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Meniere's Disease: Symptoms and Diagnostic Tests
Numerous factors can cause disorders of the ear. Infections, physical obstruction, disturbance of the acoustic nerve, and so on can lead to a range of disorders that are fraught with serious consequences, including hearing loss, vertigo, vomiting, and abscess formation. For this reason, ear examination should be the number one procedure for a patient with complaints of hearing loss and vertigo. Taking into account the complaints of the 55-year-old patient, she can be diagnosed with Meniere's disease, the exact causes of which are rather difficult to identify. Audiometric evaluation, electrocochleography, and vestibular testing should be used to diagnose the disease and differentiate the causes of the patient's symptoms.
Meniere's Disease: Causes
First of all, it is necessary to identify the causes of the patient's symptoms. Generally, Meniere's disease is typical of middle-aged and older patients. This disorder occurs due to damage to the receptor cells of the cochlea and vestibular system (Harman & Mason, 2002, p. 278). This disease causes deafness and such symptoms as uncontrollable eye movements, tinnitus, vertigo, heavy sweating, nausea, vomiting, and so on. To diagnose a patient with Meniere's disease, either tinnitus or [aural] fullness or both must be present on the affected side (Hughes & Pensak, 2007, p. 355).
Depending on the cause, Meniere's disease can be either extrinsic or intrinsic, that is, it is either caused by trauma, infections, chronic diseases, and so on or by genetics. About this, Meniere's disease can be caused by infection (inflammation bacterial, viral), otosclerosis, trauma (physical or acoustic), syphilis, others including allergy, tumors, leukemia, and autoimmune disorders (Harris, 1999, p. 30). As far as genetic factors are concerned, no chromosomal anomalies are typical of Meniere's disease as, for instance, in the case of Downs syndrome. Nevertheless, many patients with Meniere's disease have certain anatomical abnormalities (for example, sigmoid sinus location and, as a result, a smaller Trautmann's triangle) that their blood relatives also report (Harris, 1999). Thus, certain tests should be performed to identify why the patient in question has symptoms of Meniere's disease.
Since the causes of the disease are numerous, the patient under consideration should be carefully examined and several important tests should be performed to diagnose her with Meniere's disease. First of all, it is necessary to exclude genetic factors. The next step is to determine the details of the patient's disease. These are going to include factors that could provoke the disease, the onset of the illness, as well as the nature of vertigo episodes (their frequency, duration, and so on) (Hughes & Pensak, 2007).
A physical examination is of utmost importance for diagnosing a patient with Meniere's disease because it helps rule out the causes of the patient's symptoms. For instance, diabetes, vascular insufficiency, and different medical illnesses that can cause sensory problems (such as migraine) should be taken into consideration when diagnosing a patient. A physical examination should be followed by an otolaryngologic examination. Oropharynx and oral examination should also be performed because Meniere's disease is often caused by viral and respiratory infections. One more step is a neurological examination that can help elicit possible spontaneous nystagmus or head-shaking nystagmus. The results of simple tests (for example, head shaking) can be used to differentiate Menieres disease from related diseases.
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Diagnostic Tests to Detect Menieres Disease
Examination alone is not enough to diagnose a patient with Meniere's disease. The following diagnostic tests should be performed to identify the causes of the disease:
An audiometric evaluation (a hearing test). This test reveals the quality of the patient's hearing and helps identify the cause of the hearing loss (either the nerve or the inner ear).
Electrocochleography (ECochG). This test uses computerized signal-averaging techniques to record the electrical signals from the cochlea and the auditory nerve in response to an auditory signal (Hughes & Pensak, 2007, p. 359). It can help differentiate Menieres disease from other illnesses, such as auditory neuropathy or nonhydropic sensorineural loss (Hughes & Pensak, 2007).
Vestibular testing can provide useful information about a patient suffering from Meniere's disease. It employs such studies as electronystagmography (ENG), posturography, and rotational testing. ENG tests the reaction of the eye nerve and the acoustic nerve to the cold or warmth. A similar test is a caloric stimulation. Together with ENG, it helps evaluate certain patterns of eye movements and find nystagmus, if any. Posturography is a computerized test that involves assessing the patient's ability to maintain balance while standing (Gelfand, 2009, p. 356). It tests inner ear function helping to identify the cause of Meniere's disease. Finally, rotational testing is another test related to evaluating inner ear function based on the patient's eye movement patterns.
Magnetic resonance imaging (MRI). This procedure helps detect hearing nerve tumors that cause symptoms similar to the symptoms of Meniere's disease.
All these diagnostic tests can help not only diagnose a patient with Meniere's disease but also identify a cause of the disease as such.
In conclusion, based on the patient's symptoms, she can be diagnosed with Meniere's disease. Physical, otolaryngologic, oropharynx, oral examination, and neurological examinations should be performed to diagnose this disease. However, the disease cannot be diagnosed based on the examinations alone. Such diagnostic tests as audiometric evaluation, electrocochleography, and vestibular testing (that includes ENG, posturography, and rotational testing) can help differentiate Menieres disease from similar illnesses, as well as identify the causes of the patients Meniere's disease. This disease can be treated with medications, but there are cases when surgery is needed (for example, when medications do not help control vertigo attacks).