Meniere’s disease audiogram-various-aspects-
1. Introduction
Meniere’s disease, named after the Italian scientist Prosper Meniere, is a progressive condition marked by recurrent episodes of spontaneous vertigo, sensorineural hearing loss, and tinnitus, frequently accompanied by a sensation of fullness in the ear [1]. This disorder is characterized by its unpredictability and variability, leading to significant hidden disability.
The exact cause of Meniere’s disease remains under investigation. It is thought to be linked to endolymphatic hydrops, which refers to elevated endolymph pressure in the membranous labyrinth of the inner ear, causing dilation similar to a balloon when pressure rises and drainage becomes obstructed. This leads to swelling in the endolymphatic sac and other structures in the vestibular system (which is responsible for balance), creating an acute vestibular imbalance that results in vertigo and fluctuating hearing loss.
An additional proposed cause is the autoimmune aspect of the disorder. The concept of autoimmunity emerged when improvements in bilateral progressive sensorineural hearing loss were noted after immunosuppressive treatment. Research on the human endolymphatic sac has also indicated that it is the primary immunocompetent structure within the inner ear, capable of processing antigens, generating antibodies, and initiating a cellular immune response.
If any patient of ENT requires any surgery, opd consultation or online consultation in clinic of ENT specialist Doctor Dr Sagar Rajkuwar ,he may contact him at the following address-
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No singular test has been established that definitively diagnoses Meniere’s disease. A thorough medical history, inclusive of a detailed account of the disease presentation pattern supported by quantitative testing, is crucial for reaching a diagnosis.
Several international interdisciplinary organizations have outlined diagnostic criteria for Meniere’s disease in a consensus paper. The document proposes two categories of Meniere’s disease: definite and probable. The definition of the definite type includes clinical criteria and observations of vertigo episodes linked with audiometric evidence of sensorineural hearing loss affecting low and middle frequencies, along with a trio of symptoms including fluctuating hearing loss, tinnitus, and/or fullness in the affected ear. The criteria stipulate that the duration of vertigo should be between 20 minutes and 12 hours. The definition for the probable type of Meniere’s disease includes vertigo or dizziness and extends to episodic ear-related symptoms, which may last for varying durations from 20 minutes to 24 hours.
The natural progression of Meniere’s disease is inconsistent but typically progressive. The classic triad of tinnitus or aural fullness, along with episodic vertigo and hearing impairment, is often not evident at the onset of the disease. It begins with a single symptom, and only cochlear symptoms are present in the initial stage. The duration between the onset of primary symptoms and the emergence of additional symptoms ranges from months to several years, with an average estimated at 6–18 months. After this period of varied length, the complete triad of symptoms will become apparent.
Episodic occurrences of vertigo (commonly referred to as Meniere’s attacks) are the most distressing symptoms for the patient, and it is typically this symptom that leads the patient to seek medical attention. The patient experiencing vertigo may feel that the environment is spinning around them or that they themselves are in motion. Generally, this manifests as a series of attacks over a few weeks or months, interrupted by periods of remission of varying lengths.
When the patient feels a sensation of spinning, the sign present is nystagmus, which has been characterized as a condition involving involuntary movements of the eyeball. This is also accompanied by additional symptoms such as dizziness and perspiration.
In most cases, patients report a feeling of heaviness or fullness in the affected ear, which is linked with hearing impairment and a ringing sensation. Frequently, the onset of symptoms is abrupt, reaching its peak within minutes to hours. The entire episode lasts for about an hour before it diminishes. The patient may feel unsteady for several hours or days following the cessation of the attack. Between episodes of the condition, individuals may experience positional vertigo.
Vertigo is the most debilitating symptom among the key manifestations of the condition. It negatively impacts nearly every aspect of life, disrupting the normal routine of the patient. The vertigo worsens particularly during movement. The risks of falling hinder the patient’s ability to maintain a normal lifestyle. Such incidents become more likely with minor head movements, which make the patient feel extremely “ill. ” Vertigo can entirely incapacitate the individual. This forces patients to remain in bed until their symptoms improve.
