Meniere’s Disease in Children

What is Meniere’s Disease in Children?

Meniere’s disease is a non-inflammatory disease of the inner ear, accompanied by bouts of spinning dizziness, noise, ringing in the ears, sudden vomiting, and hearing loss. In the interictal spaces, the patient’s condition is good.

In 1861, the French doctor Prosper Menier first described the disease. He drew attention to the fact that the symptoms of this disease are caused not by changes in the brain, as was customary in those years, but by damage to the inner ear. He combined the symptoms of this disease, after which it was called Meniere’s disease.

Causes of Meniere’s Disease in Children

Currently, there is no accurate data on the causes of the disease. Most likely, the disease appears against the background of various disorders in the human body:

  • Violations of the structure or work of the inner ear.
  • Endolymphatic hydrops, or increased pressure of endolymphatic fluid. With endolymphatic hydrops, unequal expansion of the cochlear duct, sac, sac, uterus, and semicircular canals, deformation, disruption of the integrity of membranous formations, and pronounced degenerative changes in the nerve components are observed. The reason for the increase in endolymphatic hydrops is a violation of the circulation of labyrinth fluids and metabolism in them. Endolymph accumulates due to the permeability of the membranes of the endolymphatic system, which in turn is caused by vasomotor disorders in the inner ear and dysfunction of the vascular cavity. Endolymphatic hydrops also occurs due to degenerate changes in the cervical spine, impaired vascular wall permeability, from impaired functioning of the sympathetic and parasympathetic parts of the autonomic nervous system, water-salt imbalance, improper protein and carbohydrate metabolism in the body.
  • Endocrine changes – dysfunction of the thyroid gland, areas of the cortical and brain adrenal glands.
  • Changes in the environment of liquid electrolytes of the inner ear.
  • Vascular disorders in the maze. This is affected by changes in the balance in the coagulation and anticoagulation systems of the blood in the form of hypercoagulation.
  • Allergic predisposition and strong sensitivity to bacterial and non-bacterial allergens, allergic changes in the body. Food allergy.
  • Changes in the activity of hormone-producing cells located in the maze. These cells produce bioactive substances – melatonin, norepinephrine, serotonin, adrenaline.
  • Heredity. If the mother or father had the disease, then the likelihood of its transmission to the child increases.
  • Viral and infectious diseases (e.g. syphilis).
  • Nervous Disorders.

Pathogenesis during Meniere’s Disease in Children

As a rule, Meniere’s disease affects only one ear, less often two. Attacks of the disease begin due to swelling of the maze.

Symptoms of Meniere’s Disease in Children

The main complaint of the disease is the noise in the shah, it is constant and has a mixed tone. It can turn into hearing loss, which over time begins to progress. Sometimes patients complain of a painful perception of sounds between attacks.

Headache and heaviness in the head are observed in the neck.

Dizziness attacks are manifested by the rotation, swimming and waving of nearby objects. During attacks, the skin becomes pale, body temperature is lowered.

Imbalance occurs when walking or when a person stands still. In this case, there is a tendency to fall in one direction, rarely – in different directions.

Spontaneous nystagmus (rapid involuntary oscillatory eye movements) is horizontal rotator, often directed towards the affected ear.

With the Romberg position (body position with closed eyes, legs joined and arms extended), the patient has deviations in the direction of spontaneous nystagmus.

Autonomic disorders are manifested by the following symptoms: general weakness of the body, nausea and vomiting, high blood pressure, tachycardia, bradycardia, severe sweating, frequent urination, diarrhea.

The disease has three degrees of flow:

  • I degree (mild) – a unilateral manifestation of the disease, has rare attacks (1 or 2 times a year) lasting 30-120 minutes. At I degree, vegetative and statokinetic disorders are not observed. In the interictal period, the hearing is practically not disturbed, only slowly progressive hearing loss can be observed.
  • II degree (medium) – frequent seizures (1-2 times per month), seizures last 2-3 hours or 1-2 times in 3 months, in the latter case last about 4-8 hours. Vegetative and statokinetic disorders are quite pronounced. Significant hearing loss is possible with unilateral lesion and more pronounced with bilateral. Imbalances disappear, and hearing is restored a few days after the attack.
  • III degree (severe) – the disease has a bilateral lesion, accompanied by severe daily or weekly seizures that last 8 hours or more. Autonomic symptoms are very pronounced, the balance is disturbed. Hearing loss progresses rapidly. Vestibular disorders can be observed in the interictal period. During an attack, they intensify.

