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Mnire's disease
Classification and external resources
Inner ear
ICD-10H81.0
ICD-9 386.0
OMIM 156000
DiseasesDB 8003
MedlinePlus 000702
eMedicine emerg/308
MeSH D008575
Mnire's disease
Mnire's disease ( /menjrz/)[1]
is a disorder of the inner ear that can
affect hearing and balance to a
varying degree. It is characterized by
episodes of vertigo, low pitchedtinnitus, and hearing loss.
The
hearing loss has a fluctuating then
permanent nature, meaning that it
comes and goes, alternating between
ears for some time, then becomes
permanent with no return to normal
function. It is named after the Frenchphysician Prosper Mnire,
who, in
an article published in 1861, first
reported that vertigo was caused by
inner ear disorders. The condition
affects people differently; it can range
in intensity from being a mild
annoyance to a chronic, lifelong
disability.[2]
[edit] Signs and symptoms
Mnire's often begins with one symptom, and gradually progresses.
However, not
all symptoms must be present to confirm the diagnosis[3]
although several
symptoms at once is more conclusive than different symptoms at
separate times.[4]
Other conditions can present themselves with Mnire's-like
symptoms, such assyphilis, Cogan's syndrome, autoimmune disease of
the inner ear, dysautonomia,
perilymph fistula, multiple sclerosis, acoustic neuroma, and
both hypo- and
hyperthyroidism.[5]
The symptoms of Mnire's are variable; not all sufferers
experience the same
symptoms. However, so-called "classic Mnire's" is considered to
have the
following four symptoms:
[6]
Attacks of rotational vertigo that can be severe,
incapacitating, unpredictable,
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and last anywhere from minutes to hours,[7] but generally no
longer than 24
hours. For some, prolonged attacks can occur, lasting from
several days to
several weeks, often causing the sufferer to be severely
incapacitated.[8] This
combines with an increase in volume of tinnitus and temporary,
albeit
significant, hearing loss. Hearing may improve after an attack,
but often
becomes progressively worse. Nausea, vomiting, and sweating
sometimes
accompany vertigo, but are symptoms of vertigo, and not of
Mnire's.[9]
Fluctuating, progressive, unilateral (in one ear) or bilateral
(in both ears)
hearing loss, usually in lower frequencies.[10] For some, sounds
can appear
tinny or distorted, and patients can experience unusual
sensitivity to noises.[11]
Unilateral or bilateral tinnitus.
A sensation of fullness or pressure in one or both ears.
Some may have parasitic symptoms, which aren't necessarily
symptoms ofMnire's, but rather side effects from other symptoms.
These are typically nausea,
vomiting, and sweating which are typically symptoms of vertigo,
and not of
Mnire's. Vertigo may induce nystagmus, or uncontrollable
rhythmical and jerky
eye movements, usually in the horizontal plane, reflecting the
essential role of non-
visual balance in coordinating eye movements.[12] Sudden, severe
attacks of
dizziness or vertigo, known informally as "drop attacks," can
cause someone who is
standing to suddenly fall.[13]
Drop attacks are likely to occur later in the disease, butcan
occur at any time.[13]
[edit] Migraine
There is an increased prevalence of migraine in patients with
Mnires disease.
[edit] Cause
Mnire's disease is idiopathic, but it is believed to be linked
to endolymphatic
hydrops, an excess of fluid in the inner ear.[14] It is thought
that endolymphatic fluid
bursts from its normal channels in the ear and flows into other
areas, causing
damage. This is called "hydrops." The membranous labyrinth, a
system of
membranes in the ear, contains a fluid called endolymph. The
membranes can
become dilated like a balloon when pressure increases and
drainage is blocked.[15]
This may be related to swelling of the endolymphatic sac or
other tissues in the
vestibular system of the inner ear, which is responsible for the
body's sense of
balance. In some cases, the endolymphatic duct may be obstructed
by scar tissue, or
may be narrow from birth. In some cases there may be too much
fluid secreted by
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the stria vascularis. The symptoms may occur in the presence of
a middle ear
infection, head trauma, or an upper respiratory tract infection,
or by using aspirin,
smoking cigarettes, or drinking alcohol. They may be further
exacerbated by
excessive consumption of salt in some patients. It has also been
proposed that
Mnire's symptoms in many patients are caused by the deleterious
effects of a
herpes virus.[16][17][18]Herpesviridae are present in a majority
of the population in a
dormant state. It is suggested that the virus is reactivated
when the immune systemis depressed due to a stressor such as
trauma, infection, or surgery (under general
anesthesia). Symptoms then develop as the virus degrades the
structure of the inner
ear.
