About Ménière’s disease
Ménière’s disease is a chronic, idiopathic disorder of the inner ear, characterised by spontaneous attacks of vertigo, fluctuating hearing loss (usually in one ear), tinnitus and a feeling of aural fullness. The underlying pathologic basis of Ménière’s disease is the distortion of the membranous labyrinth, characterised by endolymphatic hydrops. The diagnosis is most common in adults during their 4th or 5th decade of life and has a slight female preponderance (most common between 40–60 years of age. There also appears to be a strong genetic component.
Causes of Meniere’s disease
The pathogenesis behind Ménière’s disease is unknown, but impaired production and/or transport of endolymph seems to be of central importance. However, histological studies of temporal bones have shown the presence of endolymphatic hydrops in patients without symptoms associated with Ménière’s disease, raising the question of why some people with hydrops are symptomatic while others are not. Other possible origins of the disease are perisaccular fibrosis, atrophy of the endolymphatic sac and loss of epithelial integrity, hypoplasia of the vestibular aqueduct, and narrowing of the lumen of the endolymphatic duct.
Major Signs and Symptoms
The excess fluid in the ear disturbs the ear’s balance and hearing mechanisms and produces a range of symptoms:
- vertigo (a form of dizziness where your surroundings appear to spin);
- tinnitus (an abnormal ringing noise inside the ear);
- fluctuating hearing loss; and
- a feeling of pressure or fullness in the ear due to fluid build-up.
Vertigo attacks can occur without any warning and the patient cannot predict how severe the vertigo will be or how long it will last. Tinnitus, distorted hearing and pressure in the ear often occur in conjunction with vertigo. In the early stages of the condition, hearing returns to normal levels following an attack, but as the disease progresses measurable and permanent hearing loss occurs.
Incidence and Prevalence
Ménière’s disease affects one in every 600-1000 Australians. It appears that Ménière’s is diagnosed in the late thirties to early fifties (it is uncommon for children to be diagnosed). Unfortunately, this is a time of life when people are busy with family and careers.
There are a number of medical and surgical therapies, which aim to reduce or ameliorate the symptoms of Ménière’s disease, however there is no proven cure currently available. No gold standard exists for the treatment of Ménière’s disease and most treatment regimens are tailored to the individual patient and their symptoms. Optimal treatment would be aimed at preventing vertigo, ameliorating tinnitus and reversing hearing loss. However, the majority of treatments are aimed principally at reducing vertigo, and have no effect on the prevention of long-term hearing impairment.
Antisecretory Factor and Ménière’s disease
The pathogenesis behind Ménière’s disease is unknown, but impaired production and/or transport of endolymph seems to be of central importance.
It has been hypothesised that the symptoms of vertigo in patients with Ménière’s disease are related to impaired production and/or transport of endolymph. This is supported by a pilot study, that was followed by a randomised trial of patients who experienced a reduction of vertigo attacks; these patients had significantly higher final AF-levels than those with no effects from the treatment. Consequently, researchers suggest that antisecretory factor might play an important part in the regulation of endolymph turnover, thereby improving the clinical outcome of Ménière’s disease. This hypothesis is further supported by immunohistochemical demonstration of antisecretory factor in the epithelial lining of the endolymphatic space in the inner ear.
Antisecretory factor (AF) is a protein known to affect transport processes in the intestine and it has been shown that intake of specially processed cereals can increase endogenous AF synthesis. In the prospective open pilot study mentioned above, 24 patients with severe Ménière’s disease (functional level scale 5-6 according to the criteria of AAO-HNS) received SPC-Flakes for 14-30 days. AF levels in plasma increased by 83% in 20 of the 24 patients studied. The attacks of rotatory vertigo were reduced, to final AAO-HNS functional level scale 1-3, in 12 patients and in three of these hearing was normalized. Twelve patients had no or minor effects from the treatment.
Experience with Salovum in Sweden suggests that Ménière patients who best respond to Salovum are those with fluctuating hearing, which may point to a disturbance of fluid homeostasis in the ear.
There are limited clinical data. A subsequent double blind, placebo-controlled study was performed in 51 patients with long-standing and well documented Ménière’s disease. The patients were randomised to intake of SPC-flakes or control cereals for 3 months, and were examined by otoneurological methods before and after the treatment. The results show that vertigo decreased significantly in the group treated with SPC-flakes, while no influence on the hearing capacity was registered. The authors concluded that that in patients suffering from Ménière’s disease intake of SPC-flakes may improve their clinical performance especially the vertigo component, and therefore could be initially recommended for treatment of this disease.
SPC-flakes and Salovum are both available from orpharma and can be ordered online. Please visit http://www.orpharma.com/products/medical-nutrition.
%20Scanning%20Report%20Final.pdf (accessed 14 Sept 2015)
http://www.asha.org/aud/articles/menieres-disease-eval-management/ (accessed 14 Sept 2015)
_best_toward_salovum_are_those_with_flu (accessed 14 Sept 2015)
http://www.menieres.org.au/menieres-disease.php (accessed 14 Sept 2015)
Hanner, P., E. Jennische and S. Lange (2003). “Antisecretory factor: a clinical innovation in Ménière’s disease?” Acta oto-laryngologica 123(6): 779-780.
Hanner, P., E. Jennische, S. Lange, I. Lonnroth and B. Wahlstrom (2004). “Increased antisecretory factor reduces vertigo in patients with Ménière’s disease: a pilot study.” Hearing research 190(1-2): 31-36
Jennische E and et. al. (2009). “ANTISECRETORY FACTOR AND ITS BIOLOGICAL ACTIVITIES.” Old Herborn University Seminar Monograph 22: 93-03.
McCall, A. A., G. P. Ishiyama, I. A. Lopez, S. Bhuta, S. Vetter and A. Ishiyama (2009). “Histopathological and ultrastructural analysis of vestibular endorgans in Ménière’s disease reveals basement membrane pathology.” BMC Ear, Nose and Throat Disorders 9(4).
Minor, L. B., D. A. Schessel and J. P. Carey (2004). “Ménière’s disease.” Current opinion in neurology 17(1): 9-16.
Moffat DA and Ballagh RH. (1997). Menière’s disease. Scott-Brown’s otolaryngology. Oxford, Butterworth-Heinemann.
Saeed, S. R. (1998). “Fortnightly review. Diagnosis and treatment of Ménière’s disease.” British Medical Journal 316(7128): 368-372.
Sajjadi, H. and M. M. Paparella (2008). “Ménière’s disease.” Lancet 372: 406–414.
Watanabe Y, Mizukoshi K, Shojaku H and et al. (1995). “Epidemiological and clinical characteristics of Ménière’s disease in Japan.” Acta Otolaryngol Suppl. 519: 206–210.