Features of the diagnosis of meniere's disease on the example of a clinical case
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
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
The Journal of V. N. Karazin Kharkiv National University, series Medicine has following copyright terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work, with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.