Mnire's disease affects about 190 people per 100,000.[19] Recent
gender
predominance studies show that Mnire's tends to affect women
more often than
men.[19]
Age of onset typically occurs in adult years, with prevalence
increasingwith age.[19]
[edit] Diagnosis
Doctors establish a diagnosis with complaints and medical
history. However, a
detailed otolaryngological examination, audiometry, and head MRI
scan should be
performed to exclude a vestibular schwannoma or superior canal
dehiscence which
would cause similar symptoms. Some of the same symptoms also
occur with benignparoxysmal positional vertigo (BPPV), and with
cervical spondylosis (which can
affect blood supply to the brain and cause vertigo). There is no
definitive test for
Mnire's; it is only diagnosed when all other causes have been
ruled out. If any
cause had been discovered, this would eliminate Mnire's disease,
as by its very
definition,[20] as an exclusively idiopathic disease -- it has
no known cause.
[edit] History
Mnire's disease had been recognized as early as 1860s, but it
was still relatively
vague and broad at the time. The American Academy of
Otolaryngology-Head and
Neck Surgery Committee on Hearing and Equilibrium (AAO HNS CHE)
set criteria
for diagnosing Mnire's, as well as defining two sub categories
of Mnire's:
cochlear (without vertigo) and vestibular (without
deafness).[21]
In 1972, the academy defined criteria for diagnosing Mnire's
disease as:[22]
1. Fluctuating, progressive, sensorineural deafness.
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2. Episodic, characteristic definitive spells of vertigo lasting
20 minutes to 24
hours with no unconsciousness, vestibular nystagmus always
present.
3. Usually tinnitus.
4. Attacks are characterized by periods of remission and
exacerbation.
In 1985, this list changed to alter wording, such as changing
"deafness" to "hearing
loss associated with tinnitus, characteristically of low
frequencies" and requiring
more than one attack of vertigo to diagnose.[23] Finally in
1995, the list was again
altered to allow for degrees of the disease:[24]
1. Certain - Definite disease with histopathological
confirmation
2. Definite - Requires two or more definitive episodes of
vertigo with hearing loss
plus tinnitus and/or aural fullness
3. Probable - Only one definitive episode of vertigo and the
other symptoms and
signs4. Possible - Definitive vertigo with no associated hearing
loss
[edit] Management
Several environmental and dietary changes are thought to reduce
the frequency or
severity of symptom outbreaks. It is believed that since high
salt diets cause water
retention, it can lead to an increase (or at least preventing
the decrease) of fluid
within the inner ear, although the relationship between salt and
the inner ear is notfully understood. High-salt intake is thought
to alter the concentrations of fluid in
the inner ear and Mnire's episodes could be accelerated by
high-salt binges.[25]
Recommended salt intake is often around one to two grams per
day.[25] One source
recommends taking two gramms of potassium or more daily.;
; Diuretics have traditionally been
prescribed to facilitate a low-salt diet although there is no
definite supportive
evidence.[25]
Additionally, patients may be advised to avoid alcohol,
caffeine, and tobacco, all of
which can aggravate symptoms of Mnire's. Many patients will have
allergy
testing done to see if they are candidates for allergy
desensitization, as allergies
have been shown to aggravate Mnire's symptoms.[26]
Both prescription and over-the-counter medicine can be used to
reduce nausea and
vomiting during an episode. Included are antihistamines such as
meclozine or
dimenhydrinate, trimethobenzamide and other antiemetics,
betahistine, diazepam,
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or ginger root.[27] Betahistine, specifically, is of note
because it is the only drug
listed that has been proposed to prevent symptoms due to its
vasodilation effect on
the inner ear.[25]
The antiherpes virus drug acyclovir has been used with some
success to treat
Mnire's Disease.[16] The likelihood of the effectiveness of the
treatment was found
