Mnire's disease (pronounced /menjrz/[1]) is a disorder of t e inner ear t at can affect earin!

and "a#ance$ %t is c aracterized "& episodes of dizziness and tinnitus and pro!ressi'e earin! #oss( usua##& in one ear$ %t is caused "& #&mp atic c anne# di#ation([)] affectin! t e draina!e of endo#&mp $ %t is named after t e *renc p &sician +rosper Mnire( , o first reported t at 'erti!o ,as caused "& inner ear disorders in an artic#e pu"#is ed in 1-.1 %t is su!!ested t at reducin! t e amount of sa#t in t e diet and a#so reducin! t e inta/e of tea and coffee ma& "e e#pfu# in pre'entin! attac/s$ You will probably have to limit your salt intake. Controlling the level of salt in your body will indirectly control the amount of fluid in your inner ear. A medicine called a diuretic (water pill) may also help. The symptoms of Mnire's are variable; not all sufferers experience the same symptoms. However, so-calle !classic Mnire's! is consi ere to comprise the followin" four symptoms#$%&

'erio ic episo es of rotary verti"o or i((iness. )luctuatin", pro"ressive, unilateral *in one ear+ or bilateral *in both ears+ hearin" loss. ,nilateral or bilateral tinnitus. - sensation of fullness or pressure in one or both ears. dizziness and a sensation that the world is spinning around (similar to the symptoms of vertigo) nausea vomiting deafness and a buzzing or ringing noise in the ears (tinnitus)

Mnire's often be"ins with one symptom, an "ra ually pro"resses. However, not all symptoms must be present for a octor to ma.e a ia"nosis of the isease.$/& 0everal symptoms at once is more conclusive than ifferent symptoms at separate times. $1& -ttac.s of verti"o can be severe, incapacitatin", an unpre ictable. -ttac.s of verti"o last no lon"er than 2% hours. $3& This combines with an increase in volume of tinnitus an temporary, albeit si"nificant, hearin" loss. Hearin" may improve after an attac., but often becomes pro"ressively worse. 4ausea, vomitin", an sweatin" sometimes accompany verti"o. 0ome sufferers experience what are informally .nown as ! rop attac.s!5a su en, severe attac. of i((iness or verti"o that causes the sufferer, if not seate , to fall. 'atients may also experience the feelin" of bein" pushe or pulle *'ulsion+. 0ome patients may fin it impossible to "et up for some time, until the attac. passes or me ication ta.es effect. 6n a ition to hearin" loss, soun s can seem tinny or istorte , an patients can experience unusual sensitivity to noises *hyperacusis+. 0ome sufferers also experience nysta"mus, or uncontrollable rhythmical an 7er.y eye movements, usually in the hori(ontal plane, reflectin" the essential role of non-visual balance in coor inatin" eye movements. 0tu ies one on both ri"ht an left ear sufferers show that patients with their ri"ht ear affecte ten to o si"nificantly worse in co"nitive performance.$8& 9eneral intelli"ence was not hin ere , an it was conclu e that eclinin" performance was relate to how lon" the patient ha been sufferin" from the isease.$:& -ttac.s often come in series of a few minutes to a few hours. $e it& ;ause The exact cause of Mnire's isease is not .nown, but it is believe to be relate to endolymphatic hydrops or excess flui in the inner ear. 6t is thou"ht that en olymphatic flui bursts from its normal channels in the ear an flows into other areas causin" ama"e. This is calle !hy rops!. The membranous labyrinth, a system of membranes in the ear, contains a flui calle en olymph. The membranes can become ilate li.e a balloon when pressure increases an raina"e is bloc.e .$<=& This may be relate to swellin" of the en olymphatic sac or other tissues in the vestibular system of the inner ear, which is responsible for the bo y's sense of balance. 6n some cases, the en olymphatic uct may be obstructe by scar tissue, or may be narrow from birth. 6n some cases there may be too much flui secrete by the stria vascularis. The symptoms may occur in the presence of a mi le ear infection, hea trauma or an upper respiratory tract infection, or by usin" aspirin, smo.in" ci"arettes or rin.in" alcohol. They may be further exacerbate by excessive consumption of salt in some patients. 0ome have pointe out that this !central hypothesis! of Mnire's is >uestionable, as many people without Mnire's have evi ence of increase pressure in the inner ear too.

