Definition
Ménière's syndrome - also known as endolymphatic hydrops - is a disease that affects the inner ear. It is a debilitating disease that greatly affects the quality of life of patients.
Generally, Ménière's syndrome affects only one ear, but it cannot be ruled out that - after some time - the disease can affect both ears.
Causes
Ménière's syndrome appears to be caused by the accumulation of endolymph (also called hydrops) in the inner ear or labyrinth, which we recall being composed of the cochlea (the organ of hearing) and the vestibule (the organ of balance).
The accumulation of endolymph causes an increase in pressure in the inner ear, causes cellular damage and alters the transmission of the nerve signal between the inner ear and the brain.
The triggering cause of this accumulation of endolymph has not yet been fully clarified, but it seems that the main risk factors for the onset of the disease are genetic predisposition, the presence of pre-existing autoimmune diseases (such as, for example, lupus erythematosus systemic or rheumatoid arthritis), migraine, allergies, head trauma or ear trauma and, in some cases, syphilis.
Symptoms
The main symptoms that occur in patients with Ménière's syndrome are dizziness, loss of balance, nausea and vomiting, hearing loss, "closed ear" sensation and tinnitus (or tinnitus). Furthermore, cold sweating and arterial hypotension may also occur.
Finally, in more rare cases, nystagmus and sudden fainting could occur, but without loss of consciousness.
In the early stages of the disease, the symptoms appear as transient attacks. However, as the disease progresses, some of these symptoms can become permanent. This is the case with dizziness and a decrease in hearing that can develop into total deafness. Furthermore, the decrease in patients' quality of life - caused by the continuous repetition of the attacks - can favor the onset of psychiatric disorders, such as anxiety and depression.
Diet
Information on Ménière Syndrome - Drugs and Care is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Ménière Syndrome - Drugs and Care.
drugs
Unfortunately, there are no specific drugs for the treatment of Ménière's syndrome. The medicines used, in fact, are mostly palliative; therefore, their use is aimed at reducing the symptoms of the disease and improving the quality of life of the patients who are affected.
Furthermore, patients suffering from this disease must be attentive to their diet. In fact, it seems that a diet poor in salt can help in reducing the symptoms caused by Ménière's syndrome.
In the most serious cases and in patients in whom conservative therapy is not able to control the symptoms of the disease, it may instead be thought to resort to intratympanic administration of gentamicin or to surgery.
Betahistine
Betahistine (Microser ®, Vertiserc ®) is a similar drug to histamine, having as its specific therapeutic indication the treatment of symptoms of Ménière's syndrome.
Betahistine, in fact, is able to improve the blood flow of the inner ear, thus reducing the increase in pressure and improving the typical symptoms of the disease, such as dizziness and tinnitus. For these reasons, betahistine is a drug of first choice in the treatment of symptoms induced by the aforementioned syndrome.
Betahistine is available for oral administration and the dose normally used in adults is 16-48 mg of drug per day, to be taken in divided doses. The exact amount of active ingredient to be taken must however be established by the doctor.
antiemetics
Anti-emetic drugs can be administered to reduce or prevent nausea and vomiting caused by Ménière's syndrome.
These include:
- Scopolamine (Scopolamine hydrobromide SALF ®): scopolamine is an anticholinergic drug with antiemetic action. It is available for intramuscular or intravenous administration. The usual dose is 0.25 mg of active ingredient, to be administered up to a maximum of four times a day.
- Proclorperazine (Stemetil ®): Proclorperazine is an antiemetic available for oral and rectal administration. When the latter route of administration is used, the dose usually used in adults is two suppositories per day (containing 10 mg of active ingredient), one in the morning and one in the evening.
- Dimenidrinato (Xamamina ®, Travelgum ®): dimenhydrinate is an antiemetic used to prevent the onset of nausea and vomiting. It is available for oral administration in the form of capsules or chewing gum. The dose of dimenhydrinate usually used in adults is 25-50 mg, to be taken at the first symptoms of nausea.
Antivertiginosi
Anti-viral drugs are used to decrease and control the typical attacks of vertigo triggered by Ménière's syndrome.
- Cinnarizine (Toliman ®, Cynazin ®, Stugeron ®): cinnarizine is a drug used for the treatment of balance disorders. The dose of cinnarizine usually given in adults is 25 mg, to be taken orally three times a day. In any case - if it is deemed necessary - the doctor may decide to vary the usual dose of medication.
Furthermore, cinnarizine is also available in pharmaceutical formulations in combination with dimenhydrinate (Arlevertan ®).
Diuretics
Diuretic drugs are used in the treatment of Ménière's syndrome to reduce the high pressure that is generated within the vestibular apparatus.
- Acetazolamide (Diamox ®): acetazolamide is a drug belonging to the class of carbonic anhydrase inhibitors. The usual dose of medication varies from 250 mg to 500 mg, to be taken orally once a day. However, the exact dosage of the medicine must be established by the doctor.
- Chlorthalidone (Igroton ®): chlorthalidone is a diuretic belonging to the thiazide class. The dose of medication to be taken should be determined by the doctor on an individual basis.
Gentamicin
Gentamicin (an antibiotic drug) has a certain vestibular toxicity, which can be exploited for the treatment of Ménière's syndrome.
Its use is only taken into consideration if conservative treatments are not effective in controlling vertigo induced by Ménière's syndrome. The doctor can therefore decide to resort to intratympanic administration (or transtympanic if you prefer) of the same gentamicin. This practice is also called chemical labyrinthectomy .
Gentamicin administered via the low-dose transtympanic route, in fact, exerts its toxic action against the cells of the vestibule, thus reducing the impulses they send to the vestibular nerve. In this way, vertigo is reduced.
This treatment has proved to be very effective and, moreover, does not affect the patient's hearing, since gentamicin has a relatively selective toxicity towards the vestibular cells, while it presents a poor toxicity towards the cochlea cells.