to decrease with increasing duration of the disease, probably
because viralsuppression does not reverse damage. Morphological
changes to the inner ear of
Mnire's sufferers have also been found in which it was
considered likely to have
resulted from attack by a herpes simplex virus.[17] It was
considered possible that
long term treatment with acyclovir (greater than six months)
would be required to
produce an appreciable effect on symptoms. Herpes viruses have
the ability to
remain dormant in nerve cells by a process known as HHV Latency
Associated
Transcript. Continued administration of the drug should prevent
reactivation of thevirus and allow for the possibility of an
improvement of symptoms. Another
consideration is that different strains of a herpes virus can
have different
characteristics which may result in differences in the precise
effects of the virus.
Further confirmation that acyclovir can have a positive effect
on Mnire's
symptoms has been reported.[28]
Studies done over the use of transtympanic micropressure pulses
have indicated
promise with patients who had not been previously treated by
gentamicin or
surgery.[29][30] Other studies suggest less clear results and
propose that
micropressure devices are simply placebos.[25]
[edit] Coping
Sufferers tend to have high stress and anxiety due to the
unpredictable nature of the
disease.[31]
Healthy ways to combat this stress can include aromatherapy,
yoga, t'aichi,[32] and meditation. Greenberg and Nedzelski
recommend education to alleviate
feelings of depression or helplessness.[25]
[edit] Surgery
If symptoms do not improve with typical treatment, more
permanent surgery is
considered.[33] Unfortunately, because the inner ear deals with
both balance and
hearing, few surgeries guarantee no hearing loss.
Nondestructive surgeries include those which do not actively
remove any
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functionality, but rather aim to improve the way the ear works.
[34] Intratympanic
steroid treatments involve injecting steroids (commonly
dexamethasone) into the
middle ear in order to reduce inflammation and alter inner ear
circulation.[35]
Surgery to decompress the endolymphatic sac has shown to be
effective for
temporary relief from symptoms. Most patients see a decrease in
vertigo occurrence,
while their hearing may be unaffected. This treatment, however,
does not address
the long-term course of vertigo in Mnire's disease.[36] Danish
studies even link
this surgery to a very strong placebo effect, and that very
little difference occurred
in a 9-year followup, but could not deny the efficacy of the
treatment. [37]
Conversely, destructive surgeries are irreversible and involve
removing entire
functionality of most, if not all, of the affected ear.[38] The
inner ear itself can be
surgically removed via labyrinthectomy although hearing is
always completely lost
in the affected ear with this operation.[4] Alternatively, a
chemical labyrinthectomy,in which a drug (such as gentamicin) that
"kills" the vestibular apparatus is injected
into the middle ear can accomplish the same results while
retaining hearing. [39] In
more serious cases surgeons can cut the nerve to the balance
portion of the inner ear
in a vestibularneurectomy. Hearing is often mostly preserved,
however the surgery
involves cutting open into the lining of the brain, and a
hospital stay of a few days
for monitoring would be required.[40] Vertigo (and the
associated nausea and
vomiting) typically accompany the recovery from destructive
surgeries as the brainlearns to compensate.[40]
[edit] Physiotherapy
Physiotherapists also have a role in the management of Menieres
disease. In
vestibular rehabilitation, physiotherapists use interventions
aimed at stabilizing
gaze, reducing dizziness and increasing postural balance within
the context of
activities of daily living. After a vestibular assessment is
conducted, the
physiotherapist tailors the treatment plan to the needs of that
specific patient. [41]
The central nervous system (CNS) can be re-trained because of
its plasticity, or
alterability, as well as its repetitious pathways. During
vestibular rehabilitation,