6t has also been propose that Mnire's symptoms in many patients are cause by the eleterious effects of a herpes virus. $<<&$<2&$<?& Herpesviri ae are present in a ma7ority of the population in a ormant state. 6t is su""este that the virus is reactivate when the immune system is epresse ue to a stressor such as trauma, infection or sur"ery *un er "eneral anesthesia+. 0ymptoms then evelop as the virus e"ra es the structure of the inner ear. $e it& @ia"nosis Many isor ers have symptoms similar to Mnire's isease. @octors establish it with complaints an me ical history. However, a etaile otolaryn"olo"ical examination, au iometry an hea ma"netic resonance ima"in" *MA6+ scan shoul be performe to exclu e a tumour of the ei"hth cranial nerve *vestibulocochlear nerve+ or superior canal ehiscence which woul cause similar symptoms. Because there is no efinitive test for Mnire's, it is only ia"nose when all other causes have been rule out. Mnire's typically be"ins between the a"es of ?= an 1= an affects men sli"htly more than women.$<%&$</& $e it& History Mnire's isease ha been reco"ni(e prior to <:32, but it was still relatively va"ue an broa at the time. The -merican -ca emy of Ctolaryn"olo"y-Hea an 4ec. 0ur"ery ;ommittee on Hearin" an D>uilibrium *--C H40 ;HD+ ma e set criteria for ia"nosin" Mnire's, as well as efinin" two sub cate"ories of Mnire's# cochlear *without verti"o+ an vestibular *without eafness+. $<1& 6n <:32, the aca emy efine criteria for ia"nosin" Mnire's isease as#$<3& <. )luctuatin", pro"ressive, sensorineural eafness. Dpiso ic, characteristic efinitive spells of verti"o lastin" 2= minutes to 2% hours with no unconsciousness, vestibular nysta"mus always present. ,sually tinnitus. -ttac.s are characteri(e by perio s of remission an exacerbation.

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6n <:8/, this list chan"e to alter wor in", such as chan"in" ! eafness! to !hearin" loss associate with tinnitus, characteristically of low fre>uencies! an re>uirin" more than one attac. of verti"o to ia"nose.$<8& )inally in <::/, the list was a"ain altere to allow for e"rees of the isease#$<:&

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2. ?. %.

;ertain - @efinite isease with histopatholo"ical confirmation @efinite - Ae>uires two or more efinitive episo es of verti"o with hearin" loss plus tinnitus an Eor aural fullness 'robable - Cnly one efinitive episo e of verti"o an the other symptoms an si"ns 'ossible - @efinitive verti"o with no associate hearin" loss

$e it& Treatment 6nitial treatment is aime at both ealin" with imme iate symptoms an preventin" recurrence of symptoms, an so will vary from patient to patient. @octors may recommen vestibular trainin", metho s for ealin" with tinnitus, stress re uction, hearin" ai s to eal with hearin" loss, an me ication to alleviate nausea an symptoms of verti"o.$citation needed& 0everal environmental an ietary chan"es are thou"ht to re uce the fre>uency or severity of symptom outbrea.s. Most patients are a vise to a opt a low-so ium iet, typically one to two "rams *<===F2=== m"+ per ay$1& at first, but iets as low as %== m" are not uncommon.$citation needed& 'atients are a vise to avoi caffeine, alcohol an tobacco, all of which can a""ravate symptoms of Mnire's. 0ome $who?& recommen avoi in" -spartame.$citation needed& 'atients are often prescribe a mil iuretic *sometimes vitamin B1+. Many patients will have aller"y testin" one to see if they are can i ate for aller"y esensiti(ation as aller"ies have been shown to a""ravate Mnire's symptoms. $2=& $e it& Me ication 0ome octors recommen Gipoflavonoi s.$2<& Cutsi e of the ,nite 0tates, Betahistine is use to mana"e symptoms.

