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Meniere’s Disease

Meniere’s disease, also called idiopathic endolymphatic hydrops, is a condition that causes attacks of vertigo (spinning sensation), hearing loss, tinnitus (roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear.

The attacks of vertigo may be accompanied by disequilibrium (feeling off-balanced), nausea and vomiting. The attacks last 20 minutes to several hours. Many individuals feel off-balanced and fatigued for days after an attack.

The hearing loss may fluctuate and often affects the low pitches. It is common for hearing to gradually worsen as the illness progresses. Many individuals find that loud noises are uncomfortable (hyperacusis).

A feeling of pressure or fullness is often felt at the onset of an attack.

Meniere’s disease generally affects only one ear but may affect both ears in 15%. The onset of Meniere’s disease is usually between 20-50 years of age and affects men and woman equally.

The cause of Meniere’s disease is unknown but is thought to be caused by an abnormality in the fluids of the inner ear. The inner ear is important for both hearing and balance. Fluid, called endolymph fills canals within the inner ear. Movement of fluid in the hearing portion of the inner ear (cochlea) allows sound waves to be changed into a message that is transmitted to the brain. Movement of fluid in the balance portion of the inner ear creates messages about the position and movement of your body.

In Meniere’s disease, too much fluid (endolymph) builds up in the inner ear. This affects the signals to the brain, causing the symptoms of Meniere’s (vertigo, hearing loss, tinnitus and hear pressure).

There are several possible causes for Meniere’s disease but most are idiopathic or unknown . Some cases are caused by injuries to the head or ear, by middle ear infections and some from syphilis or a virus. Allergies and autoimmune disease may be a cause.

How Is Meniere's Disease Diagnosed?

The history of symptoms is important in diagnosing Meniere’s disease. Prior to your visit, we ask that you review and answer the dizziness questionnaire (link to questionnaire).

An examination will help determine if there are any other conditions that may be causing your symptoms.

Diagnostic tests may include:

  • Audiometric examination (hearing test).
  • Auditory brain stem response (ABR), a test that uses electrodes to record how well sound signals travel along the hearing nerve to the brain.
  • Electrocochleography (ECog) measure electrical activity in the inner ear and is often abnormal in people with Meniere’s.
  • An MRI may be indicated to rule out other causes for symptoms similar to Meniere’s disease.
  • An ENG (electronystagmography) assesses balance. This study measures eye movements when the inner ear is stimulated by moving the head or filling the ear canals with warm and cold water or air.
  • Blood and allergy testing may be ordered to determine if other disorders such as infection, autoimmune, endocrine disorders or allergies are causing your symptoms.

How Is Meneire's Disease Treated?

Most individual’s symptoms improve with a low salt diet and a diuretic (water pill). Diuretics help reduce fluid buildup in the inner ear. A diet with no more than 2,000 mg sodium is recommended. You will need to read the sodium content of the foods that you eat as 1 cup of cottage cheese, one dill pickle or 10 pretzels contain over 900 mg of sodium.

Over the counter medications such as meclizine (Antivert) and prescription diazepam (Valium) and anti-nausea medications may help control symptoms.

Reducing stress, avoiding caffeine, tobacco and alcohol may be helpful. Getting enough sleep and regular physical activity is often beneficial.

In some individuals with autoimmune disease, steroids are usually recommended. Treatment for inhalant and/or food allergies may lesson symptoms of Meneire’s.

Remember that vertigo may occur without warning. Driving, climbing ladders, scaffolds or even swimming may be hazardous when symptoms occur.

Surgical Treatment For Meneire's

Most individuals with Meneire’s disease (80-85%) do not require surgery. Surgery may be recommended if symptoms are severe or do not respond to medications. There are certain risks to these procedures, including damage to hearing and possible worsening of balance.

There are several procedures that are available:

  • Injection of an antibiotic (Gentamicin) into the middle ear (through the eardrum) is used to control dizziness. Gentamicin is toxic to certain cells within the inner ear that are thought to cause the dizziness symptoms. This is done in the office over a period of several days or weeks. It may cause hearing loss and imbalance and is best used in individuals with poorer hearing.
  • Meniette device- This is a portable air pressure pulse generator that is marketed in the U.S. by Medtronic. How it works is not fully understood but it may act by forcing the excess endolymphatic fluid in the inner ear back into the endolymphatic sac.
  • Endolymphatic sac decompression – This procedure places a small tube into the endolymphatic sac (inner ear) to relieve pressure in the sac. It is successful in controlling dizziness in 65-70% of patients. Over time, dizziness may recur because the tube becomes blocked or non-functional.
  • Selective vestibular neurectomy- The balance nerve is cut as it leaves the inner ear to the brain. Vertigo is controlled in the majority (90-95%) of patients. Although the hearing nerve is spared, hearing loss may occur. This procedure is usually considered when an individual has good hearing, or has continued vertigo after an endolymphatic sac decompression.

Labyrinthectomy – The balance canal is removed, eliminating balance and hearing in that ear. This procedure may be recommended when there is poor hearing in the affected ear. Vertigo is controlled in most patients (90-95%), however all hearing is lost in that ear. Some individuals such as the elderly, those with poor vision or other brain dysfunction, should consider other procedures as they are more likely to have persistent difficulty with balance following this procedure.

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