physiotherapists take advantage of this characteristic of the
CNS by provoking
symptoms of dizziness or unsteadiness with head movements while
allowing the
visual, somatosensory and vestibular systems to interpret the
information. Thisleads to a continuous decrease in
symptoms.[41]
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Although a significant amount of research has been done
regarding vestibular
rehabilitation in other disorders, substantially less has been
done specifically on
Menieres disease. However, vestibular physiotherapy is currently
accepted as part
of best practices in the management of this condition. [41]
The Merck Manual has added head trauma as a risk factor due to
the research on
300 Meniere's patients over the past fourteen years. Michael
Burcon, BPh, DC hasestablished a link between whiplash as a result
of vehicular accidents or falling on
one's head and Meniere's disease. It takes an average of fifteen
years after the
trauma before the onset of symptoms. Case history, thermography,
MRI, CScan,
and/or cervical x-ray and modified Prill relative leg length
tests are used for
diagnosis and upper cervical specific adjustments are performed
for treatment to
reduce or eliminate vertigo. [42]
[edit] Prognosis
Mnire's disease usually starts confined to one ear, but it often
extends to involve
both ears over time. The number of patients who end up with
bilaterial Mnire's is
debated, with ranges spanning from 17% to 75%.[43]
Some Mnire's disease sufferers, in severe cases, may end up
losing their jobs, and
will be on disability until the disease burns out.
[44]
However, a majority (60-80%) ofsufferers will not need permanent
disability and will recover with or without
medical help.[43]
Hearing loss usually fluctuates in the beginning stages and
becomes more
permanent in later stages, although hearing aids and cochlear
implants can help
remedy damage.[45] Tinnitus can be unpredictable, but patients
usually get used to
it over time.[45]
Mnire's disease, being unpredictable, has a variable prognosis.
Attacks could
come more frequently and more severely, less frequently and less
severely, and
anywhere in between.[46] However, Mnire's is known to "burn out"
when
vestibular function has been destroyed to a stage where vertigo
attacks cease.
Studies done on both right and left ear sufferers show that
patients with their right
ear affected tend to do significantly worse in cognitive
performance.[47]
Generalintelligence was not hindered, and it was concluded that
declining performance was
related to how long the patient had been suffering from the
disease. [48]
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[edit] Notable cases
[edit] Known cases
Alan B. Shepard, the first Americanastronaut and fifth man on
the Moon, was
diagnosed with Mnires disease in 1964, grounding him after only
one brief
spaceflight. Several years later, an endolymphatic shunt surgery
(which wasthen at the experimental stage) was performed, allowing
Shepard to fly to the
Moon on Apollo 14.[49]
Jonathan Swift, Anglo-Irish satirist, poet, and cleric, is known
to have suffered
from Mnires disease.[50]
Varlam Shalamov, a Russian writer, was affected.[51]
Su Yu, PLA General who achieved many victories for the
communists during
the Chinese Civil War was hospitalized in 1949 and that
prevented him fromtaking command in the Korean War, and Mao Zedong
selected Peng Dehuai
instead.[52]
Ryan Adams, an American musician, had to take a two year break
from music
because the disease became so degenerative to him, and needed to
undergo
therapy to get back on stage to overcome the anxiety the disease
caused
him.[53]
Katie Leclerc, an American actress.Dana White, president and
minority owner of the Ultimate Fighting
Championship (UFC).[54]
Chris Packham, British wildlife photographer and television
presenter.[55] Has
suffered with condition since he was 37, but has vowed to
continue with his
work regardless.
Kristin Chenoweth, Broadway and film star, and opera
singer.[56]
Abdullah Gl, the 11th and current President of the Republic of
Turkey.[57]
Brent Crosswell, former Australian Rules football player.