Treatments aime at lowerin" the pressure within the inner ear inclu e antihistamines, anticholiner"ics, steroi s, an iuretics.$1& @evices that provi e transtympanic micropressure pulses *such as the Meniett+ are now showin" some promise an is becomin" more wi ely use as a treatment for Mnire's.$22& The Meniett, specifically, is proven to be a safe metho for re ucin" verti"o fre>uency for a ma7ority of users. $2?& The anti-herpes virus ru" -ciclovir has also been use with some success to treat Mnire's @isease.$<<& The li.elihoo of the effectiveness of the treatment was foun to ecrease with increasin" uration of the isease probably because viral suppression oes not reverse ama"e. Morpholo"ical chan"es to the inner ear of Mnire's sufferers have also been foun in which it was consi ere li.ely to have resulte from attac. by a herpes simplex virus.$<2& 6t was consi ere possible that lon" term treatment with acyclovir *"reater than six months+ woul be re>uire to pro uce an appreciable effect on symptoms. Herpes viruses have the ability to remain ormant in nerve cells by a process .nown as HHH Gatency -ssociate Transcript. ;ontinue a ministration of the ru" shoul prevent reactivation of the virus an allow for the possibility of an improvement in symptoms. -nother consi eration is that ifferent strains of a herpes virus can have ifferent characteristics which may result in ifferences in the precise effects of the virus. )urther confirmation that acyclovir can have a positive effect on Mnire's symptoms has been reporte .$2%& Halium has been prescribe to help se ate the vestibular system. $e it& 0ur"ery 0ur"ery may be recommen e if me ical mana"ement oes not control verti"o.$citation needed& 'ermanent sur"ical estruction of the balance part of the affecte ear can be performe for severe cases if only one ear is affecte . This can be achieve throu"h chemical labyrinthectomy, in which a ru" *such as "entamicin+ that !.ills! the vestibular apparatus is in7ecte into the mi le ear. -lternatively, sur"eons can cut the nerve to the balance portion of the inner ear in a vestibular neurectomy, or the inner ear itself can be sur"ically remove *labyrinthectomy+. These treatments eliminate verti"o, but because they are estructive, they are a last resort. Typically balance returns to normal after these proce ures *albeit a balance system only usin" the unaffecte si e+ but hearin" loss may continue to pro"ress.$1& 0ur"ery to ecompress the en olymphatic sac has shown to be effective for temporarily relief from symptoms. Most patients see a ecrease in verti"o occurrence, while their hearin" may be unaffecte . This treatment, however, oes not a ress the lon"-term course of verti"o in Mnire's isease.$2/& @anish stu ies even lin. this sur"ery to a very stron" placebo effect, an that very little ifference occurre in a :-year followup, but coul not eny the efficacy of the treatment.$21& $e it& 'ro"ression Meniere's isease usually starts confine to one ear but it often exten s to involve both ears over time so that after ?= years, /=I of patients with Meniere's have bilateral isease *0tahle et al, <::<+. There is some controversy about this statistic however; some authors su""est that the prevalence of bilaterality is as low as <3I *0ilverstein, <::2+. 0ufferers whose Mnire's be"an with one or two of the classic symptoms may evelop others with time. -ttac.s of verti"o can become worse an more fre>uent over time, resultin" in loss of employment, loss of the ability to rive, an inability to travel. $citation needed& 0ome patients become lar"ely houseboun . Hearin" loss can become more profoun an may become permanent. 0ome patients become eaf in the affecte ear. Tinnitus can also worsen over time. 0ome patients with unilateral symptoms, as many as fifty percent by some estimates, will evelop symptoms in both ears.$citation needed& 0ome of these will become totally eaf. Jet the isease may en spontaneously an never repeat a"ain. $citation needed& 0ome sufferers fin that after ei"ht to ten years their verti"o attac.s "ra ually become less fre>uent an less severe; in some patients they isappear completely. 6n some patients, symptoms of tinnitus will also isappear, an hearin" will stabili(e *thou"h usually with some permanent loss+. $citation needed& $e it& Mi"raine lin. There is an increase prevalence of mi"raine in patients with MnireKs isease$citation needed&. -s well, mi"raine lea s to a "reater susceptibility of evelopin" MnireKs isease$citation needed&. The istinction between mi"raine-associate verti"o an MnireKs is that mi"raine-associate verti"o may last for more than 2% hours.$3& $e it& )amous sufferers an possible sufferers The Mnire's @isease 6nformation ;enter lists poet Dmily @ic.inson, author Lonathan 0wift, 4B- player 0teve )rancis, an many others as Mnire's isease sufferers.$23& $e it& 6n history

-lan B. 0hepar , the first -merican astronaut, was ia"nose with MnireKs isease in <:1%, "roun in" him after only one brief spacefli"ht. 0everal years later, sur"ery *which was then at the experimental sta"e+ was performe , allowin" 0hepar to fly to the Moon on -pollo <%.$28&

