MENYERA DISEASE ( P. Meniere , the fr. doctor, 1799 — 1862) — the disease which is characterized by slukhovestibulyarny frustration which are caused by damage of an inner ear. Sometimes for designation only of vestibular frustration use the terms «Menyer's Syndrome», «menyerovsky symptom complex». Nek-ry researchers identify two of these terms with Menyer's disease, however most of others consider such identification unreasonable.
M. the form apprx. 120 years ago after in 1861 P. Menyer reported about the disease of an inner ear studied by it which is characterized by symptoms of apoplectic brain hemorrhage became known as independent nozol. In 1895 this disease was called by his name. According to most of researchers, at M. the inner ear is surprised preferential on the one hand. Allocate classical (typical) and atypical forms M.
Data on M.'s frequency. in literature is almost not present. At children's and youthful age of M. develops seldom.
Etiology and pathogeny
M.'s Aetiology. it is unknown. Nek-ry researchers would consider M. polyetiological disease; disbolism, in particular water-salt, disturbance of a hemopoiesis, function of closed glands, a vitamin deficiency, an allergy can be the cause. Most of researchers holds the opinion that development of symptoms of M. it is caused by an endolymphatic hydrodog — the increased quantity of an endolymph (labyrinth liquid) and the labyrinth hypertensia caused by it. One researchers consider the reason a hydra of a dog of disturbance in arteriokapillyarny system of a labyrinth, others — disturbances of the mechanism of a producing and absorption of an endolymph.
Pathological anatomy it is quite uniform: there is considerable, but not uniform extension of a webby labyrinth, hl. obr. a cochlear channel (ductus cochlearis) and a spherical sack (sacculus), to a lesser extent an elliptic sack (utriculus) and in smaller — semicircular channels. Stretching of a webby labyrinth is caused by increase in volume of an endolymph, a cut is also followed by change and shift of separate anatomic elements of an inner ear. Besides, numerous ruptures of walls of a webby labyrinth, fresh and cicatrized are found. The described changes received the name of a hydrodog (edema) of a labyrinth.
A clinical picture
P. Menyer in the description a wedge, displays of a disease called three main symptoms: a hearing disorder, noise in an ear (see. Sonitus ) and pristupoobrazny dizziness (see), followed by disorder of balance, nausea, vomiting, changes of activity of cardiovascular, digestive, uric systems, strengthening of sweating (see. Vestibular symptom complex ). Simultaneous disturbance of acoustical and vestibular functions, i.e. classical picture M., occurs only at 35 — 46% of patients, approximately in half of cases the disease begins with acoustical frustration and in 15 — 20% of cases — with vestibular. The time gap between acoustical and vestibular (or between vestibular and acoustical) disturbances can be various — several days, weeks, months, years.
A hearing disorder at M. designate as relative deafness at an endolymphatic hydrodog. For relative deafness (see) the following is characteristic. 1. Uniform increase in thresholds of hearing on all frequency range both at air, and at bone sound carrying out. 2. Preferential low-frequency hearing loss at early stages of a disease at safety of acoustical sensitivity to ultrasound and sick thresholds of ultrasonic irritation, normal at the majority. 3. The fluctuating hearing or fluctuating relative deafness (fluctuation of auditory acuity, results of a tone threshold audiometriya, and also ear noise and a congestion of an ear); noise and a congestion of an ear increase in an ear before an attack, often being its harbinger, reach a maximum during an attack, and after it considerably decrease, being followed it is frequent improvement of hearing. 4. A positive phenomenon of acceleration of increase of loudness (see. Audiometriya ), found very much early and almost in 100% of observations. 5. Disturbance of accurate perception of the speech, a cut concerns usually increase in thresholds of legibility; a small part of patients has no absolute legibility of the speech.
The heaviest symptom of M. attacks of dizziness are. Dizziness is more often shown by feeling of rotation or shift of surrounding objects (visual), is more rare — feeling of fall, rotation of own body (tactile). Weight of a condition of patients during an attack substantially is defined by expressiveness of vegetative symptoms (nausea, vomiting, the strengthened sweating, decrease in the ABP, body temperature, the speeded-up urination). During an attack it is often noted spontaneous nystagmus (see), to-ry during the sighting comes to light at 65 — 70% of patients, at a nistagmografiya (see. Elektronistagmografiya ) — more than at 90%.