[edit] Possible cases
Marilyn Monroe, American actress and cultural icon was known to
experience
the vertigo and compromised hearing associated with
Mnires.[58]
Charles Darwin may have suffered from Mnires disease.[59] This
idea is
based on a common list of symptoms which were present in
Darwin's case,such as tinnitus, vertigo, dizziness, motion
sickness, vomiting, continual
malaise and tiredness. The absence of hearing loss and
'fullness' of the ear (as
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far as known) excludes, however, a diagnosis of typical Mnires
disease.
Darwin himself had the opinion that most of his health problems
had an origin
in his 4-year bout with sea sickness. Later, he could not stand
traveling by
carriage, and only horse riding would not affect his health. One
of the
diagnoses that he received from his physicians at the time was
that of
"suppressed gout". The source of Darwin's illness is not known
for certain. See
Charles Darwin's health.Martin Luther wrote in letters about the
distresses of vertigo, and suspected
Satan was the cause.[60][61]
Julius Caesar was known to have suffered from the "falling
sickness" as noted
in Plutarch's Parallel Lives, and has been cited by Shakespeare,
noting that
Caesar was unable to hear fully in his left ear.[62]
It has been suggested that Vincent Van Gogh may have suffered
from
Mnire's,[63]
though this is now considered conjectural.[64]
See Vincent vanGogh's medical condition for a discussion of the
range of possible alternative
diagnoses.
[edit] Notes
1. Dictionary.com Unabridged (v 1.1). Random House, Inc.
Accessed on 9
September 2008
2. Mnire's disease at Who Named It?3. Hazell, Jonathan.
"Information on Mnire's Syndrome". Retrieved 2007-02-27.
4. ^ a b "Menir's disease". Maryland Hearing and Balance Center.
Retrieved
2008-03-03.
5. Haybach, pg. 55
6. "Meniere's disease symptoms". Mayo Clinic. 2008-06-18.
Retrieved 2008-10-17.
7. Haybach, pg. 70
8. Lempert, T.; Neuhauser, H. (November 2008). "Epidemiology of
vertigo,migraine and vestibular migraine". Journal of Neurology 256
(3): 333338.
doi:10.1007/s00415-009-0149-2. PMID19225823.
9. Haybach, p. 72
10. Haybach, p. 71
11. Haybach, pg. 79
12. Haybach, pg. 46
13. ^ ab Haybach, pg. 90
14. Haybach, pg. 8
15. Menieres Causes at the American Hearing Research Foundation
Chicago,
Illinois 2008.
http://en.wikipedia.org/w/index.php?title=American_Hearing_Research_Foundation&action=edit&redlink=1http://www.american-hearing.org/disorders/menieres/menieres.html#causeshttp://www.ncbi.nlm.nih.gov/pubmed/19225823http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1007%2Fs00415-009-0149-2http://en.wikipedia.org/wiki/Digital_object_identifierhttp://en.wikipedia.org/wiki/Mayo_Clinichttp://www.mayoclinic.com/health/menieres-disease/DS00535/DSECTION=symptomshttp://www.umm.edu/otolaryngology/menieres_disease.htmlhttp://www.tinnitus.org/home/frame/meniere.htmhttp://en.wikipedia.org/wiki/Who_Named_It%3Fhttp://www.whonamedit.com/synd.cfm/2073.htmlhttp://dictionary.reference.com/browse/meniere%27s%20syndromehttp://en.wikipedia.org/w/index.php?title=M%C3%A9ni%C3%A8re%27s_disease&action=edit§ion=14http://en.wikipedia.org/wiki/Vincent_van_Gogh%27s_medical_conditionhttp://en.wikipedia.org/wiki/Vincent_Van_Goghhttp://en.wikipedia.org/wiki/Shakespearehttp://en.wikipedia.org/wiki/Parallel_Liveshttp://en.wikipedia.org/wiki/Plutarchhttp://en.wikipedia.org/wiki/Julius_Caesarhttp://en.wikipedia.org/wiki/Martin_Lutherhttp://en.wikipedia.org/wiki/Charles_Darwin%27s_healthhttp://en.wikipedia.org/wiki/Gout
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16. ^ a b Shichinohe, Mitsuo (December 1999). "Effectiveness of
Acyclovir on
Meniere's Syndrome III Observation of Clinical Symptoms in 301
cases".
