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Patients with Ménière's disease experience periodic attacks of disabling symptoms of loss of hearing and balance. The disease is progressive, but in between attacks patients are usually free of symptoms. Attacks tend to occur in clusters over a few weeks and they can last for up to two or three days. There may be periods of remission between attacks of weeks or even months. During the acute episode the following symptoms are commonly experienced:
Vertigo
This is a sudden sense of loss of equilibrium, or dizziness, often described as if "everything seems to be going around" or "the whole room seems to be spinning." Vertigo may appear without warning at any time and is not usually associated with a change in position. It may make sitting or walking difficult. Any head motion, even when lying flat, may aggravate the sensation. These spells of dizziness may last from five minutes to 72 hours. The spells may stop gradually or very suddenly. Sufferers are usually obliged to lie down with their heads placed in the position of greatest comfort.
Nausea
Nausea usually accompanies the vertigo because of stimulation of nerves in the ear that affects the nerve supply to the stomach and intestines. Any head movement may aggravate nausea. As a consequence, the head is usually held rigidly to one side. Vomiting may be violent or prolonged for hours.
Ear fullness
The sensation of ear fullness may precede other symptoms by several days or occur abruptly with tinnitus and hearing loss.
Tinnitus
Tinnitus is described as a sudden roar, whistling, ringing, cricket hum, or rushing sound deep within the ear that is unremitting and constant. Pulsating or throbbing tinnitus does not occur with Ménière's disease and its presence suggests a disorder of the blood vessels. The tinnitus may improve or disappear as the attack subsides. However, in more than 50 per cent of patients, the tinnitus continues after the first attack and may rival vertigo as the most severe symptom.
Loudness sensitivity
Loudness sensitivity is known as "recruitment." Recruitment is an abnormally rapid increase in the sense of loudness as sound intensity increases. The comfortable range of hearing becomes narrow and patients become intolerant of sounds barely above their hearing threshold.
Hearing loss
Sudden profound hearing loss may occur with the first attack. It may persist, but hearing usually returns and fluctuates close to normal. Hearing loss becomes progressive with each attack. Characteristically, low-tone loss develops, followed by high-tone loss as repeated attacks occur. The hearing may become useless for normal conversation as pure-tone and speech discrimination levels decline. Total deafness for all sounds is rare. Hearing may improve suddenly as nausea and vomiting occur.
Impaired vision
Patients may experience blurred or "jerky" vision, created primarily by the rapid, involuntary stimulation from the inner ear. This can be constant during the first few hours of the attack. The entire room may seem to be in rotation from the vertigo also.
Headache
About one in every four patients experiences generalized vague headache, even between attacks. This may be accentuated with attacks and persist to a lesser degree almost daily. The mechanism of this headache is unclear, but it may be related to constriction of blood vessels common to the inner ear and other cerebral vessels. In some patients this is the most distressing part of the disease.
An acute episode typically follows this course:
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Warning symptoms of pressure sensation or fullness in one ear, which feels "blocked," precede an attack. |
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Hearing then becomes impaired, accompanied by a loud roaring tinnitus. |
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Vertigo soon follows and lasts from a few minutes to many hours, rarely lasting as long as 24 hours. The interval between the onset of symptoms and the peak of vertigo varies from a few minutes to a full day or so. |
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Depending on the severity of the vertigo, patients may experience nausea, vomiting or diarrhea. |
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Pallor and cold sweat are common. |
The patient may feel weak and unsteady for one or two days following a severe attack. Recurrence of the attacks is a fundamental feature of the disease. The attacks are of unpredictable frequency. At first, patients may have one attack per year. Then attacks may occur more frequently, once a week or even daily. |
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TCM practitioners will examine a sufferer and categorize symptoms under special syndrome groups known as "disharmony patterns." Certain disharmony patterns are present at different stages of a disorder. In Ménière's disease these can be classified into the following types:
Deficit in the sea of marrow
Individuals present with frequent attacks of dizziness accompanied by severe ringing in the ears and obvious hearing loss. Other symptoms include listlessness, soreness and weakness in the back and knees, insomnia and irritability, nightmares, spermatorrhea, poor memory, and a hot sensation in the chest, palms of the hands and the feet.
Deficiency in qi and blood
During the dizziness attacks, individuals look pallid, are fatigued or sleepy, lack emotion and are reluctant to speak. Other symptoms include loss of appetite, diarrhea, shortness of breath, and wheezing and palpitation on exertion.
Flood of cold-dampness
Individuals experience forceful palpitations during attacks, accompanied by an aversion to cold, a low body temperature and the spitting-up of large amounts of thin, clear sputum. Other symptoms include pain and a sensation of cold in the loin area, listlessness and lack of affect (emotion), frequent nocturnal urination, and production of large volumes of clear urine.
Disturbance of liver-yang
These episodes usually happen after an emotional disturbance and are accompanied by impetuosity and irritability, headache, a flushed face and blood-shot eyes. Other symptoms include a bitter taste in the mouth, a dry throat, and a feeling of fullness and discomfort in the chest and below the ribs. Insomnia and nightmares may occur.
Obstruction by viscous phlegm
Individuals experience heaviness and distension in the forehead during dizzy spells. Chest discomfort, nausea and sometimes severe vomiting can accompany these symptoms. Other symptoms include the production of large amounts of saliva and sputum, palpitation, poor appetite and fatigue.
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