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Meniere's Disease

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Updated March 29, 2014

Meniere's Disease

Anatomy of the Ear

Photo © A.D.A.M.

Meniere's disease is a cause of vertigo, which is severe dizziness which causes a feeling of being off balance. It is a disorder of the inner ear and lymphatic system which is not entirely understood and usually affects only one ear. Meniere's disease is also called idiopathic endolymphatic hydrops.

One theory is that Meniere's disease is caused when the fluids inside the ear -- called endolymph and perilymph -- are not balanced. Other theories include a viral infection as the culprit or an immune system malfunction.

Symptoms of Meniere's Disease

The symptoms of Meniere's disease vary in severeness from person to person. Some individuals can be completely debilitated by the disease while others experience symptoms only once or twice a year. Symptoms of Meniere's disease include:

In addition to these symptoms, the risk of falling and subsequent injuries is high with this disease. Symptoms have a tendency to come in waves lasting from two to four hours and followed by a period of time where the individual feels exhausted and needs to sleep. In between "attacks" an individual may have no symptoms for a period of time.

Diagnosing Meniere's Disease

Diagnosing Meniere's disease can be difficult since dizziness is a symptom that overlaps with many other conditions including life threatening neurological illnesses such as a stroke. An MRI is often used to rule out tumors or other abnormal growths in the ear.

A test called caloric testing determines balance by flushing the ears with water or air. This results in rapid eye movement called nystagmus.  According to the pattern of rapid eye movement, the physician can sometimes interpret the balance disorder.

Various hearing tests are used to diagnose Meniere's disease. It is important to determine if the hearing loss is caused by a problem in the inner ear or if it is a malfunction of the hearing nerve. To do this, the function of the brain stem can be recorded to show activity in the hearing nerve. Electrocochleography is a test which can record the activity of the inner ear.

Treating Meniere's Disease

There is currently no cure for Meniere's disease, so treatments revolve around alleviating symptoms. Changing to a low salt diet and avoiding caffeine and alcohol may be beneficial in keeping your fluid balance in check and reducing inner ear pressure. Eliminating certain medications like high blood pressure pills and allergy medications can be sometimes help. However, high blood pressure itself may contribute to symptoms. Stress reduction seems to reduce the severity of symptoms.

One method that is gaining popularity for people who have failed medical therapy is injecting Gentamycin, an antibiotic, directly into the middle ear space.

Some medications used to treat sudden attacks include:

  • Meclizine (Antivert)
  • Lorazepam (Ativan)
  • Phenergan, this is an anti-nausea medication. Other anti-nausea medications that can be used include compazine and ondansetron.
  • Dexamethasone (Decadron)

Some medications can be used to prevent attacks or at least reduce their frequency. These include:

  • Dyazide (Triamterine/HCTZ)
  • Klonapin
  • Lorazepam (Ativan)
  • Diazepam (Valium)
  • Meclizine (Antivert)

One newer treatment for controlling symptoms is called a Meniett device. While the device itself is not need to be surgically installed it requires a tympanostomy (ventilation) tube in order to work. The device delivers pulses of pressure into the inner ear through the tympanostomy tube. This treatment is new and medical professionals are not currently sure why the device works but early research indicates symptomatic relief if the device is used on a daily basis.

Vestibular rehabilitation, exercises to improve balance, have not been shown to be particularly helpful in the treatment of Meniere's disease. There are some reports that the epley manuever, a treatment for BPPV, may relieve the symptoms of vertigo associated with Meniere's disease at least on a temporary basis.

Surgical options are risky and are reserved for severe and debilitating vertigo. All current surgical options for the treatment of Meniere's disease are controversial. A labyrinthectomy removes the labyrinth of the ear, a sensory organ containing endolymph, which sends signals to the brain about body movement. This surgery causes hearing loss and is reserved for individuals who have already lost their hearing in that ear. Another surgery which preserves hearing but still carries risks is called a vestibular neurectomy. This surgery involves severing the nerve which is connected to the malfunctioning inner ear organ. Other procedures include endolymphatic sac decompression or shunt placement.

Risk Factors and Prevalence of Meniere's Disease

According to the National Institute of Deafness & Other Communication Disorders, approximately 615,000 individuals are currently diagnosed with Meneire's disease in the United States. They estimate another 45,500 cases newly diagnosed each year. Roughly 0.2% of the population in the United States has Meneire's disease. It is important to remember that these numbers are estimates only, some professionals believe that the disease is under reported.

Many individuals with Meniere's disease have a history of migraine headaches. The majority of individuals with Meniere's disease are over 40 years old, although it can occur at any age, and it seems to affect both men and women equally. Some reports suggest a genetic component but this has not been proven.

Coping with Meniere's Disease

The best way to cope with attacks of vertigo seems to be lying down on a flat surface until it passes. You may try to stare at a fixed object. Do not try to eat or drink as it may cause nausea and vomiting. If you ever experience nausea and vomiting for more than 24 hours, contact your doctor to avoid severe dehydration. The above-mentioned medications can help with vertigo and nausea and vomiting. When the vertigo passes, make sure you stand up slowly. It also helps to hold onto something stable such as a wall or rail. Trying to walk during an attack can lead to falls and serious injury so always be careful.

As with any debilitating and chronic illness, Meniere's disease can cause depression. If you experience these feelings please talk to your doctor. It can also be helpful to talk and interact with other people who are suffering from this disease.

Though Meniere's disease can be debilitating, it is not deadly and new medications are emerging which help control this disorder and improve quality of life.

Sources:

American Academy of Speech-Language-Hearing. Evaluation and Management of Meneire's Disease. Accessed: June 4, 2011 from http://www.asha.org/aud/articles/menieres-disease-eval-management/

Medscape. Meniere Disease. Accessed: March 29, 2014 from http://emedicine.medscape.com/article/1159069-overview

National Institute on Deafness & Other Communication Disorders. Meneire's Disease. Accessed: April 14, 2009 from http://www.nidcd.nih.gov/health/balance/meniere.asp

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