Meniere’s Disease – A Crippling Condition of the Inner Ear
Readers who have experienced vertigo, dizziness, lack of balance, nausea and sometimes migraines may well have a condition called Meniere’s Disease. This affliction, named after the French physician who studied its causes and potential treatments in the late 1880s, can be debilitating and frightening.
Many specialists have described the disease as “glaucoma of the ear,” as the condition is found when pressure building in the inner ear affects balance and equilibrium. Like glaucoma, the pressure increases until the membranous sac filled with a fluid called endolymph bursts. As the disease progresses, hearing loss increases. To make matters worse, the dizziness, vertigo and nausea are unpredictable, causing frustration and fear. While some patients will find relief without medical intervention, hearing loss may become progressively worse.
Diagnosis is based on a combination of the right set of symptoms (usually episodic vertigo, fullness in the ear and fluctuating hearing loss. All of these symptoms can occur by themselves— other causes must be ruled out.
There is no definitive cause or cure for the disease. Stress, allergies, excess salt in the diet, caffeine, alcohol, even a history of migraine headaches, or changes in air pressure due to weather patterns, in some way may all contribute to the onset of the symptoms. It is sometimes attributed to viral infections of the inner ear, head injury, a hereditary predisposition, and allergy. For the most part, the underlying cause of Meniere’s disease is unknown.
There are essentially three surgical treatment options, from minimal to radical, when diuretics, medication, diet and life style changes fail to control the symptoms that have been proven to relieve the vertigo of Meniere’s. A minimally invasive treatment was developed by Herbert Silverstein, MD, FACS, President of the Silverstein Institute in Sarasota, Florida. This treatment involves the use of a device he invented, the MicroWick™, which is inserted into the ear via a tube, under local anesthetic, in the doctor’s office. Medication (dilute gentamicin or steroids) is applied as an eardrop by the patient at home for a period of several weeks, and it is absorbed by the wick. At the end of the treatment procedure, the wick and tube are removed and the opening closed with a paper patch. The MicroWick™ (patented 1999) and gentamicin have been used with positive results in most patients since 1997. (81 percent are free of vertigo for four years). If given early in the disease, in many cases treatment with steroids may relieve the fullness sensation in the ear and improve the hearing.
In 1977, Dr. Silverstein also developed a safe approach to cut the balance nerve to the brain, whichpreserves the hearing and relieves the vertigo in 95 percent of cases, while preserving hearing in 98 percent of the cases. He has performed 250 of these cases (vestibular neurectomy). Today, this procedure is used most often when the minimally invasive procedures fail.
After other methods fail (about 6 percent of patients), surgically removing the inner ear membranes (labyrinthectomy) is necessary. This is considered radical surgery, as it renders the affected ear completely deaf but cures the vertigo in almost every case. It is the gold standard for curing vertigo. A cross type of hearing aid or bone-anchored hearing device will allow the patient to hear out of the deaf ear by transmitting the sound to the good ear.
Dr Silverstein states that “in 50 percent of the cases, the vertigo attacks will cease after two years, and in 70 percent will cease after eight years. Therefore, minimally-invasive surgery and natural approaches should be used as the first line of treatment.”
Managing an attack of Meniere’s Disease is no simple matter. Some suggestions from highly respected medical professionals as well as sufferers of the disease offer these tips:
Lie down on a firm surface, as motionless as possible, with eyes open and fixed on a stationary object.
Do not sip or drink water, as this may induce vomiting.
After the spinning (vertigo) passes, sit up slowly.
Be prepared to sleep for several hours.
If vomiting persists over a 24-hour period, contact your doctor for nausea medication.
Sleep with a nightlight and remove throw rugs to help prevent injuries from falls.
Taken at the onset of vertigo, Lorazepam 0.5 mg, placed under the tongue will reduce the symptom of vertigo.
Diet is important in treating Meniere’s Disease. Eating foods that are high in salt or sugar causes yourblood level concentration of salt or sugar to increase, and this, in turn, will affect the concentration of substances in your inner ear. Limiting or eliminating your use of caffeine and alcohol will also help to reduce symptoms of dizziness and ringing in the ears. Diuretics may be prescribed to reduce the fluid concentrations in the body and therefore the inner ear.
Dietary and lifestyle goals are basic and applicable to most of the population, whether afflicted with Meniere’s or not. Here are some tips:
Distribute food and fluid intake evenly throughout the day and from day to day. Eat approximately the same amount of food at each meal and do not skip meals. If you eat snacks, have them at regular times.
Avoid eating foods or fluids that have a high salt content. Do not add salt to the food. Aim for a diet high in fresh fruits, vegetables and whole grains, and low in canned, frozen or processed foods. Sugar intake should kept to minimum. Drink adequate amounts of fluid daily, not just water, but also milk (unless you are lacto-sensitive) and low-sugar fruit juices.
Limit caffeine and chocolate.
Limit alcohol intake to one glass of beer or wine each day. Alcohol may trigger migraine-associated vertigo.
Avoid foods containing MSG (monosodium glutamate).
Avoid aspirin and medications that contain aspirin. In high doses aspirin can cause reversible tinnitus (ringing in the ear). Nonsteroidal anti-inflammatory agents such as ibuprofen or naproxen should also be avoided when practical.
Avoid cigarettes. The nicotine present in cigarettes constricts blood vessels and can decrease the blood supply to the inner ear, making your symptoms worse.
With Meniere’s Disease, it’s important to remember that you are not alone, that no definitive cause has been identified and that there are multiple treatment options available. If you are experiencing any of the symptoms of this disease, please see a qualified professional who can identify, evaluate and prescribe a treatment plan for you.
Herbert Silverstein, MD, FACS, is internationally regarded as a leading authority on Meniere’s Disease, having received multiple awards and recognitions. For more information on the Institute and the nonprofit Ear Research Foundation, visit earsinus.com or call toll-free 888-416-9200.