Some individuals experience “drop attacks,” which are abrupt, severe unexplained falls without loss of consciousness or accompanying vertigo. These drop attacks result from acute utriculosaccular dysfunction and are triggered by alterations in inner ear pressure that affect otolith function.
An atypical form of clinical presentation has been documented, known as Lermoyez attacks. Unlike typical episodes where tinnitus and hearing loss occur before and worsen with the onset of vertigo, in Lermoyez attacks elevated tinnitus and hearing loss precede the vertiginous episode and significantly resolve with the onset of vertigo.
Tinnitus experienced by patients with Meniere’s is persistent and does not diminish over time, although its intensity may fluctuate. Additionally, it may be perceived more as a loud roaring or buzzing sound, rather than a whistling noise, and is predominantly non-pulsatile and of the low-frequency variety. The pitch tends to correlate with the area of the most significant hearing loss, and the degree of tinnitus is roughly proportional to the severity of hearing impairment.
A feeling of aural fullness that may precede a definite vertiginous attack is regarded as a symptom alternative to tinnitus in the AAO-HNS criteria (1985, 1995) and is experienced by 74. 1% of patients.
Hearing loss typically impacts one ear, which usually loses sensitivity to low-frequency sounds and is classified as sensorineural. As hearing thresholds increase, the dynamic range shrinks; patients often describe the sounds as “tinny,” sound quality worsens, and the loudness of intense sounds escalates quickly due to a phenomenon referred to as recruitment. Patients become intolerant of such loud sounds. In the early stages of the condition, hearing loss generally returns to normal thresholds; however, as the disease progresses, hearing loss remains and can even worsen over subsequent episodes. Furthermore, regarding frequency involvement, the hearing loss expands to include all frequencies, resulting in a flat line on the audiogram. The sensorineural hearing loss associated with Meniere’s disease predominantly affects low frequencies, producing a flat audiometric pattern, though there are instances where we observe peak audiograms that approach normal hearing at around 2 kHz, with reduced sensorineural hearing at both lower and higher frequencies. This specific pattern is considered diagnostic of Meniere’s disease and is more frequently observed in patients with a shorter duration of illness. Over time, the hearing loss tends to flatten and become less variable.
Patients become severely deaf infrequently, occurring in 1–2% of those significantly affected.
Additional characteristics include diplacusis, which is an unusual sensitivity to noise; sounds may appear tinny or distorted, referred to as dysacusis; a difference in pitch perception between the ears (43. 6%); and recruitment (56%).
In Meniere’s disease, an audiogram generally reveals a variable, low-frequency sensorineural hearing loss. This loss can initially present as a rising curve (greater loss at higher frequencies) and develop into a peak or flat configuration as the disease advances. The audiogram serves as an essential instrument for diagnosing and tracking Meniere’s, and its patterns can signify the stage and progression of the condition.
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Elaboration:
Low-Frequency Loss:
Meniere’s disease frequently causes hearing loss in the lower frequencies first, which may or may not improve with treatment.
Fluctuation:
The hearing loss can vary, indicating it may enhance and deteriorate over time, even between audiogram assessments.
Progression:
The audiogram may display a progression from a rising curve (greater loss at higher frequencies) to a peak or flat configuration as the disease progresses.
Diagnosis:
The distinctive audiogram pattern, in conjunction with other symptoms such as vertigo and tinnitus, aids in confirming a diagnosis of Meniere’s.
Monitoring:
The audiogram can be utilized to monitor the advancement of hearing loss and the efficacy of treatment.
Stages of Meniere’s and Audiogram Patterns:
Early Stage: A rising curve audiogram, with hearing loss predominantly in the low frequencies.
Middle Stage: A peak audiogram, with loss at both low and high frequencies.
Late Stage: A flat audiogram, with hearing loss across all frequencies.