Sapporo Medical Journal68 (4/6): 7177.
17. ^ a b Gacek RR, Gacek MR (2001). "Menire's disease as a
manifestation of
vestibular ganglionitis". Am J Otolaryngol 22 (4): 24150.
doi:10.1053/ajot.2001.24822. PMID11464320.
18. Gacek RR (2009). "Mnire's disease is a viral neuropathy".
ORL J
Otorhinolaryngol Relat Spec. 71 (2): 7886.
doi:10.1159/000189783.
PMID19142031.
19. ^ a b c Thomas, Alexander; Jeffrey Harris (October 2010).
"Current
Epidemiology of Meniere's Syndrome". The Otolaryngologic clinics
of North
America43 (5): 965970. doi:10.1016/j.otc.2010.05.001.
PMID20713236.
20. Haybach, pg. 9
21. Beasley, Jones, p.1111, para.elsei 322. Beasley, Jones,
p.1111, para. 2/table I
23. Beasley, Jones, p.1111, para. 4/table II
24. Beasley, Jones, p.1112, para. 2/table III
25. ^ abc d ef Greenberg, Simon; Julian Nedzelski (October
2010). "Medical and
Noninvasive Therapy for Meniere's Disease". The Otolaryngologic
clinics of North
America43 (5): 10811090. doi:10.1016/j.otc.2010.05.005.
PMID20713246.
26. Derebery MJ (2000). "Allergic management of Meniere's
disease: an outcomestudy". Otolaryngology--head and neck surgery :
official journal of American
Academy of Otolaryngology-Head and Neck Surgery 122 (2):
17482.
PMID10652386.
27. Haybach, p. 198
28. Gacek RR (2008). "Evidence for a viral neuropathy in
recurrent vertigo". ORL J
Otorhinolaryngol Relat Spec.70 (1): 614. doi:10.1159/000111042.
PMID18235200.
29. Rajan GP, Din S, Atlas MD (2005). "Long-term effects of the
Meniett device in
Mnire's disease: the Western Australian experience". The Journal
of laryngology
and otology119 (5): 3915. doi:10.1258/0022215053945868.
PMID15949105.
30. Gates GA, Verrall A, Green JD, Tucci DL, Telian SA (December
2006). "Meniett
clinical trial: long-term follow-up". Arch. Otolaryngol. Head
Neck Surg. 132 (12):
13116. doi:10.1001/archotol.132.12.1311. PMID17178941.
31. Haybach, p. 231
32. Haybach, p. 198-200
33. Haybach, p. 18134. Haybach, p.209
35. Hain, Timothy (2009-06-26). "Intratympanic Steroid Treatment
For Meniere's
http://www.dizziness-and-balance.com/treatment/it-steroids.htmhttp://www.ncbi.nlm.nih.gov/pubmed/17178941http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1001%2Farchotol.132.12.1311http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/15949105http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1258%2F0022215053945868http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/18235200http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1159%2F000111042http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/10652386http://en.wikipedia.org/wiki/PubMed_Identifierhttp://www.ncbi.nlm.nih.gov/pubmed/20713246http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1016%2Fj.otc.2010.05.005http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/20713236http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1016%2Fj.otc.2010.05.001http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/19142031http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1159%2F000189783http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/11464320http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1053%2Fajot.2001.24822http://en.wikipedia.org/wiki/Digital_object_identifier
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Disease". Retrieved 2011-01-16.
36. Tsun-Sheng, Huang; Ching-Chen, Lin; Yun-Lan, Chang
(1991).
