Features of the diagnosis of meniere's disease on the example of a clinical case

Keywords: Meniere’s disease, dizziness, deafness, imbalance

Abstract

Introduction. Meniere’s disease is accompanied by a non-infectious pathology of the inner ear, during which can lead to systemic labyrinth dizziness, nausea, vomiting, hearing loss and tinnitus in one ear. It is a rare disease, affecting up to 200 cases per 100,000 people. Aim. The purpose of this article was to analyze the clinical case of a patient with Meniere's disease. Materials and methods. Patient S., was admitted to the Department of Vascular Pathology of the Brain and Rehabilitation of the State Institution «Institute of Neurology, Psychiatry and Narcology of the NAMS of Ukraine» with complaints of regular attacks of systemic vertigo with a frequency of up to 7 times a week lasting 1–4 hours, sometimes accompanied by vomiting, constant noise and whistling in the left ear. He considers himself ill since 05.11.19, when during training in the gym there was the first case of dizziness and vomiting, which lasted 3 hours. In August 2019, the attacks continued, became more frequent and prolonged, passed on their own, sometimes in a specific position of the head - the head tilted forward with the neck stretched out. Neurological examination revealed that the palpebral fissures and pupils were equal. Eye movements are full, painless. Convergence insufficiency was examined. Corneal reactions are reduced. Horizontal positioning nystagmus was examined. There are no pathological signs, no sensory disturbances. The patient performed coordination tests with uncertainty. The patient showed unsteadiness during Romberg's test. The patient felt pain during the palpation of paravertebral points. The patient experienced exaggerated changes in mood. Results. 1. Brain MRI results showed a thinning and a decrease in the MR signal on T2 from the cochlea of the inner ear to the left. CT scanning of the mastoid processes revealed an increased density of bone structures of the labyrinth nucleus on the left. 2. During the otoneurological examination, the asymmetry of vestibular responses along the labyrinth, slight stimulation of the left labyrinth were established. The patient was diagnosed with peripheral cochleovestibular syndrome on the left, Meniere's syndrome. Conclusions. This clinical case illustrates the importance of collecting a detailed medical history and examination of a patient with complaints of dizziness, hearing loss, tinnitus, and repeated vomiting. To establish a diagnosis and develop a treatment plan for a patient, the coordinated work of a multidisciplinary group is required, which should consist of a neurologist, audiologist, and otolaryngologist.

Downloads

Download data is not yet available.

Author Biographies

Kateryna Kharina, MD, PhD, Assistant of the Department of Clinical Neurology, Psychiatry and Narcology of V. N. Karazin Kharkiv National University

6, Svobody  sq., Kharkiv, Ukraine, 61022

Veronika Shepel, student of V. N. Karazin Kharkiv National University, School of Medicine

6, Svobody sq., Kharkiv, Ukraine, 61022

Taisiia Sazonova, student of V. N. Karazin Kharkiv National University, School of Medicine

6, Svobody sq., Kharkiv, Ukraine, 61022

References

Gibson WPR. Meniere’s Disease. Advances in Oto-Rhino-Laryngology. 2019; 82: 77–86. https://doi.org/10.1159/000490274

Basura GJ, Adams ME, Monfared A, et al. Clinical Practice Guideline: Ménière's Disease Executive Summary. Otolaryngology–Head and Neck Surgery. 2020; 162 (4): 415–434. https://doi.org/10.1177/0194599820909439

Nakashima T, Pyykkö I, Arroll MA, et al. Meniere’s disease. Nature reviews Disease primers. 2016; 2: 16028. https://doi.org/10.1038/nrdp.2016.28

Gürkov R, Pyykö I, Zou J, Kentala E. What is Menière’s disease? A contemporary re-evaluation of endolymphatic hydrops. Journal of neurology. 2016; 263 Suppl 1: S71-S81. https://doi.org/10.1007/s00415-015-7930-1

Tabet P, Saliba I. Meniere’s Disease and Vestibular Migraine: Updates and Review of the Literature. Journal of Clinical Medicine Research. 2017; 9 (9): 733–744. https://doi.org/10.14740/jocmr3126w

Perez-Carpena P, Lopez-Escamez JA. Current Understanding and Clinical Management of Meniere’s Disease: A Systematic Review. Seminars in neurology. 2020;40(1): 138-150. https://doi.org/10.1055/s-0039-3402065

Clyde JW, Oberman BS, Isildak H. Current Management Practices in Ménière’s Disease. Otology & Neurotology. 2017; 38 (6): e159–e167. https://doi.org/10.1097/MAO.0000000000001421

Shin CH, Kim Y, Yoo MH, et al. Management of Ménière’s Disease: How Does the Coexistence of Vestibular Migraine Affect Outcomes? Otology & Neurotology. 2019; 40 (5): 666–673. https://doi.org/10.1097/MAO.0000000000002176

Published
2020-12-08
How to Cite
Kharina, K., Shepel, V., & Sazonova, T. (2020). Features of the diagnosis of meniere’s disease on the example of a clinical case. The Journal of V. N. Karazin Kharkiv National University, Series "Medicine", (40), 134-140. https://doi.org/10.26565/2313-6693-2020-40-16