According to most of researchers, the prevailing type of dysfunction of a vestibular analyzer at experimental tests is the hyporeflexia testimonial of decrease in excitability of receptors of semicircular channels. At 12% of patients the symptom of dominance of an experimental nystagmus in the direction, at 2% — the general hyperreflexia comes to light. Assume that at M. there can be a reversible and irreversible stage of Endo of a lymphatic hydrodog. The reversible stage of a hydrodog (still endolymphatic system can extend at the expense of perilymphangeal) is clinically characterized by typical attacks with light intervals, vestibular dysfunction during remission is completely stopped, and disturbance of acoustical function is shown by fluctuating relative deafness with signs of more expressed defeat of the sound carrying out system of an inner ear. At an irreversible stage attacks become very frequent and long, light intervals almost completely disappear, hearing quickly and sharply worsens, gaining lines of neurosensory relative deafness, spontaneous vestibular frustration are defined also in the mezhpristupny period. About a stage of a hydrodog it is possible to judge also by a glitseroltest (intake of mix of glycerin in half with water or fruit juice at the rate of 1 g of glycerin on 1 kg of body weight). Positive consider the test, at Krom thresholds of tone hearing improve not less than on 10 dB and not less than at three frequencies, and parameters of nistagmenny reactions at vestibular tests change not less than for 25% in relation to initial sizes.
The positive glitserol-test speaks about reversibility of a hydrodog.
For M.'s diagnosis. it is necessary to collect carefully the anamnesis, to conduct detailed otonevrologichesky examination. If as a result of a research the picture of a peripheral kokhleovestibulyarny syndrome of labyrinth level comes to light, then it would be possible to make the diagnosis to M. If the disease begins with one vestibular frustration, then diagnosis is complicated, however special character of attacks of dizziness and hearing disorder helps, to-rye only M. are inherent.
Differential diagnosis M. it is carried out with a neurinoma of an acoustical nerve (see. Eighth cranial nerve ), a pia-arachnitis (arachnoiditis) of a mostomozzhechkovy corner, trunk encephalitis with the preferential defeat of vestibular nuclei, vegetovascular crises specific labyrinthitis (see), vascular, toxi-infectious defeat and injury of a labyrinth.
Treatment conservative and operational. Conservative treatment is carried out with use of the following main methods: drug treatment, reflexotherapy, giperbarooksigenoterapiya, LFK, karbogeno-and oxygenotherapies, roentgenotherapies. In conservative therapy of M. distinguish two periods: 1) stopping of an attack; 2) treatment in the mezhpristupny period. During an attack of the patient it is recommended to put to bed in situation, at Krom at it expressiveness of vestibular frustration weakens, to exclude bright light and sharp sounds, to legs — a hot-water bottle, on cervicooccipital area — mustard plasters. Intravenously enter 20 ml of 40% of solution of glucose, 5 ml of 0,5% of solution of novocaine or 1% of solution of xylocainum, into a muscle of 2 ml of 2,5% of solution of Pipolphenum (isopromethazine) or 1 ml of 2,5% of solution of aminazine, under skin of 1 ml of 0,1% of solution of sulfate of atropine or 2 ml of 0,2% of solution of hydrotartrate Platyphyllinum and 1 ml of 10% r-ra caffeine. It is possible to apply meatotimpanalny novocainic blockade according to Soldatov (at intolerance of novocaine Trimecainum is used) to stopping of an attack: the patient is in a dorsal decubitus, skin of zaushny area and outside acoustical pass is processed twice by alcohol, then skin of outside acoustical pass — ether before emergence of an easy hyperemia; the needle is entered in zaushny area, in the area of an attachment of an auricle, at the level of a posterosuperior wall of outside acoustical pass and advanced deep into to a nadprokhodny awn (spina supra meatum) where enter medicinal substance (1 — 1,5 ml of 1 — 2% of solution of novocaine or 0,5% of solution of Trimecainum). If an arrangement of a needle correct, then after introduction of the first: portions of solution skin of acoustical pass in bone department, and then back quadrants of a tympanic membrane begins to grow white.