"Endolymphatic Sac Surgery for Meniere's Disease". Acta
Otolaryngol111 (S485):
145154. doi:10.3109/00016489109128054.
37. Thomsen, J; Bretlau, P.; Tos, M.; Johnsen, N.J. (1981).
"Placebo effect in surgery
for Meniere's disease. A double-blind, placebo-controlled study
on
endolymphatic sac shunt surgery". Acta Otolaryngol 107 (5):
55861.PMID6517150.
38. Haybach, p.212
39. Hain, Timothy (2010-10-06). "Intratympanic/Transtympanic
Gentamicin
Treatment for Meniere's Disease". Retrieved 2011-01-16.
40. ^ ab Haybach, p.215
41. ^ ab c Gottshall, K.; Topp, S. & Hoffer, M. (2010).
"Early Vestibular Physical
Therapy Rehabilitation for Menieres Disease". Otolaryngol Clin N
Am43: 11131119.
42. BurconMT, Upper Cerical Protocol for Ten Meniere's Patients,
Upper Cervical
Subluxation Complex, a review of the chiropractic and medical
literature, Kirk
Ericksen, Lippincott, Williams & Wilkins, 2004
43. ^ ab Haybach, pg. 10
44. Haybach, pg. 224
45. ^
a
b
Haybach, pg. 22346. Haybach, pg. 221
47. Theilgaard, Laursen, Kjaerby, et al. p. 103
48. Theilgaard, Laursen, Kjaerby, et al. p. 104
49. Gray, Tara. "Alan B. Shepard, Jr.". 40th Anniversary of
Mercury 7. NASA.
Retrieved May 25, 2012. "After the cancellation of Shepard's
second Mercury
flight, he began training with Frank Borman, a member of the
second group of
astronauts selected by NASA, for the flight of the first manned
Gemini mission.
However, in early 1964 Shepard awoke one morning feeling
nauseated. He metwith Chief Astronaut Deke Slayton to report on
what he encountered. He had
become extremely dizzy, fallen and then became ill. For several
days Shepard
felt fine, his episode apparently behind him. Until the fifth
day, when he again
experienced head-spinning and vomiting.28 Once again the room
whirled
madly. He felt and heard an awful ringing in his left ear that
went as quickly
as it came. It came back several times and Shepard knew
something was
dangerously, terribly wrong so he checked in with the flight
surgeons.29 Hewas diagnosed with Meniere's syndrome, a condition in
which fluid pressure
builds up in the inner ear and makes the semicircular canals and
motion
http://history.nasa.gov/40thmerc7/shepard.htmhttp://www.dizziness-and-balance.com/treatment/ttg.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/6517150http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.3109%2F00016489109128054http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.dizziness-and-balance.com/treatment/it-steroids.htm
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detectors extremely sensitive. It results in disorientation,
dizziness and nausea.
He was also diagnosed with glaucoma, an elevated pressure in the
eyeballs."
50. Crook, Keith (1998). A Preface to Swift . Longman. pp. 6.
ISBN978-0582289789.
51. Toker, Leona (2000). Return from the Archipelago: narratives
of Gulag survivors .
Bloomington: Indiana University Press. pp. 149.
ISBN0-253-33787-9.
"Meanwhile, Shalamov's health kept deterioratingthe Kolyma twig
would
have but a short time before wilting in Moscow. The body of a
Kolymasurvivor bore witness of its own: blindness, deafness,
frostbitten skin,
Mnires disease, chronic congestion, and apparently also minor
strokes,
angina pectoris, Parkinson's disease, and incipient dementia.
Iulii Shreider
found a woman to cook and clean for him, yet eventually Shalamov
broke with
her too. Unable to take care of himself, in 1979 he was placed
in a nursing
home (see Isaev 1996)."