Important Note: The audiogram is merely one aspect of the diagnostic process for Meniere’s. A comprehensive clinical evaluation, including a detailed medical history and other tests such as electrocochleography, is also necessary.
Explained meniere’s disease audiogram
In Ménière’s disease, audiograms usually indicate sensorineural hearing loss, often beginning with low-frequency deficits and potentially impacting all frequencies as the condition advances. This hearing loss is often one-sided and can vary in intensity. The audiogram may initially display a flat configuration, but can also present a “worse” audiogram at the lower frequencies.
Key features of Ménière’s disease audiograms:
Sensorineural Hearing Loss:
The key feature of Ménière’s disease is a reduction in hearing capability due to damage in the inner ear or auditory nerve, rather than the outer or middle ear.
Low-Frequency Impairment:
At first, hearing loss typically appears more severe at lower frequencies, but it can spread to include higher frequencies over time.
Unilateral Involvement:
Typically, Ménière’s disease affects only one ear, although it may eventually involve both ears.
Fluctuations:
Audiogram results can vary over time, with hearing loss either deteriorating or improving during or after episodes of vertigo.
Flat or Sloping Audiograms:
Audiograms might demonstrate a flat pattern where hearing loss remains consistent across frequencies or a sloping pattern where hearing loss is more significant at lower frequencies.
Meniere’s disease audiogram examples
In Meniere’s disease, audiograms frequently display a flat or sloping sensorineural hearing loss, typically starting with an impact on low frequencies. Nevertheless, various audiometric patterns may be observed, such as peaked audiograms and unusual notches. Initial stages might show a rising curve, where hearing loss diminishes as the frequency rises.
Here’s a more thorough breakdown of audiogram patterns in Meniere’s disease:
Flat or Sloping:
The most prevalent pattern demonstrates a gradual reduction in hearing throughout the frequency spectrum, with a slight inclination towards low frequencies.
Peaked Audiogram:
Certain individuals might have normal hearing at about 2 kHz, yet reduced hearing at both lower and higher frequencies.
Rising Curve:
In the early phases, the audiogram may illustrate a rising curve, with hearing loss being more evident at lower frequencies and improving as the frequency ascends.
Atypical Notches:
Some patients may show an atypical notch or dip in the audiogram, often in the 1 or 2 kHz region.
Descending Audiogram:
A rarer pattern where hearing loss is more notable at higher frequencies.
It’s crucial to remember:
- The audiogram by itself cannot conclusively diagnose Meniere’s disease.
- Other assessments, such as vestibular tests, are frequently employed alongside audiometry to validate the diagnosis.
- The particular audiometric pattern may differ based on the disease stage and individual variances.
Other Audiological Findings:
Word Discrimination Tests:
Individuals with Ménière’s disease may have trouble comprehending speech, even if pure-tone hearing is intact, due to inner ear effects.
Electrocochleography (ECoG):
ECoG may be utilized to evaluate the inner ear’s response to sound and assist in diagnosis.
Acoustic Reflex Testing:
Acoustic reflex testing might also be performed to evaluate the functioning of the inner ear and auditory nerve.
Important Considerations:
No Single Pathognomonic Pattern:
There is no singular audiogram pattern that definitively diagnoses Ménière’s disease, but the characteristics listed above are indicative.
Clinical Context:
Audiogram findings should be assessed alongside the patient’s symptoms (vertigo, tinnitus, aural fullness) and other diagnostic evaluations (e. g. , MRI).
Progression:
As the disease advances, hearing loss can intensify and become more extensive.
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If Any Patient of ENT Requires Any Surgery, Opd Consultation Or Online Consultation In Clinic of ENT Specialist Doctor Dr. Sagar Rajkuwar ,He May Contact Him At The Following Address-
Prabha ENT Clinic, Plot no 345,Saigram Colony, Opposite Indoline Furniture Ambad Link Road ,Ambad ,1 km From Pathardi Phata Nashik ,422010 ,Maharashtra, India-Dr. Sagar Rajkuwar (MS-ENT), Cell No- 7387590194, 9892596635
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