American Medical Association Family Medical Guide - American Medical Association [711]
Vertigo is a false sense that you or your surroundings are moving. A person with vertigo may also experience nausea, vomiting, and loss of balance. Vertigo is usually a symptom of disorders of the inner ear, the part of the ear that senses movement and maintains balance.
The vestibular labyrinth
Disorders of the Inner Ear
Disorders of the inner ear affect the extremely sensitive structures inside it—the cochlea and the vestibular labyrinth. The cochlea transforms sound vibrations into electrical signals that are transmitted to the brain along the auditory nerve. The vestibular labyrinth helps provide balance. If these structures are damaged, they cannot be repaired because they are too delicate for surgery. Damage to either structure can result in sensorineural hearing loss (see page 1016), which is usually permanent.
The inner ear
Ménière’s Disease
Ménière’s disease results from an increase in a fluid called endolymph inside the membranous labyrinth, the part of the ear that is involved with balance and hearing. The excess fluid causes the vestibular and cochlear portions of the membranous labyrinth to swell, which can affect balance and hearing. Ménière’s disease usually affects one ear but can sometimes affect both ears.
Symptoms
The most common symptoms of Ménière’s disease are hearing ringing or other noises in the ear (tinnitus ; see page 1020) and muffled, distorted hearing, especially of low tones. Other symptoms can include a false sense that you or your surroundings are moving (vertigo; see previous page) and nausea and vomiting. The symptoms develop in episodes that may occur every few days, every few weeks, or every few years and can last from 20 minutes to several hours. A person may feel pressure in the affected ear before or during an episode.
Episodes of Ménière’s disease usually become less severe over time, but some hearing loss and noises in the ear may persist between episodes. In some people, the disorder is mild and goes away on its own. The nausea and the vomiting tend to stop after the first few episodes. After several years, the dizzy spells usually stop; at this point, doctors consider the disease to have run its course. However, Ménière’s disease usually leaves a person with severe hearing loss in the affected ear.
If you have symptoms of Ménière’s disease, see your doctor or an otolaryngologist (a doctor who specializes in disorders of the ear, nose, and throat) immediately.
Diagnosis
To diagnose Ménière’s disease, a doctor will take a detailed health history and examine your ears. A doctor is usually able to make a diagnosis from the health history, but he or she will probably recommend hearing (audiometry) tests (see page 1016) and may recommend balance tests. You may also have an MRI (see page 113) to rule out a brain tumor as a possible cause of your symptoms.
Treatment
To treat nausea and vomiting associated with Ménière’s disease, a doctor will prescribe a medication such as meclizine. He or she may also prescribe a diuretic to reduce fluid accumulation in the membranous labyrinth, which may help prevent future episodes.
Your doctor may recommend measures you can take to help minimize your symptoms. For example, he or she may suggest lying still when you are having an episode. Because an increase in fluid in the ear causes Ménière’s disease and too much salt can cause your body to retain fluid, the doctor may ask you to cut down on your salt intake.
If (even after treatment) fluid remains in the labyrinth and damages it or if you are incapacitated by your symptoms, your doctor may inject a drug called gentamicin into the middle ear to destroy the hair cells that play a role in vertigo.
Doctors sometimes recommend surgery on a part of the membranous labyrinth