Marilyn Monroe, -merican actress an cultural icon was .nown to experience the verti"o an compromise hearin" associate with MnireKs.$2:& ;harles @arwin may have suffere from MnireKs isease.$citation needed& This i ea is base on a common list of symptoms which were present in @arwin's case, such as tinnitus, verti"o, i((iness, motion sic.ness, vomitin", continual malaise an tire ness. The absence of hearin" loss an 'fullness' of the ear *as far as .nown+ exclu es however a ia"nosis of typical MnireKs isease. @arwin himself ha the opinion that most of his health problems ha an ori"in in his %-year bout with sea sic.ness. Gater, he coul not stan travelin" by carria"e, an only horse ri in" woul not affect his health. Cne of the ia"noses that he receive from his physicians at the time was that of !suppresse "out!. The source of @arwin's illness is not .nown for certain. 0ee Charles Darwin's illness for more etails. Martin Guther wrote in letters about the istresses of verti"o, an suspecte 0atan was the cause. $?=&$?<& Lulius ;aesar was .nown to have suffere from the !fallin" sic.ness! as note in 'lutarch's Parallel Lives an has been cite by 0ha.espeare, notin" that ;aesar was unable to hear fully in his left ear.$?2& - paper by -renber" et al., <::=, su""este that Hincent Han 9o"h, the @utch 'ost-6mpressionist, may have suffere from Mnire's, $??& thou"h this is now consi ere con7ectural.$citation needed& 0ee Hincent van 9o"h's me ical con ition for a iscussion of the ran"e of possible alternative ia"noses. 0ome believe !The 0tarry 4i"ht! illustrates his i((iness. 6t's also speculate that ear pressure an eafness coul have inspire him to cut off his own ear.$citation needed& Lonathan 0wift, -n"lo-6rish satirist, poet, an cleric, is .nown to have suffere from MnireKs isease.$?%& Harlam 0halamov, Aussian writer.$?/&#<%: 0u Ju, 'G- 9eneral who achieve many victories for the communists urin" the ;hinese ;ivil Mar was hospitali(e in <:%: an that prevente him from ta.in" comman in the Norean Mar, an Mao selecte 'en" @ehuai instea .$?1&

$e it& 6n popular culture

-ccor in" to his blo", -uthor an entrepreneur 9uy Nawasa.i has the illness.$?3& L-pop sin"ers -yumi Hamasa.i an -i Na"o$?8& both sin" espite sufferin" from Mnire's. ;ontemporary artist an "raphic esi"ner @oc Hammer, of The Venture Bros. fame, has Mnire's syn rome accor in" to his May <1, 2==/ 7ournal entry.$?:& 'a y Mc-loon, the sin"er an son"writer for the British pop "roup 'refab 0prout, was ia"nose with Mnire's in 2==%.$%=& )ictional comic boo. villain ;ount Herti"o suffers from Mnire's isease an has the ability to inflict its symptoms on others. 6n the Taiwanese rama Mysterious Incredi le Terminator, the lea character ==3 suffers from Mnire's isease. Bas.etball player 0teve )rancis suffers from Mnire's.$%<& The ;ar inals sin"er Ayan - ams ma e it .nown he suffere from Mnire's isease when he announce his eparture from the ban .
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@awn Miceli, po caster, iscovere she may have MnireKs isease while rea in" an article in !ed oo".$%?& 0hawnae Lebbia, Miss ,0- <::8, was ia"nose with Mnire's isease while fulfillin" her uties as Miss ,0- for the followin" year. 'reviously, she ha a successful run as a fitness mo elEinstructor on D0'42, but this force Lebbia into retirin" from the entertainment business.$%%& 0in"er an actress Nristin ;henoweth has performe on sta"e while sufferin" from severe symptoms of Mnire's isease. 0he wrote about her experience with Mnire's in her 2==: autobio"raphy an tal.e about it on !)resh -ir with Terry 9ross! in -pril 2==:.$%/&
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Aeference in s.it on Gate 4i"ht with Limmy )allon. -u"ust 8, 2==:. Both -aron Jan an ;alvin ;hen from )ahrenheit are confirme to have this isease

What is the prognosis? There is no typical pattern to eniere!s disease. "ufferers can be affected to a variable degree. The tendency over time is for attacks to gradually reduce both in intensity and fre#uency of occurrence. $nfortunately some sufferers may be left with residual deafness even after the attacks have subsided. What should I do during an attack? %uring an attack& you should try to lie flat on a surface that doesn!t move& such as the floor. To cope with the dizziness& keep your eyes aimed at an ob'ect that doesn!t move. You will be less likely to vomit if you don(t eat or drink much. )hen your symptoms go away& get up slowly. You may feel very sleepy and want to sleep for several hours after an attack. *f you keep vomiting for more than +, hours and can!t keep down any li#uids& call your doctor for medicine to help control the vomiting.