What is Meniere's Disease?
Meniere's disease is a disorder caused by increased fluid pressure in the
inner ear. The fluid chamber of the inner ear that has increased pressure is
called the endolymphatic chamber and therefore the disease is also known as
endolymphatic hydrops (increased fluid pressure in the endolymphic chamber). The
exact cause of the disease is unknown, though genetic and environmental causes
are thought to contribute to its development.
What are the Symptoms of Meniere's Disease?
There are 4 main symptoms associated with Meniere's disease. These are:
episodic vertigo (spinning dizziness), tinnitus (roaring or ringing in the ears
[usually just one ear]), fluctuating hearing loss, and pressure sensation in the
ear. An episode of Meniere's usually starts with a pressure sensation in the ear
with increasing roaring sound in the ear and hearing loss and a sudden attack of
vertigo. The vertigo generally lasts at least 30 minutes and may last up to or
greater than 24 hours. Once the vertigo stops, the patients generally experience
some imbalance which takes days to weeks to resolve. The hearing generally
returns, but over time, the hearing and balance function are lost with each
attack of the vertigo. Some patients may just have fluctuating hearing loss
without vertigo or
episodic vertigo without hearing loss. These are termed cochlear hydrops and
vestibular hydrops respectively.
What Causes an Attack to Occur?
There are some known triggers of a Meniere's attack, which include, high salt
foods, too much caffeine, drinking alcohol, and stress. While the triggers
differ between patients, the above 4 triggers are found most commonly.
I Know I have Meniere's Disease, What Will Happen To Me?
Approximately 60% of patients with Meniere's disease stop having attacks
after a few years (also called the disease burning out). The rest continue to
have problems. Of these, a high percentage (60%-80%) are controlled with a very
strict control of their diet and lifestyle changes and sometimes medications.
The strict diet includes limiting your diet to a daily sodium of 1500 mg,
eliminating all caffeine (not even decaf coffee, which has caffeine), and no
alcohol. The lifestyle change includes reduction of stress by biofeedback,
meditation, yoga, daily exercise, etc.
Some people (20%-30%) may develop the disease in the other ear after a few
years. A small percentage of the patients will continue to have episodes which
may occur every day to once a few months or years. When despite maximal medical
therapy and lifestyle changes the patients continue to have frequent episodes of
Meniere's disease and the disease is affecting their daily life, then surgery is
considered for treatment.
What Is the Treatment of Meniere's Disease?
The treatment of Meniere's disease follows a stepwise fashion from diet and
stress control to medical treatment to surgical treatment. The dietary/lifestyle
changes for treating Meniere's Disease are discussed above. The next step is
taking medications which are believed to decrease the inner ear fluid pressure.
The medicines that cause reduction of fluid pressure in the inner ear also make
you lose extra water from the kidneys. These medications, called diuretics,
include Dyazide, methazolamide, furosemide, among others.
For controlling the dizziness or imbalance, medications such as meclizine (Antivert),
Robinul, scopolamine patches, among others is used. These medications decrease
the abnormal signal that the diseased inner ear sends the brain.
Other treatments include the use of the Meniett Device. The
Meniett device is a device that is used after placing a small tube in the ear
drum. It is used in the ear 3 times a day for 5 minutes each time. It is
successful in controlling the symptoms in ~50% of patients. Unfortunately it is
not always covered by health insurance companies and the cost is ~$3000.
The newest treatment for Meniere's disease is the placement of medications
behind the ear drum. In a recent study, over 90% of patients with Meniere's
disease were found to have significant control of their symptoms with
intratympanic steroid (anti-inflammatory medications placed behind the ear
drum). The injections (using dexamethasone or methylprednisolone [Solu Medrol])
are generally given after a local anesthetic in the office and are repeated
every 2 to 4 weeks until the attacks stop. In our experience at UC Irvine, most
patients with Meniere's undergoing intratympanic steroid treatment have only
required 2-3 injections for full control of their symptoms. We recommend it for
patients prior to doing any surgery or in those with a history suggestive of
autoimmune Meniere's disease or those who are unable to take steroids by mouth.
These injections are different from gentamicin injections that cause destruction
of the inner ear balance cells. We rarely use gentamicin injections in the ear
for Meniere's disease due to the destruction of the inner ear it causes.
Gentamicin injection is reserved for patients with end stage Meniere's disease
with very little hearing or balance function.
intratympanic steroid therapy for Meniere's disease a few years ago, we have not
needed to use any surgical treatment for patients suffering from Meniere's
Surgery for treating Meniere's disease is used when medical treatment has
failed and that the vertigo has become incapacitating. The type of surgery
depends on your hearing in the affected ear, if the other ear is also affected
by the disease, your age, and if you have any medical problems.