According to the manifestation of symptoms, the cochleovestibular and vestibulocochlear forms of the disease are distinguished. The course of the disease can be complicated by concomitant diseases such as vegetovascular dystonia, atherosclerotic cardiosclerosis, coronary and cerebral arteriosclerosis, hypertension, functional disorders of the central nervous system, thyrotoxicosis, obesity, diabetes mellitus, osteochondrosis of the cervical spine, food allergy or medication.

Diagnosis of Meniere’s Disease in Children

The diagnosis of Meniere’s disease is based on detailed data collection, analysis of symptoms and examination. In the diagnosis, special specifying tests and studies are used:

  • Otoscopy – examination of the ear.
  • Audiometry – determines bone and air conduction. In Meniere’s disease, a lesion of the sound-conducting system is noted.
  • >A glycerol test is performed to detect endolymphatic hydrops. The test is carried out as follows: 12 hours after eating food and liquid, the patient in the morning takes a mixture of pure medical glycerin with water (calculation of 1.5 grams per 1 kg of body weight). Before taking the glycerin mixture and 2-3 hours after the audio and vestibulometry are performed. The glycerol test shows how the threshold of tonal hearing decreases.
  • Vestibular studies.
  • Bacteriological research.
  • Hormone blood test.
  • Magnetic resonance imaging of the ear and head.
  • Thyroid ultrasound.
  • Differential diagnosis – differentiate otitis media, otosclerosis, labyrinthitis, tumors.

Treatment of Meniere’s Disease in Children

Meniere’s disease is treated with conservative and surgical methods. Signs that indicate conservative treatment are dizziness attacks, I and II degree (mild, moderate) disease, if the phenomena of increased endolymphatic fluid pressure and changes in the labyrinth receptor apparatus are reversible. In some cases, conservative treatment can be combined with surgical treatment.

Treatment is selected based on pathomorphology and pathophysiology. The action of medications is aimed at normalizing microcirculation and hydropic phenomena, reducing the activity of the vestibular analyzer, and preventing impulsive impulses from the ear maze.

During treatment, the patient needs rest and isolation from all possible visual and sound stimuli. In this case, you can use distracting therapy: apply mustard plasters to the cervical-occipital zone, a heating pad to the legs.

Drug therapy is successfully carried out in the early stages of the disease. It consists of the internal administration of 20 ml of a 40% glucose solution; intramuscular administration of antihistamines such as 2.5% pipolfen solution or 1% diphenhydramine solution; 1% solution of chlorpromazine, 1% solution of atropine or 0.2% solution of platifillin; 10% caffeine solution. Effective is the use of 1-2% solution of novocaine, 0.2% solution of platifillin, 0.1% solution of atropine. Improvement can be observed within 1-2 months after the application of therapy. Drug therapy is aimed at relieving seizures.

Diuretics are prescribed for some patients, which remove water from the body, thereby reducing the volume of endolymph in the inner ear.

A widely applicable course of intravenous administration of 4% sodium bicarbonate solution.

Betagistin (vestibo, betaserk) is used to relieve dizziness. Betagistin is prescribed for vestibular disorders, which are accompanied by noise in the ear, nausea and vomiting, hearing loss. The course of treatment with the drug for a month or more.

To support the cardiovascular system, sedatives are used that inhibit the nervous system, vasodilators and antihistamines.
In treatment, hyperbaric oxygenation is prescribed in a course of 10 sessions.

In the interictal period, patients attend physical therapy classes. Be sure to sanitize all foci of chronic infection.

Surgical intervention is carried out only after conservative treatment, if after it was not achieved a beneficial effect. The operation labyrinthectomy (complete removal of the bone or membranous labyrinth) is used after complete hearing loss in one ear, but when it is stored on the other. After such an operation, the patient will never be able to hear.

Surgery is performed in the form of a resection of a drum string and drum plexus; decompression surgery on the endolymphatic sac, saculotomy and utriculotomy, fenestration of the cochlea with drainage or bypass surgery, bypass of the cochlea through its window. The beneficial effect during surgery is observed in 70% of patients.

Prevention of Meniere’s Disease in Children

No specific prophylaxis has been developed at this time. Children with Meniere’s disease should not engage in extreme sports: climbing mountains, hiking in caves, diving and more. Having reached working age, sick children will not be able to work with moving mechanisms and vehicles. Non-extreme sports can be practiced only at extraordinary intervals.

As a preventive measure, patients should regularly visit the otolaryngologist to prevent hearing loss, since it will constantly deteriorate.

Patients need to follow a low-salt diet. Such food reduces the amount of fluid in the inner ear. Also, patients should abandon tonic drinks (tea, coffee).

Some patients need to be consulted by a psychotherapist, because they are frightened by severe attacks.