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Meniere's Disease

A French physician, Prosper Meniere first described Meniere's disease in 1861. Meniere's disease is a disorder of the inner ear and causes attacks of vertigo, ringing (tinnitus), a fluctuating hearing loss, and/or a feeling of fullness (pressure in the ear). Although the complete cause of Meniere's disease is still unknown today, the symptoms are believed to be caused by an increase in the amount of inner ear fluids. Two types of fluids are present in the inner ea. These fluids are known as perilymph and endolymph. The inner ear is divided into two chambers; one chamber is filled with endolymph and another with perilymph. The chamber of perilymph surrounds the chamber of endolymph. In Meniere's disease, it is believed that there is excess endolymph fluid. Therefore, another term for physiologic changes of Meniere's disease is endolymphatic hydrops (i.e. excess endolymph). Circulatory, metabolic, toxic, allergic, and/or emotional factors may influence the intensity of the attacks, as well as trigger an attack.

Chambers of a normal cochlea
Cochlea with endolymphatic hydrops

A Meniere's attack can produce incapacitating vertigo with violent spinning, nausea and vomiting. During these attacks one may feel that the room spins, objects seem to whirl, or that one has the feeling of being pulled to the side or through a tunnel. The attack may last a few minutes to several hours. Following a severe attack, most people are exhausted and sleep for several hours. Although the attacks can be severe, Meniere's disease is not life threatening.

Meniere's disease follows no recognizable pattern and, therefore, affects each person differently. At times, Meniere's attacks may occur at regular intervals. Other attacks may occur in clusters, within a very short period of time. In other cases, individuals may be free from symptoms for months or years at a time. Sometimes the attacks reoccur, the intensity and duration lasting less than the initial attack. In between attacks, most people are free of symptoms.A Meniere's attack may be preceded by symptoms that occur before the spinning. These symptoms include a fullness or aching in one or both ears, a ringing (tinnitus), and/or fluctuation in hearing.

Variations of Meniere's disease exist. In some cases, individuals experience only dizziness without any hearing problems. At other times, individuals experience hearing loss, tinnitus, and ear fullness without any dizziness.

Treatment of Meniere's Disease

Treatment of Meniere's disease may be medical or surgical. Both treatments have the goal of improving inner ear circulation, and controlling the fluid pressure changes of the inner ear. Medical treatment of Meniere's disease varies depending on the individual and the suspected cause of Meniere's disease. In approximately 80% of cases medical treatment is effective in alleviating the attacks of dizziness.

Medical Treatment

The goal of controlling the fluid pressure changes of the inner ear is accomplished by lowering the fluid level in the inner ear itself. To do this, patients are placed on a low salt diet with the goal of achieving a 2,000 - 2,500 mg salt intake per day. It is suggested that no salt be added to the food either while cooking or at the table. In addition to a low salt diet, a water pill (diuretic) is sometimes prescribed.

Vasodilators are sometimes used to improve inner ear circulation. Vasodilators increase the blood supply to the inner ear. In this way, these medications ensure adequate nutrition to the inner ear.

Other suggested diet modifications sometimes include limiting the amount of caffeine, which is found in coffee, colas and chocolate, and the avoidance of nicotine (cigarettes). Caffeine and nicotine decrease the amount of circulation to the delicate inner ear structures.

Sometimes medications that make the balance system less susceptible to dizziness are used. These medications are known as labyrinthine or vestibular suppressants. Some of these medications include Meclizine/Antivert, Compazine, Dramamine, and Diazepam.

Meniere's disease may be caused or aggravated by metabolic or allergic disorders. Special diets or drug therapy are used to control Meniere's disease due to these causes.

Chemical Labyrinthectomy (Gentamicin perfusion)

Gentamicin perfusion is one of the newer techniques to treat the vertigo of Meniere's disease. A medication (gentamicin) that is toxic to the balance system is placed into the middle ear. From there, the medication diffuses into the inner ear. The procedure is performed in the office and can prevent further attacks of vertigo in up to 85% of cases.

Surgical Treatment

Surgical treatment of Meniere's disease is reserved for those cases that do not respond to medical treatment. Fortunately, in 80% of cases of Meniere's disease, medical management along with diet modification, will control the episodes of vertigo. Surgical treatment for Meniere's disease is performed to cure the symptom of vertigo. Please talk to your doctor about the different types of surgery for Meniere's disease. The physicians of the Ohio Ear Institute, LLC have many years of experience with all surgical treatments for Meniere's disease.

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