving cerebral circulation (cinnarizine).
Actions at attacks. At an attack of dizziness it is recommended to lay down and hold the head quietly, without movements, there will not pass the attack yet. For reduction of manifestation of an attack of dizziness antihistaminic drugs can be used (Dimedrol, Suprastinum, Phencarolum, Diazolinum, бетасерк, меклозин etc.). Antiemetics — such as cerucal, Metoclopramidum and others are applied to reduction of nausea and vomiting during an attack.
At inefficiency of conservative treatment of symptoms of a disease of Menyer, surgical intervention is applied. The purpose of surgical treatment at this disease is in eliminating its manifestations, without damaging at the same time structure of the affected ear.
In hard cases of the expressed dizziness which is not eliminated with medicamentous means surgical destruction of a vestibular mechanism of an inner ear (labyrinthectomy) or by introduction of antibiotics to it (chemical ablation) is applied. As these methods lead to deafness, they are means of despair and are applied in the latest case.
Prevention of a disease of Menyer. In most cases prevention of a disease Menyera is impossible. However in certain cases Menyer's disease can be provoked by craniocereberal injuries. Therefore it is always necessary to put on a helmet when driving the bicycle or the motorcycle, sports. Besides, by means of a low-salt diet it is possible to reduce emergence of attacks of dizziness. Prevention of a disease of Menyer consists also in tobacco smoking restriction, alcohol intake and coffee. Reduction of a stress also exerts impact on a possibility of development of this disease. One more factor provoking Menyer course of a disease is the allergy. Therefore try to avoid allergenic factors.