One theory is that Meniere’s disease is caused when there is a change in volume of the fluids inside the labyrinth of the inner ear. Other theories include a viral infection as the culprit or an immune system malfunction.
Symptoms
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:
Vertigo Tinnitus Fluctuating hearing loss Pain or pressure in the ears Nausea and vomiting Sweating Headaches Abdominal pain and diarrhea
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.
Diagnosis
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.
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 healthcare provider 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 that can record the activity of the inner ear.
Treatments
Medications
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 sometimes help. However, high blood pressure itself may contribute to symptoms. Stress reduction seems to reduce the severity of symptoms.
One method for people who have failed other medical therapy is injecting gentamicin, an antibiotic, directly into the middle ear space. Some medications used to treat sudden attacks include meclizine (Antivert) and lorazepam (Ativan). There’s also dexamethasone (Decadron) and Phenergan, an anti-nausea medication. Other anti-nausea medications that can be used include Compazine and ondansetron.
Some medications can be used to prevent attacks or at least reduce their frequency. These include dyazide (Triamterene/HCTZ), Klonopin, and diazepam (Valium).
Devices, Exercises, and Procedures
One treatment for controlling symptoms is called a Meniett device. While the device itself does 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. Overall research suggests that symptoms of vertigo can be reduced and may improve hearing.However, this procedure remains somewhat controversial and is not widely performed in the United States.
Vestibular rehabilitation exercises to improve balance, have not been shown to be particularly helpful in the treatment of Meniere’s disease.
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
According to the National Institute of Deafness & Other Communication Disorders, approximately 615,000 individuals are currently diagnosed with Meniere’s disease in the United States. They estimate another 45,500 cases are newly diagnosed each year. 0.2 percent of the population in the United States has Meniere’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
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 healthcare provider to avoid severe dehydration. The above-mentioned medications can help with vertigo and nausea and vomiting. When 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 healthcare provider. 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.