52. Su Yu (simplified Chinese wiki)
53. Drew, Ian (October 21, 2011). "Ryan Adams Opens Up About
Tragic Ear
Disease". US Weekly. Retrieved May 25, 2012. "Having your first
album of new
material immediately break into the Billboard Top 200 albums
chart on release
week is usually cause for celebration for most rock stars. But
Ryan Adams isn't
smiling just because his brilliantly subdued new disc, Ashes
& Fire, slid right
in at #7 this week. That's because the alternative singer, 36,
is still grappling
with Meniere's Disease, a debilitating and incurable inner ear
condition that
forced him to take a break from music for over two years."54.
UFC President Dana White pushing for surgery, vows to beat
Meniere's
disease
55. [1]
56. [2]
57. [3]
58. Brown, Peter and Barham, Patte Marilyn: The Last Take. New
York: Dutton,
1992, p. 221 ISBN 0-525-93485-5
59. Hayman, John (2009-12-13). "Darwins illness revisited". BMJ
339: b4968.
doi:10.1136/bmj.b4968. PMID20008377. Retrieved 2010-05-22.
60. Feldmann H (1989). "Martin Luther's seizure disorder" (in
German). Sudhoffs
Archiv73 (1): 2644. PMID2529669.
61. Cawthorne, T (1947). "Mnire's disease". Annals of Otology56:
1838.
62. Cawthorne, T (1958). "Julius Caesar and the falling
sickness". Proceedings of the
Royal Society of Medicine51 (1): 2730. PMC1889541.
PMID13518145.
63. Arenberg IK, Countryman LF, Bernstein LH, Shambaugh GE
(1990). "VanGogh had Menire's disease and not epilepsy". JAMA 264
(4): 4913.
doi:10.1001/jama.264.4.491. PMID2094236.
http://www.ncbi.nlm.nih.gov/pubmed/2094236http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1001%2Fjama.264.4.491http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/13518145http://en.wikipedia.org/wiki/PubMed_Identifierhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1889541http://en.wikipedia.org/wiki/PubMed_Centralhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1889541/http://www.ncbi.nlm.nih.gov/pubmed/2529669http://en.wikipedia.org/wiki/PubMed_Identifierhttp://www.ncbi.nlm.nih.gov/pubmed/20008377http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1136%2Fbmj.b4968http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.bmj.com/cgi/content/full/339/dec11_2/b4968http://en.wikipedia.org/wiki/Special:BookSources/0525934855http://www.hurriyet.com.tr/yazarlar/21354765.asp?yazarid=10&hid=21356447http://www.prevention.com/health/emotional-health/kristin-chenoweth-exclusive-interview-preventionhttp://www.dailymail.co.uk/health/article-1382836/Wildlife-star-Chris-Packham-living-chronic-vertigo.htmlhttp://www.mmatorch.com/artman2/publish/UFC_2/article_13407.shtmlhttp://www.usmagazine.com/moviestvmusic/news/ryan-adams-opens-up-about-tragic-ear-disease-20112110http://zh.wikipedia.org/wiki/%E7%B2%9F%E8%A3%95http://en.wikipedia.org/wiki/Special:BookSources/0-253-33787-9http://en.wikipedia.org/wiki/International_Standard_Book_Numberhttp://en.wikipedia.org/wiki/Special:BookSources/978-0582289789http://en.wikipedia.org/wiki/International_Standard_Book_Number
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64. Arnold, Wilfred N. (1992). Vincent van Gogh: Chemicals,
Crises, and Creativity.
ISBN0-8176-3616-1
Katie Leclerc a known actress and main star in the abc family
television series
switched at birth is known to suffer from vertigo and was
diagnosed as having
Mnire's disease
[edit] References
[edit] External links
http://en.wikipedia.org/w/index.php?title=M%C3%A9ni%C3%A8re%27s_disease&action=edit§ion=16http://en.wikipedia.org/w/index.php?title=M%C3%A9ni%C3%A8re%27s_disease&action=edit§ion=15http://en.wikipedia.org/wiki/Special:BookSources/0-8176-3616-1http://en.wikipedia.org/wiki/International_Standard_Book_Number
