Presentation
Meniere’s disease is a medical condition that can cause dizzy spells and hearing loss. It is crucial to remember that Meniere’s disease typically only affects one ear, and infections of both ears are extremely uncommon. On the other hand, Benign Positional Vertigo is a medical condition that causes vertigo. Vertigo is a symptom of both diseases, though they are typically unrelated. Internationally renowned medical scholars have described vertigo as severe dizziness that makes patients feel like their heads are spinning (Kutlubaev et al., 2019). Benign positional vertigo and Meniere’s disease are mutually exclusive, but a person can have both illnesses.
Meniere’s condition affects both kids and parents and is a chronic condition that can result in hearing loss. Medical experts disagree on the exact cause of Meniere’s disease, but many think that changes in the fluid levels in the ear tubes are to blame. The imbalance brought on by these fluid changes creates the conditions for the emergence of Meniere’s disease. This school of thought’s academics and practitioners contend that when the ear’s inner membranes are overly fluid-filled, the ear’s internal structures swell (Li et al., 2022). Other well-known medical experts have hypothesized that various factors, including allergies, migraines, environmental factors, genetics, autoimmune reactions, viral infections, and head injuries, may contribute to Meniere’s disease (Pender, 2022).
In contrast, benign Positional Vertigo (BPV) is not typically a chronic illness. Despite not being a chronic condition, benign positional vertigo causes great discomfort to its sufferers. It is treated seriously when it increases a patient’s risk of falling. Falls related to benign positional vertigo can be harmful and put a patient at risk for serious injury. As a result, it’s crucial to care for and treat those with this particular disease effectively. Furthermore, it’s important to note that the otoconia’s displacement from the utricle to one of the semi-circular canals causes BPV (Von Brevern et al., 2017). Changes in head positioning, such as abrupt head movements, tipping the head down and up, or even turning over in bed and Dehydration, can cause such otoconia movement.
As the disease progresses, more ear functions are impacted, making Meniere’s worse over time. Vertigo and temporary hearing loss are the main symptoms of this particular illness. A cross-section of patients also reported experiencing increased anxiety, blurred vision, nausea, diarrhea, rapid heartbeat, trembling, and cold sweats. Depending on the patient and infection stage, the nature of attacks that cause these symptoms can vary. For this reason, the duration of a Meniere’s disease attack can range from twenty minutes to more than twenty-four hours. Poor balance and tinnitus are more likely to develop as the disease worsens for the patient (Baloh, 2017).
Vertigo, lightheadedness, blurred vision, loss of balance, vomiting, and nausea are typical symptoms of BPV, in contrast. Patients with the two illnesses experience different symptoms, particularly in severity. The typical duration of benign positional vertigo symptoms is one minute. The signs and symptoms might periodically come and go. Importantly, stress, inadequate sleep, and variations in barometric pressure can all worsen benign positional vertigo (Imai et al., 2017).
Pathophysiology
They knew how the inner ear functions are essential for understanding the pathophysiology of BPV. The otoconia typically reside in the labyrinth, which is significant in this regard. Otoconia are calcium crystals that support the ear’s healthy operation. An individual develops BPV if these calcium crystals migrate from their natural location within the utricle of the inner ear to the semi-circular canals. The otoconia are likely to migrate into the posterior canal because of its anatomical location. Gravity is frequently a major factor in the progression of otoconial debris inside the semi-circular canal. Because of this, when the head is turned about gravity, an endolymph fluid displacement occurs in the inner ear, causing the patient to feel dizzy. This kind of condition, known as canalithiasis, is more common. The semi-circular canal cupula may align with the otoconia in unique circumstances, making it denser than the surrounding fluid. As a result, cupulolithiasis develops when the head is reoriented concerning gravity.
There is disagreement regarding the pathophysiology and initial causes of Meniere’s disease. The essence brings this on endolymphatic hydrops in the inner ear can result from various possible inflammatory causes. It’s interesting to note that some people can have Meniere’s disease but not endolymphatic hydrops. These intricate problems have fueled various theories about the pathophysiology of Meniere’s disease (Baloh, 2017). Notably, the cochlea and the vestibular system are frequently impacted by advanced Meniere’s disease, impairing hearing and balance in the patient.
Assessment
A hearing test to determine the patient’s hearing capacity and a balancing test are necessary for diagnosing Meniere’s disease. The hearing test determines a patient’s ability to detect sounds of various pitches and volumes regarding hearing assessment. In-depth tests are also administered to the patient to determine their ability to distinguish between words with similar sounds. The hearing test here recognizes that people with this disease have trouble hearing low-frequency sound stimuli and a combination of low-frequency sounds (Pender, 2022). These individuals frequently have normal hearing in mid-range frequencies as a result. Therefore, the goal of the hearing evaluation is to highlight any hearing issues that a person with Meniere’s disease may have.