Treatment in the mezhpristupny period includes: injections of 40% of solution of glucose on 20 ml, 0,5% of solution of novocaine, on 5 ml (only 10 injections); intramusculary a complex of vitamins — Thiamini bromidum (B 1 ) — 1 ml of 6% of solution, pyridoxine hydrochloride (B 6 ) — 1 ml of 1% of solution, cyanocobalamine on 1 ml of 0,01% of solution (100 mkg) daily' within 20 days. Use also hydrosodium carbonate in the form of 5% of solution. in number of 100 — 250 ml, to-ry enter kapelno (120 drops in 1 min.) into a vein; injections are repeated through; 1 — 2 day, on a course 7 — 15 injections: (hydrosodium carbonate is used * and during an attack). Intranasal novocainic blockade by Ageeva-Maykova's method are effective in respect of impact on vestibular dysfunction: 1 ml of 2% of solution of novocaine is entered into a mucous membrane of the back end of the lower nasal sink with one (at hemilesion) or both parties (at bilateral defeat); such blockade repeat every other day, only 6 times.
Inside appoint within two weeks Belloidum on 1 dragee 4 times a day, Dedalonum on 1 tablet 2 times a day.
Various mixes which include substances } the changing microcirculation, sedative, acting on the cholinereactive systems exciting c are effective. N of page. The positive take is often noted at the use of these drugs in the following copy-book: Cofeini natrio-benzoatis 0,015; Papaverini hydrochloridi 0,02; Phenobarbitali 0,05; Bromisovali 0,2; Calcii gluconatis 0,05. Mix prepares in the form of powders, to-rye accept within two weeks on 1 powder twice a day (in 19 hours and 22 hours). The giperbarooksigenoterapiya gives good effect. For M.'s treatment. use also acupuncture (see).
For M.'s treatment. in out-patient conditions it is possible to appoint all complex of the pharmaceuticals applied in a hospital in the mezhpristupny period (hydrosodium carbonate is appointed in candles — 0,5 and 0,7 g of hydrosodium carbonate to a candle — for rectal administration of 1 — 2 time a day; on a course of 30 candles).
Complex conservative therapy of M. it is effective at 70 — 80% of patients. At unsuccessfulness of conservative treatment it is applied operational with use of the microsurgical equipment (see. Microsurgery ). Earlier it was used only for the purpose of impact on vestibular dysfunction, and then nek-ry operations (a drainage and shunting of an endolymphatic bag, an ekstralabirintny transcranial vestibular neurotomy. neurectomy, skarpektomiya) began to consider as prophylactic of the progressing falling of hearing.
Operative measures divide into five basic groups: interventions on nerves of a drum cavity, decompressive operations on a labyrinth, destructive operations on a labyrinth, destructive operations on an eighth cranial nerve, section of muscles of a drum cavity.
For the choice of the corresponding treatment of M. it is necessary to consider a possibility of existence of two stages of an endolymphatic hydrodog — reversible and irreversible. In the presence a wedge, the signs assuming a reversible stage of an endolymphatic hydrodog and at confirmation by its positive glitserol-test reasonablly early use of operations on nerves of a drum cavity. The resection of a drum string and a drum texture can lead to reorganization of a vegetative innervation of vessels of an inner ear of N in this regard to some extent to reduce development of an endolymphatic hydrodog. From means of conservative therapy in this stage of a disease it is necessary to use the dehydrating drugs, diuretics, substances changing microcirculation, sedatives. The combination of drug treatment to acupuncture, LFK, hyperbaric oxygenation is the most effective. In the absence of effect of operations on nerves of a drum cavity and complex conservative treatment decompressive operations on en to a lymphatic bag (fig. 1) — drainage, shunting are reasonable. on a sack of a threshold — a sakkulotomiya (fig. 2), on a snail — drainage, shunting of a cochlear channel. The choice of a type of an operative measure completely depends on a condition of acoustical function. At good shape of acoustical function operations on an endolymphatic bag can be applied. Sakkulotomiya operations, drainage or shunting of a webby labyrinth can be executed both in reversible, and in an irreversible stage of an endolymphatic hydrodog. In an irreversible stage from medicamentous therapy the means improving a hemodynamics, circulation of endolymphatic liquid, metabolism of nervous tissue are shown.
Dehydrational means and diuretics in this stage of a disease are inexpedient. Destructive operations on a labyrinth or a vestibular part of an eighth cranial nerve are shown.
Very important factor in prevention of a recurrence of M. observance of a diet is. The constant or long exception of food of hot and salty dishes is hard transferred by patients and is hardly justified. It is more reasonable to keep to such diet within one week of every month for a number of years. This week the amount of liquid in days shall not exceed 0,5 l, and salt 0,5 g; first course three times a week shall be replaced with the shredded vegetables and fruit, in other days of the week first course shall be constant (milk, vegetable soups); meat and fish can be used in a boiled look; it is necessary to include daily in food baked potatoes, cottage cheese. In the same week it is before going to bed recommended to apply a mustard plaster to zaushny area (with struck or on both sides) and to do a hot foot bath.
