Meniere's Disease

Meniere's Disease is a condition caused by disorder of the inner ear. The patient suffers sudden and severe bouts of vertigo. Meniere's disease caused by changes in fluid pressure in the inner ear. Though it is not life-threatening, symptoms of Meniere's disease can be disturbing and unnerving. Though only one ear is affected in most patients, in rare cases both ears are involved. This medical condition is also called idiopathic endolymphatic hydrops.

Symptoms of Meniere's Disease are dizziness or vertigo and episodes of tinnitus. The patient may experience a pressurized feeling inside the ear. The vertigo might bring on nausea, vomiting and sweating spells. Ménière's disease symptoms come in sporadic attacks, often without warning. The unsteady feeling can linger for days. The person might occasionally experience headaches and abdominal pain. Ménière's disease often brings on progressive hearing loss, especially low-frequency hearing.

Hearing and balance tests and MRI scans aid in diagnosing Ménière's disease. Electrocochleography is helpful in recording the electrical activity of the inner ear. Audiometry is performed to rule out vestibular disorder. There is no cure for Ménière's disease but lifestyle changes and medications can alleviate some of the symptoms and reduce intensity and occurrence of attacks. Antibiotic injections of gentamicin into the inner ear helps in restoring balance function. Anti-vertigo medications such as meclizine or diazepam may provide temporary relief during the attacks of vertigo. The patient must limit salt and MSG consumption and avoid triggers such as caffeine, chocolate, tobacco, aerated drinks and tea. Surgical procedures such as removal of nerves that trigger the condition are resorted to in acute cases of vertigo resulting from Ménière's disease.

Nystagmus

'Dancing eyes' or Nystagmus means uncontrolled movements of the eyes, from side to side, up and down or rotary. Thus Nystagmus could be horizontal, vertical or torsional. Sometimes, however the eyes can jerk sideways or up or down. These dance movements in the eyes could be in both or in just one eye. Interestingly, people with nystagmus are usually not aware of their eye movements.

Causes of Nystagmus

Abnormal function in the areas of the brain that control eye movements is usually the cause for the involuntary eye movements. It is that part of the inner ear that senses movement and position. Nystagmus syndrome can be present at birth or develop later in life because of a disease or injury. Nystagmus is usually infantile and is present from a very early age. Studies reveal that about one child out of every several thousand has nystagmus.

While the nystagmus that is present at birth is not severe, acquired nystagmus is caused by certain drugs or medicine. Such drugs include phenytoin or dilatin, an anti- seizure medicine, excessive alcohol or any other sedating medicine that can impair the labyrinth function. Acquired nystagmus may also be caused by any disease of the brain such as multiple sclerosis or brain tumor, when the areas controlling eye movements are damaged. Nystagmus may also be caused by congenital disease of the eye. This is rare and an ophthalmologist should evaluate a child with nystagmus to check any eye disease. Hyperventilation or flashing light in front of one eye, nicotine and vibrations are also known to cause nystagmus, but these are rare. Other causes of nystagmus include:

• Head injury from road accidents, mostly on motor bikes.
  
• Disorders of the inner ear such as labyrinthitis or Meniere's disease
  
• Stroke
  
• Thiamine or vitamin B12 deficiency.
  

Clinical manifestations

Nystagmus is a gradually developing condition leading to adverse effects. The severity of this condition is sometimes linked to congenital visual impairment. One of the important conditions associated with nystagmus is the lack of focus at a certain point. This happens because of the dispositional movement of the eye balls when the person turns the head from side to side. The classification of nystagmus gives a better understanding of the disease and its respective prophylaxis.

Different kinds of nystagmus

Manifest nystagmus which is present at all times, whereas latent nystagmus occurs only in one eye.

Manifest-latent nystagmus is continually present, but worsens when one eye is covered.

Congenital nystagmus is present at birth. The eyes swing like a pendulum in this condition. Strabismus is another term for this as the eyes do not necessarily work together all the time. It is associated with the oscillations that are horizontal in origin in the vestibular region. The occurrence of infantile nystagmus requires immediate attention as it may eventually lead to oculomotor disturbances causing permanent loss of vision.