The vestibular evoked myogenic potentials (VEMP), among other tests, can be used by medical experts to evaluate balance (Imai et al., 2017). All these balance tests are mutually exclusive, and a healthcare professional will select one depending on the specific condition that needs to be evaluated. The variety of options is advantageous because it enables doctors to select the best course of action based on the patient. As it relates to the diagnosis of benign positional vertigo, medical professionals may perform a quick physical examination to identify the patient’s condition.
Diagnosis
A patient must undergo an examination that includes a medical history to be diagnosed with Meniere’s disease. For caregivers to highlight a patient’s condition holistically, it is important to know their medical history. A patient must have experienced two episodes of dizziness for a definitive test of this condition. More than 20 minutes, but no more than 12 hours, should have passed between these episodes. Additionally, the client should have passed the hearing evaluation form, and the findings should have indicated hearing loss (Pender, 2022). To have been positively diagnosed, the patient must also have had tinnitus according to widely accepted diagnostic criteria for Meniere’s disease. Finally, medical professionals must perform tests that rule out other medical conditions. This is a precautionary measure because some illnesses and diseases may exhibit symptoms and signs that are similar to Meniere’s illness.
A doctor must perform several tests to determine the patient’s cause of dizziness to diagnose benign positional vertigo. As a result, a physical evaluation is required. The physician will specifically check for the client’s inability to control their eye movements, an eye that unintentionally moves from side to side, and dizziness connected to a particular eye due to head movements. Examining the symptoms and signs of vertigo by eye or head movements is part of an accurate and proper diagnosis of benign positional vertigo. When diagnosing the source of a patient’s symptoms and signs is challenging, a doctor may order additional tests, such as electronystagmography.
Treatment
It’s crucial to remember that Meniere’s disease cannot be cured. However, as scientific technology and research advanced, patients could now choose from various treatment plans to lessen the frequency and intensity of their experienced vertigos. Unfortunately, none of the presently offered treatment plans can reverse hearing loss in its advanced stages when it already exists. Patients are given prescriptions for various drugs, such as motion-sickness treatments, to lessen the magnitude of a vertigo attack caused by the patient’s head spinning. As a result, the drug might aid in reducing vomiting and nausea. Patients may also be treated with anti-nausea medication. A patient may be required to take specific medications that lessen fluid retention and reduce their salt intake to follow a long-term and sustainable treatment regimen (Li et al., 2022).
In some cases, doctors may advise middle ear injections of steroids and gentamicin to lessen vertigo symptoms. Another option for treatment is non-invasive methods like wearing hearing aids and positive pressure therapy. Surgery is now an option in Meniere’s severe disease cases.
Additionally, BPV may eventually go away on its own, though this varies from case to case. However, a doctor may suggest a canalith repositioning procedure, in which a patient’s head is slowly moved to achieve the desired medical outcomes to help alleviate the condition faster (Kutlubaev et al., 2019). Surgical intervention may be necessary for a patient in rare and extreme circumstances.
References
Baloh, R. W. (2017). Meniere’s disease.
Imai, T., Takeda, N., Ikezono, T., Shigeno, K., Asai, M., Watanabe, Y., & Suzuki, M. (2017). Classification, diagnostic criteria, and management of benign paroxysmal positional vertigo. Auris Nasus Larynx, 44(1), 1-6.
https://doi.org/10.1016/j.anl.2016.03.013
Kutlubaev, M. A., Xu, Y., & Hornibrook, J. (2019). Benign paroxysmal positional vertigo in Meniere’s disease: systematic review and meta-analysis of frequency and clinical characteristics. Journal of Neurology, 1-7.
https://doi.org/10.1007/s00415-019-09502-x
Li, S., Pyykkö, I., Zhang, Q., Yang, J., & Duan, M. (2022). Consensus on intratympanic drug delivery for Menière’s disease. European Archives of Oto-Rhino-Laryngology, 1-5.. https://doi.org/10.1007/s00405-022-07374-y
Von Brevern, M., Bertholon, P., Brandt, T., Fife, T., Imai, T., Nuti, D., & Newman-Toker, D. E. (2017). Benign paroxysmal positional vertigo: Diagnostic criteria Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Acta otorrinolaringologica espanola,
https://doi.org/10.3233/VES-150553 .
Pender, D. J. (2022). The Critical Role of Reissner’s Basement Membrane in Meniere’s Disease. Archives of Otolaryngology-Head and Neck Surgery, 1(1). https://doi.org/10.33425/2831-6312.1005
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