Therapy of Meniere's disease

Synonyms

Menièr's disease

definition

Ménière's Disease is a complex disease of the human body's acoustic system, consisting of three distinct symptoms that may affect the patient in varying degrees.

therapy

A rapid therapy initiation favors the healing success

The treatment of Meniere's disease should be rapid, if possible at the first onset of the symptom complex, in order to avoid a complete manifestation of the disease. Although the exact cause of the disease is still unknown today, the pathomechanism of the disease is largely clear and can be treated symptomatically.

First and foremost, there are a number of medications that are primarily designed to relieve the pressure on the inner ear:

  • Drainage medicines ( diuretics ).
  • Dizziness-minimizing drugs ( antiemetics ) Betahistin®

In the field of drug treatment of Meniere's disease, a great deal of research is being done and some promising new drug results remain to be seen.

In addition to the drug treatment, it is also necessary to clarify and treat some other causes and consequences of the disease:

  • orthopedic problems (postural problems of the cervical spine)
  • Chronic malocclusion (malposition of the temporomandibular joint) a significantly higher risk to get a recurrence of Meniere's disease than other patients. For this reason, false bites should be corrected by a dentist and posture compensated orthopedically. This should round off the treatment of Meniere's disease and reduce the frequency of seizures.
  • psychological stress (anxiety disorders, overcautiousness) In this case, an accompanying, psychological care of the patient should be considered. At least as long as the complaints are massive, anxiety training and psychological counseling should be done. Over time, depending on the frequency of seizures and on the severity of the disease, therapy may be reduced or eventually stopped altogether.

In addition to the medical procedures and the psychotherapeutic treatment, there are still numerous complementary surgical and alternative forms of treatment that have different success rates.

1. Operatively, through the eardrum a so-called

  • Tweezers are inserted, which ensures a direct connection between the middle and outer ear. For many patients for whom drug treatment has not helped, this surgical treatment is very successful and patients may be permanently symptom-free. Another advantage of a tympanic tube is that it can also be used to deliver medications directly to the middle ear, which can then migrate to the inner ear. A tympanostomy tube may remain in the ear for a long time, but from time to time the correct position should be checked by an ENT specialist.
  • Another surgical treatment of the disease is labyrinth anesthesia. Here, a small cut in the eardrum creates access to the middle ear. This way, an anesthetic is injected into the middle ear. This then migrates into the labyrinth system and can thus reduce and calm the metabolic processes. The treatment method is still relatively new, but initial results show that it seems to work. The anesthesia can lead to a short but severe dizzy spell before the positive effect of the treatment method comes into effect.
  • Tenotomy: here also the opened eardrum cuts through the muscles of the middle ear. This probably leads to a general pressure reduction and thus to the reduction of the symptoms. The results of this treatment are very positive. The organ of balance contains fluid, the pressure of which rises sharply in Menière's disease. The fluid is stored in a bony space in the skull base and can not expand when needed.
  • In operative saccotomy, an access is placed behind the ear to this reservoir and the bony wall is opened. This causes the pressure of the fluid to spread better.
  • surgical transection of the balance nerve if all treatment methods should not be successful. This procedure is more complicated and must be considered carefully, as it can lead to severe side effects after surgical transection. In some cases, facial nerve injuries may occur and, in addition, the severance of the balance nerve is accompanied by irreversible failure of the organ of equilibrium on the one hand.

This means that patients first suffer from severe seizure-type attacks of vertigo in the aftermath of the procedure, which then have to be abrained. If this succeeds, the patients have a good chance to lead a symptom-free life.

Nowadays the severing of the nerve is seldom done. By inserting into the ear pressure device that exerts different pressures on the middle ear in the inner ear, can also be tried to treat the disease.


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