Acquired nystagmus can be caused by diseases such as multiple sclerosis, brain tumor, diabetic neuropathy, accident and resulting head injury, neurological problem which could be side effect of a medication. This form of the disease is also referred as the see-saw nystagmus. It involves the impairment of the central or peripheral vestibular region. In this condition there a periodical oscillation of the eye which occurs in a rhythmic manner. There are many predisposing factors that contribute to the occurrence of this condition which include multiple sclerosis and any form of trauma affecting the head and neck.

There are two basic types of nystagmus. While the one is eye related 'optokinetic', the other is inner ear related 'vestibular'. Those with inner ear problems develop 'jerk nystagmus' where the eyes drift slowly in one direction and jerk back in the other direction. Chances are people with this condition can develop nausea and vertigo. However, this type of nystagmus is quite temporary. It can also occur in persons with Meniere's disease or when water settles into one ear. A decongestant can be taken to clear up nystagmus of this type.

Diagnosis of nystagmus

The following tests are done for diagnosis of nystagmus:

• CT scan of the head
  
• Electro oculography, which is an electrical method of measuring eye movements using tiny electrodes.
  
• MRI of the head
  
• Vestibular testing by recording the movements of the eyes.
  

History of the patient is taken and recorded, and a thorough physical examination is performed. The doctor would focus on the nervous system and inner ear. The doctor may ask the patient to wear a pair of goggles so that eyes could be magnified for the examination. Spin the patient for about 30 seconds, and stop and make her/him stare at an object. The patients' eye will first move slowly in one and then suddenly in the opposite direction. The eye movements of those suffering from nystagmus due to a medical condition will depend on the cause.

Treatment of nystagmus

The distressing fact is that there is no treatment for most cases of congenital nystagmus. Treatment for acquired nystagmus depends upon its cause. There are some instances when nystagmus. However, visual function of the patient with nystagmus can improve by some treatment. Prisms, surgeries such as tenotomy and drug therapies are used for infantile nystagmus. There are surgical treatments for people with nystagmus, and surgery usually reduces the null positions. Thus the head tilt is lessened and cosmetic appearance improves. Drug therapies include drugs such as botox or baclofen which reduce some nystagmic movements. But these results are usually temporary. Some with nystagmus benefit from biofeedback training. In some cases, wearing eyeglasses and contact lenses can help people with nystagmus see better. Contact lenses are a superior option to the glasses as the lens move with the eyes.

Some changes at home to help combat dizziness, visual problems or nervous system disorders can also be done to help the patients. And those children with nystagmus need special help in learning to adapt to school work and social conditions.

Vertigo

Vestibular imbalance, an imbalance in the inner part of the ear is a major cause of vertigo. There are health conditions that contribute as well certain factors that can result in vestibular imbalance.

• Anemia and migraine can trigger vertigo.
  
  
• Signals possibility of stroke, brain tumor, multiple sclerosis, seizures or a bleed in the brain. Neck ailments like severe spondylosis.
  
  
• Cardiovascular disorders like low blood pressure, heart rhythms and valve diseases.
  
  
• Arthritic pains can contribute to aggravating vertigo.
  
  
• Inflammation or infection of the inner ear that aid with balance and sense movement.
  
  
• Viral illnesses like common cold and flu.
  
  
• Severe migraines, Meniere's disease that causes a buildup of fluid in the inner ear and extends a feeling of ringing in the ear.
  
  
• Decreased blood flow to the brain.
  
  
• Certain medications can damage the ear and lead to vertigo.
  
  
• Psychological disturbances, post-traumatic vertigo, and post-partum vertigo can cause an off balance feeling from time to time.
  
  

Intake of certain medications like anti-depressants, anti-seizure drugs, drugs to control high blood pressure, sedatives and tranquilizers may cause sudden dizziness. General health problems such as thyroid, vitamin deficiency, diabetes, anemia, and immune system diseases are other possible causes.

If dizziness or vertigo, dizziness or lightheadedness, dizziness or disequillibrium persists, you should seek medical attention immediately. Monitor and record the symptoms. Take it along and explain in detail to the medical practitioner. If constant dizziness is associated with chest pain, heart palpitations, shortness of breath, changes in vision or speech, serious head injury, leg or arm weakness, loss of consciousness that lasts for few minutes, it is best to seek emergency medical attention. It may imply a serious health condition. An in-depth diagnosis is urgently required.

Diagnostic tests that may be required include measuring blood pressure, ECG, hearing tests, neurological tests, balance testing and MRI. Many disorders can be treated with medication, surgery, diet, a change in lifestyle, or a combination of these.