The Hearing Process

 In the course of hearing, sound waves enter the auditory canal

and strike the eardrum, causing it to vibrate. The sound waves are concentrated by passing from a relatively large area (the eardrum) through the ossicles to a relatively small opening leading to the inner ear. Here the stirrup vibrates, setting in motion the fluid of the cochlea. The alternating changes of pressure agitate the basilar membrane on which the organ of Corti rests, moving the hair cells. This movement stimulates the sensory hair cells to send impulses along the auditory nerve to the brain.

It is not known how the brain distinguishes high-pitched from low-pitched sounds. One theory proposes that the sensation of pitch is dependent on which area of the basilar membrane is made to vibrate. How the brain distinguishes between loud and soft sounds is also not understood, though some scientists elieve that loudness is determined by the intensity of vibration of the basilar membrane.  In a small portion of normal hearing, sound waves are transmitted directly to the inner ear by causing the bones of the skull to vibrate, i.e., the auditory canal and the middle ear are bypassed. This kind of hearing, called bone conduction, is utilized in compensating for certain kinds of deafness (see deafness; hearing aid), and plays a role in the hearing of extremely loud sounds.


Mnire's disease

Anatomy and Physiology

The outer ear is the external portion of the ear, which consists of the pinna, concha, and external auditory meatus. It gathers sound energy and focuses it on the eardrum (tympanic membrane). Most human speech sounds are also distributed in the bandwidth around 3 kHz. The inner ear contains the semicircular canals, which also contain fluid and hair cells. The hair cells in the semi-circular canals sense the position of the body and send this information to the brain. This structure allows the body to maintain balance and equilibrium.

Mnire's disease
 Is a disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo and tinnitus and progressive hearing loss, usually in one ear. It is named after the French physician Prosper, 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.

What causes the of Minieres Disease?:  Mnire's disease is idiopathic, but it is believed

to be linked to endolymphatic hydrops, an excess of fluid in the inner ear. 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. 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 the stria vascularis.

 The symptoms may occur in the presence of a middle

ear infection, head trauma, or anupper 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. Herpes viridae are present in a majority of the population in a dormant state. It is suggested that the virus is reactivated when the immune system is 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. 100,000. Recent gender predominance studies show that Mnire's tends to affect women more often than men. Age of onset typically occurs in adult years, with prevalence increasing with age.

 Mnire's disease affects about 190 people per

Signs & Symptoms:

 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:

 Attacks of rotational vertigo that can be severe,

incapacitating, unpredictable, and last anywhere from minutes to hours, but generally no longer than 24 hours. For some sufferers however, prolonged attacks can occur, lasting from several days to several weeks, often causing the sufferer to be severely incapacitated. 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.

 Fluctuating, progressive, unilateral (in one ear) or bilateral (in both

ears) hearing loss, usually in lower frequencies. For some, sounds can appear tinny or distorted, and patients can experience unusual sensitivity to noises.

 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 of Mnire'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. Sudden, severe attacks of dizziness or vertigo, known informally as "drop attacks," can cause someone who is standing to suddenly fall. Drop attacks are likely to occur later in the disease, but can occur at any time.

How does diagnose Minieres Disease? :

There is no definitive test or single symptom that a doctor can use to make the diagnosis. Diagnosis is based upon your medical history and the presence of:  Two or more episodes of vertigo lasting at least 20 minutes each  Tinnitus  Temporary hearing loss  A feeling of fullness in the ear

 Some doctors will perform a hearing test to establish the extent of hearing loss caused by Mnire s disease. To rule out other diseases, a doctor also might request magnetic resonance imaging (MRI) or computed tomography (CT) scans of the brain.

MANAGEMENT :
 Medications. The most disabling symptom of an attack of Mnire s disease is dizziness. Prescription drugs such as meclizine, diazepam, glycopyrrolate, and lorazepam can help relieve dizziness and shorten the attack.

 Salt restriction and diuretics. Limiting dietary salt and taking diuretics (water pills) help some people control dizziness by reducing the amount of fluid the body retains, which may help lower fluid volume and pressure in the inner ear.  Other dietary and behavioral changes. Some people claim that caffeine, chocolate, and alcohol make their symptoms worse and either avoid or limit them in their diet. Not smoking also may help lessen the symptoms.

 Pressure pulse treatment. The U.S. Food and Drug

Administration (FDA) recently approved a device for Mnire s disease that fits into the outer ear and delivers intermittent air pressure pulses to the middle ear. The air pressure pulses appear to act on endolymph fluid to prevent dizziness. treatments have failed to relieve dizziness. Some surgical procedures are performed on the endolymphatic sac to decompress it. Another possible surgery is to cut the vestibular nerve, although this occurs less frequently.

 Surgery. Surgery may be recommended when all other

 Cognitive therapy. Cognitive therapy is a type of talk therapy that helps people focus on how they interpret and react to life experiences. Some people find that cognitive therapy helps them cope better with the unexpected nature of attacks and reduces their anxiety about future attacks.

 Injections. Injecting the antibiotic gentamicin into

the middle ear helps control vertigo but significantly raises the risk of hearing loss because gentamicin can damage the microscopic hair cells in the inner ear that help us hear. Some doctors inject a corticosteroid instead, which often helps reduce dizziness and has no risk of hearing loss.