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.
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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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