"Knock down" Jacky Cheung's "ear water imbalance" What is the disease?

Some time ago, Jacky Cheung fell at the concert to attract everyone's attention, and he later explained that he had been plagued by "ear water imbalance" since childhood. The dizziness that day was also because of this disease. For a while, the word "ear water imbalance" entered the public eye. Is there really water in our ears? Where does the water come from? How is this disease treated? Today, otolaryngologists are here to reveal the secret.

We do have liquid in our ears

Let's be clear, we do have liquid in our ears. To understand where the liquid comes from, we need to understand the structure of the ear. The ear is divided into three parts: the outer ear, the middle ear, and the inner ear.

The inner ear is in the deepest part and is divided into the auditory apparatus, the cochlea, and the balancer, the vestibule. In the outer layer of the inner ear is a layer of bony structures called the bony labyrinth, which is filled with ectolymph. In the bone labyrinth, there is another membranous structure, called the membranous labyrinth, which is filled with endolymph. Under normal circumstances, the inner ear of a person is filled with lymph fluid, and when the endolymph secretion is excessive or normal absorption dysfunction, there will be labyrinthine hydrops in the inner eardrum, which is what Jacky Cheung called "ear water imbalance".

However, "ear water imbalance" is not a technical medical term. Clinically it is called Meniere's disease, which used to be called "Meniere's syndrome". In other words, Meniere's disease is an unexplained disease of the inner ear characterized by membranous labyrinthine hydrops.

There are five typical manifestations of "standing water" in the ear

In general, there are five typical clinical manifestations of Meniere's disease:

Recurrent vertigo Episodic vertigo lasts from 20 minutes to 12 hours, often accompanied by autonomic dysfunction such as nausea and vomiting, balance dysfunction such as unsteady walking, and loss of consciousness. There are no episodes of vertigo intermittently, but may be accompanied by balance dysfunction. Patients with bilateral Meniere's disease may present with dizziness, instability, shaking, or vibrating hallucinations.

Fluctuating hearing loss is generally fluctuating sensorineural hearing loss, mainly low and intermediate frequencies in the early stage, and hearing can return to normal during the intermittent period. As the disease progresses, hearing loss progresses and hearing does not return to normal or pre-morbid levels during intermittent periods. Most patients present with auditory revitalization.

Tinnitus usually precedes vertigo attacks. Tinnitus worsens with episodes of vertigo and resolves naturally during intermittent periods, but generally does not go away. Most of them are unilateral tinnitus, and a small number of patients have bilateral tinnitus.

Feeling of ear fullness, heaviness, or pressure in the affected ear during an attack. As the condition progresses, tinnitus and/or a feeling of fullness persists.

Autonomic dysfunction nausea, vomiting, pale complexion, cold sweat, slow pulse, decreased blood pressure, etc., balance disorders, but conscious consciousness. The above symptoms are exacerbated when the eyes are opened and the head is turned and reduced when the eyes are closed and lying still. Vertigo often recurs, with more relapses, longer duration, and shorter intervals.

These six tests can help confirm the diagnosis

How can Meniere's disease be diagnosed? First, basic tests include otoscopy, pure tone, and acoustic impedance. In addition, depending on the condition, the following tests may be selected:

Audiology includes dehydrator testing, electrocochlear electrogram, otoacoustic emission, ABR, etc.

Vestibular functions include spontaneous nystagmus, gaze nystagmus, visual motion, smooth tracking, saccade, position test, hot and cold test, rotation test, shaking head test, head pulse test, vestibular autorotation test, vestibular evoked myogenic potential (VEMP), etc.

Balance function Static or dynamic postural tracing, balance sensory integration ability test, and gait assessment.

Tinnitus Tinnitus, tone and intensity matching check.

Imaging: Cranial MRI with cerebellar angle of the internal auditory pontogram is preferred, and MRI imaging of the labyrinth of the inner eardrum with gadolinogram is preferred.

Etiology includes immunological tests, allergen tests, genetic tests, endocrine function tests, etc.

There is no cure but treatment can alleviate the condition

Since the cause of Meniere's disease is not yet known, it is currently considered a lifelong disease and there is no cure. However, lifestyle modification, medication, surgery, and combination therapy can prevent or reduce the severity and frequency of vertigo and maximize the quality of life.

The principle of treatment is a stepped treatment plan; Symptomatic treatment to control vertigo during acute attacks; The intermittent period is mainly to prevent and reduce the frequency of vertigo attacks, reduce and prevent hearing loss, tinnitus or ear fullness, and improve the quality of life of patients.

At present, patients with Meniere's disease can be relieved by sedative, diuretic, hormonal and other drugs. And, because Meniere's disease is a paroxysmal disease, patients only need to take the drug at the time of onset, rather than continuing it for life.

For very stubborn and severe recurrent vertigo, surgery can also be performed in cases where conservative treatment or medical therapy is ineffective for six months. For example, endolymphatic cyst surgery, three semicircular canal occlusion, vestibular nerve section, labyrinthectomy, etc. However, because labyrinth resection surgery is more harmful, it is generally chosen carefully.

Avoid triggers Remember five health tips

The causes of Meniere's disease are unclear. However, it may be related to an imbalance in endolymphatic production and absorption. Triggers include: exertion, stress and mood swings, sleep disturbances, adverse life events, weather or seasonal changes, etc.

How to avoid induction in daily life?

1. Patients should fully understand the disease and eliminate fear.

2. It is recommended to stay in bed during the attack, remember to prevent falls, and treat symptoms.

3. Adjust your lifestyle, work and rest regularly, and avoid bad emotions, stress and other inducing factors.

4. It is recommended to reduce salt intake, control water intake, and avoid the intake of caffeine products, tobacco and alcohol products.

5. In addition, try to stay away from dangerous places and pay more attention to daily activities. To avoid the danger caused by the sudden onset of Meniere's disease, pay more attention when climbing stairs, cycling, and driving.

Know more

This disease can also cause "fainting"

There are many causes of vertigo, such as otoliths, also known as "benign paroxysmal positional vertigo", which refers to brief paroxysmal episodes of vertigo and nystagmus when the head moves rapidly to a specific head position. "otoliths" are calcium carbonate crystals, which are normally located in the inner ear oval cyst spots and balloon spots, responsible for body balance. Typical clinical manifestations: repeated vertigo with head position changes lasting no more than 1 minute.

Otolith disease is self-limited, often does not require specific intervention, and can heal within weeks. If the symptoms of otolith disease are too severe, treatment with otolith reduction may be considered.

Meniere's syndrome and otolith disease are two very different diseases, and patients should understand their type of disease and treat them symptomatically based on the results of their doctor's professional treatment. In addition, in daily life, attention should be paid to avoid ear water and impact.

In a word: if there is any type of vertigo, going to a regular hospital in time is the right way to open.

Text/Du Jingyan Wen Xiaohui (Beijing Chaoyang Hospital)