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  • Vertigo, hearing loss and tinnitus, three major symptoms of Menière’s Disease

    Mari Havia, Doctor of Medicine, is senior physician at the Department of Otorhinolaryngology, Hyvinkää Hospital in Finland, and is a qualified audiologist. In 2004, Mari Havia defended her academic dissertation entitled Menière’s Disease – Prevalence and Clinical Picture.

    Academic Dissertation: Menière’s Disease. Prevalence and Clinical Picture.Department of Otorhinolaryngology. University of Helsinki.

    Quote from the dissertation Summary. MD is short for Menière’s Disease:

    ”The population-based prevalence of MD was 513 per 100,000 inhabitants aged 12 years or more, with a peak prevalence of 1,709 per 100,000 inhabitants seen in the age group 61-70 years.

    If we are extremely conservative and include only the 10 patients for whom MD diagnosis could be confirmed, the rate would still be 321 per 100,000 inhabitants. The true prevalence can however, be considered to be 513 per 100,000 inhabitants.

    The cochlear symptoms of hearing loss and tinnitus severity increased with disease duration. In 54% of definite MD patients, the disease started with cochlear symptoms.

    A subgroup of patients still had severe symptoms of dizziness 20 years after disease onset.

    The prevalence of definite MD here was much higher than previous reports based on hospital records have suggested.”

    ……………………………………………………………………………………

    Vertigo, hearing loss and tinnitus, three major symptoms of Menière’s Disease.

    Mari Havia could demonstrate in her research that the prevalence is 513 cases of Menière’s Disease per 100,000 inhabitants in Finland, which is a significantly higher figure than previously believed.

    It took Mari Havia six years to assemble underlying data for the dissertation. Her mode of procedure was systematic and meticulous. The research was initiated in 1998 with a questionnaire to 5,000 citizens in a representative suburb within the Helsinki area. The answers were then followed up individually. A total of 3,016 patients participated in the study.

    “I took care of everything myself – from writing 5,000 envelopes, posting them, opening the replies, and convening the persons concerned for a medical examination.”

    Criteria

    Dr Havia emphasises that it is easy to confuse MD with analogous diagnoses, such as for example schwannoma or vestibular migraine. Indeed, Prosper Menière pointed this out himself already in the year 1861.

    “In order to establish whether the patient really has MD, it is important to exclude diseases with similar symptoms,” she says.

    The criteria used by Dr Havia for diagnosis of MD are AAO-HNS 1995:

    Certain MD:

    • Definite MD, plus histopathologic confirmation

    Definite MD:

    • Two or more definite spontaneous episodes of vertigo lasting 20 minutes or longer
    • Audiometrically documented hearing loss on at least one occasion
    • Tinnitus or aural fullness in the treated ear
    • Other causes excluded

    Probable MD:

    • One definite episode of vertigo
    • Audiometrically documented hearing loss on at least one occasion
    • Tinnitus or aural fullness in the treated ear
    • Other causes excluded

    Possible MD:

    • Episodic vertigo of the Menière type without documented hearing loss, or
    • Sensorineural hearing loss, fluctuation of fixed, with dysequilibrium but without definitive episodes.
    • Other causes excluded

    A calmer lifestyle reduces the related problems

    Patients with MD often have a stressed and overburdened existence. A good piece of advice to patients is that they change their lifestyle in addition to their medical treatment.

    “If the patient can reorganise their life, overcome their stress, relax and sleep well at night, the related problems will be generally eased. Tinnitus will decline and hearing will improve. Impaired hearing causes irritation if one cannot hear what people are saying.

    “I usually say that MD is a stress barometer. The disease comes intermittently, often during periods of heavy workload and considerably increased stress. If one can control the situation and live a more relaxed life, the periods of suffering are often milder.

    “As a rule, the disease starts at an age of 45-50 years. It can take time to establish an MD diagnosis. Many patients say that they have been to a hospital’s emergency department, but then sent home instead of being referred to an otorhinolaryngology specialist.

    “Medical therapy must be individually adapted. My medicinal arsenal is therefore broad, and includes traditional medicines, cortisone and antisecretory factor. It is difficult to determine in advance which solution(s) may help the patient, and one often needs to feel one’s way forward.”

    Hearing rehab important

    “Regarding hearing it is very important that the patients with Menière’s disease get appropriate hearing rehabilitation. Good hearing gives them quality of life, reduces the tinnitus disturbance and helps patients to lead an active life.”

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