Ménière's disease
Ménière’s disease is a long term, progressive disease that damages both the balance and hearing parts of the inner ear. The main symptoms of the disease are vertigo (dizziness), nausea and vomiting, tinnitus and increasing hearing loss. It can occur at any age but usually starts in the 4th or 5th decades. It affects both male and female to the same extent.
Initially the disease usually affects one ear, but it can progress to involve both. As the disease progresses, a combination of hearing loss, balance problems and tinnitus are common. These can range from very severe with a significant effect on quality of life to a condition a patient can cope with.
Attacks of ‘spinning’ with associated nausea and vomiting may occur. These attacks vary in frequency and duration, with the overall effect being felt over a period of time. The attacks of vertigo may begin abruptly but are normally preceded by an intensification of the tinnitus. This or other warnings usually give the sufferer time to sit or lie down so falls are unusual. Sometimes, however, there is little warning of an attack of vertigo, precipitating nausea, vomiting or a fall. Also very occasionally the vertigo can be preceded by a “drop” attack (Tumarkin otolithic crisis), in the virulent stages of the disease.
During the course of the disease the symptoms may worsen but there may also be remission. Such remission usually leaves hearing loss and tinnitus with some relief from other symptoms. The duration of periods of remission varies considerably between individuals and with time in the individual person.
Symptoms may all present at the same time or individually over a period, making diagnosis difficult. While hearing loss and tinnitus may occur first, often a sudden fall, vertigo and vomiting may be the first indication of the disease. A confirmatory diagnosis may take 12 months or even longer. Because there is variation in the effects of Ménière’s disease, and it may sometimes be mis-diagnosed, medical advice should be sought from the individual’s doctor or specialist where necessary.
Care and Mobility Considerations
Although attacks may be extremely incapacitating at the time, it is uncommon for them to last for more than a few hours at a time or to occur frequently for more than a few weeks at a time. The overall care and mobility needs will usually be slight.
The disease can cause progressive and permanent hearing loss with the degree of communication difficulty being greater than predicted by the level of hearing loss and therefore difficult to overcome with hearing aids. Individuals may need a variety of types of support with communication.
The attacks usually last between 15 minutes and 2 hours during which time it is unusual for there to be any need for attention or supervision. However, serious attacks of vertigo with associated nausea and vomiting can be extremely incapacitating, and the person may need a considerable amount of help with personal care during these attacks. In some cases attacks during the night can give rise to a need for help with personal care, for example, with clearing up vomit, changing nightclothes and getting to the toilet.
Because, for the majority, the attacks usually occur in clusters with weeks or months in between, any care and mobility needs that may arise are usually intermittent and short-lived. At most there is usually only a need for help for a few weeks at a time. For the periods free from attacks there will be no attendance need. In between these attacks, however, some individuals may experience significant dizziness and their balance may be compromised, which means it may be difficult to do certain activities e.g. bending over, reaching up, looking up or down, and walking. There may be a need for help with activities such as getting in and out of bed, getting in and out of the bath or shower, dressing, and handling kitchenware.
The majority of people have no mobility problems. However, sometimes, individuals may not be able to travel alone. Balance problems can give rise to a need for supervision and/or physical support when walking. In some cases the severity of balance problems and the high frequency of falls without warning may render an individual virtually unable to walk without physical support from another person.
The attacks can be frightening so reassurance may be necessary, but the person is unlikely to be in any danger. Sometimes, however, the fear of an attack can cause emotional effects and behavioural changes. Sometimes even only 1 -2 attacks a year can have profound effects when the sufferer lives in fear of an attack and avoids going out in public. (An attack in public may attract the stigma of drunkenness). The consequence of this may lead to a sufferer becoming housebound with consequential psychological problems.
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Amended May 2008