The important therapeutic factor promoting perhaps full compensation of vestibular frustration and also the employee for prevention of their recurrence, is to lay down. physical culture. Except a diet and to lay down. gymnastics, the correct employment of patients is of great importance. The persons suffering from M., cannot be drivers of transport, perform the work connected with stay in a noisy situation at not protected height, at quickly moving mechanisms; they shall not work during a night shift.
Use of LFK at M. it is proved by high ability of a vestibular mechanism to a training even in the conditions of pathology and promotes recovery of statokinetic and vestibulovegetativny stability. LFK is shown only in the mezhpristupny period of a disease.
The main form of use of LFK is to lay down. gymnastics, to a lesser extent nek-ry sports exercises and passive training. In the procedure to lay down. gymnastics, in addition to fortifying (exercises for hands and legs), special exercises include: a) for a training of semicircular channels — inclinations, turns, rotations of the head, and then and the case in the frontal, sagittal and horizontal planes (fig. 3, 1—8) in a prone position, sitting, standing; b) for a training of the otolitovy device — squats, walking, run, jumpings up (fig. 3, 9—12); c) for restoring the balance and orientation in space — exercises on balance on the wide, and then narrow area of a support (fig. 3, 13—75); d) for a training of coordination of movements — gymnastic exercises with complications. For strengthening of loading a part of special exercises carry out blindly. In a condition of remission nek-ry sports exercises are recommended: skiing and pipits, driving the bicycle under a condition if the patient owns these sports. For a passive training use rotation on the rotating chair, rises and descents on the elevator, a swing.
At use of LFK it is necessary to follow the following rules: to strictly individualize procedures to lay down. gymnastics to ensure safety during the performance of exercises, at the beginning of a course of treatment rate of performance of special exercises slow, the volume of movements with restriction, at possible emergence of dizziness during the training it is obligatory 2 — 3-minute rest sitting with the quiet not forced breathing exercises. After the attack proceeding 1 — 2 hour start occupations next day; after the attack lasting several hours, days and more start a training not earlier than 2 — 3 days after its termination. Duration of the procedure at the beginning of a course of treatment of 10 — 15 min., in the middle and the second half of a course of treatment of 35 — 45 min. daily. Duration of a course of treatment is 35 — 40 days; after it results, as a rule, remain up to 4 — 6 months
Despite the forecast, favorable for life, M. it is necessary to carry to a serious illness. Periodically coming attacks of vestibular dysfunction are painful for patients, they deprive of them working capacity, result in relative deafness, and sometimes and to full deafness. Persons, it is long the suffering M., quite often there are disabled people of III, II and even the I groups.
See also Inner ear .
Bibliography: Ageeva-Maykova O. G. and Zhukovich A. V. Fundamentals of otoneurology, page 183, M., 1960; Velikov K. A. Syndrome and Menyer's disease, M., 1967, bibliogr.; Olisov V. S. Labyrinthopathy of L., 1973; Soldatov I. B., With at shch e in and G. P. and Hrappon. C. Vestibular dysfunction, M., 1980; Undrits V. F. About Menyer's disease, Vestn, otorinolar., No. 6, page 57, 1958; F e-dorova G. S. Physiotherapy exercises at vestibular disturbances, M., 1973, bibliogr.; X and l about in K. Ya. Function of an organ of equilibrium and disease of movement, L., 1969, bibliogr.; Zimmerman G. S. Clinical otoneurology, page 217, M., 1952, bibliogr.; A n t about 1 i-C ande * 1 a F. Surgery for hvdrops, Arch. Otolaryng., v. 89, p. 115, 1969; McCabe B. F. a. W o 1 s k D. Experimental inner ear pressure changes, Ann. Otol. (St Louis), v. 70, p. 541, 1961; M e n i e r e P. Maladies de 1’oreille interne offrant les symptomes de la congestion cerebrale apoplectiforme, Gaz. med. Paris, 3 ser., t. 16, p. 88, 1861; P f a 1 t z C. R. Vestibular diagnosis in Meniere’s disease, Arch. Oto-Rhmo-Larvng. (N. Y.), v. 212, p. 321, 1976; S with h u fe nee h t H. F. Pathology of the ear., p. 503, Cambridge, 1974.
I. B. Soldatov; G. S. Fedorova (to lay down. physical.).