MENIERE’S DISEASE

• Meniere’s disease, also called endolymphatic hydrops, is a disorder of the inner ear caused by impaired endolymph resorption. Usually presents with episodes of Vertigo, sensorineural hearing loss ,tinnitus and aural fullness
• The episode fluctuates in severity, typically lasting from 20 minutes to 12 hours
• Most commonly manifests in adults between 40 – 50 years of age

• Idiopathic
• Defective absorption by endolymphatic sac
• Vasomotor disturbance
• Allergy
• Sodium and water retention
• Hypothyroidism
• Viral Infections

Characteristically manifests as recurrent episodes of acute, unilateral symptoms that lasts from minutes to hours

 Meniers’s triad

• Episodic vertigo
• Fluctuating Sensorineural hearing loss
• Tinnitus- Change in intensity and pitch of tinnitus may be the warning symptom of attack

Additional symptoms

• Sense of fullness or pressure in the involved ear
• Nausea , vomiting
• Nystagmus

• Otoscopy - No abnormality is seen in the tympanic membrane
• Nystagmus - It is seen only during acute attack. The quick component of nystagmus is towards the unaffected ear
• Tuning fork tests
• Pure tone audiometry
• Speech audiometry - Discrimination score is usually 55–85% between the attacks but discrimination ability is much impaired during and immediately following an attack
• Special audiometry tests
  • Recruitment test is positive
  • SISI (short increment sensitivity index) test. SISI score is better than 70% in two-thirds of the patients
  • Tone decay test- Normally, there is decay of less than20 dB
• Electrocochleography
• Caloric test - shows reduced response on the affected side in 75% of cases
• Glycerol test -Glycerol is a dehydrating agent. When given orally, it reduces endolymph pressure and thus causes an improvement in hearing

General measures

• Reassurance
• Cessation of smoking
• Low salt diet

Management of acute attack

• Reassurance and psychological support
• Vestibular sedatives
• Vasodilators

Surgical treatment

• Endolymphatic shunt operation
• Sacculotomy

Ayurvedic Treatment

• Acute attack usually needs an emergency care

Internal Medicines

• Drakshadi kashaya
• Punarnavadi kashaya
• Punarnavaasava
• Guggulu thikthaka gritha
• Vaiswanara choorna
• Hinguvachadi choorna + Nimbu swarasa

Procedures

• Virechana - Gandharva eranda, Kalyanaka guda
• Nasya - Ksheerabala avarthi
• Thala – Nimbamrutha eranda + Rasnadi choorna
• Karnapoorana - Erandasigruadi taila
• Jaloukavacharana - karnamoola
• Shirodhara – Dhanwanthara taila