Every effort is made to conserve hearing; therefore, the type of surgery
depends on the amount of hearing loss in the affected ear. Although hearing may
be worse after surgery, it usually remains the same. Tinnitus may or may not be
improved. Generally, the surgeries have a high chance of controlling the vertigo
Endolymphatic Sac Decompression
This aim of this surgery is to drain the inner ear fluid chamber which has
increased in pressure. The surgery is done by making an incision behind the ear
and removing some of the bone behind the ear to reach the drainage area of the
inner ear, called the endolymphatic sac. A small opening is made in the
endolymphatic sac and a stent is placed in it to reduce the pressure of the
The immediate outcome of the surgery differs from patient to patient.
Some patients have an immediate improvement in symptoms, while others may be
dizzy for a few weeks before their symptoms improve. Generally, the surgery can
cause some irritation in the inner ear; therefore, dizziness and ear symptoms
may continue for several months. As a result, the success of surgery often
cannot be predicted for at least several months.
Overall, there is a 70% chance of controlling the attacks of vertigo, a 20%
chance that the attacks will remain the same, and a 10% chance that the attacks
will be worse. Hearing may stabilize but rarely improves and tinnitus may not
change at all. There is a 2% chance of complete loss of hearing in the ear that
is operated on.
This procedure is performed when the disease has destroyed all useful hearing in the
affected ear. In this procedure, the balance portion of the diseased inner
ear is surgically removed. Unlike the endolymphatic sac surgery, the
patients have to be admitted to the hospital after surgery due to the dizziness
that occurs. The patients need to undergo some physical therapy afterwards to
improve their brain's ability to learn to function with one balance organ. The
brain generally takes about 3 weeks to adjust. One's balance works better if it
gets signal from one normal balance organ and none from the other side, rather
than getting signal from one good side and one bad side.
This surgery works very well to control the dizziness, but is only considered
in patients with very poor hearing in the diseased ear and a history of
long-standing disease. It is important that the patient have had the disease for
several years, so the physicians would be sure that the disease would not
develop in the other side (generally occurs within the first 2-3 years).
Balance (Vestibular) Nerve Section
In this surgery, the balance nerves are cut to relieve the dizziness
symptoms. This surgery can be done in two different ways: 1.
Translabyrinthine, 2. Retrosigmoid or retrolabyrinthine. In the
translabyrinthine approach, after the balance portion of the inner ear is
removed, the balance nerves are cut to insure no abnormal balance information
reaches the brain to cause the dizziness. This approach is used in patients
without useful hearing.
The retrosigmoid approach involves going behind
the inner ear structures and cutting the balance nerves. This approach preserves
the hearing in 95% of cases.
There is an excellent chance (more than 90%) of controlling the vertigo with
the balance nerve section procedure.
What About Gentamicin or Steroid Treatment Behind the Ear Drum?
Gentamicin (also called intratympanic gentamicin, putting the medicine behind
your ear drum) is an antibiotic that causes the destruction of the inner ear
balance organ. The idea behind using this medication is that when the inner ear
balance organ on the diseased ear is destroyed, then the patient would not
develop vertigo anymore. Treatment with gentamicin works well and can be done in
the office, but it has several problems with it. 1. It destroys the inner ear
balance function on one side, and if you develop Meniere's disease in the other
ear (20-30% chance), you will have great difficulty with your balance. 2. It has
a 10-20% chance that it may cause hearing loss in the ear that is being treated.
3.It does not change the hearing loss, pressure, and tinnitus (ringing/roaring
Gentamicin treatment for Meniere's disease is best for people
who have had the disease for a few years and have lost hearing and most balance
function in that ear.
Generally the second ear will start showing signs of disease in the first 3-5
years after the onset of the disease. If it does not develop by then, it is
unlikely to develop. For those who have a significant hearing loss, there is less of a
problem if there is some additional loss.
Why Come to UC Irvine for the
Treatment of Your Meniere's Disease?
At UC Irvine Division of
Neurotology, Dr. Djalilian strives to bring the latest and most effective
treatments to patients with Meniere's disease. In addition to research into the
most effective treatments of Meniere's disease, Dr. Djalilian is leading a
multi-institutional study into the genetics of Meniere's disease. The study is
looking at whether a gene is associated with the development of Meniere's in
families with multiple members with Meniere's disease.
To Make an
Appointment with our Meniere's disease specialist, Dr. Djalilian, Please Call
714-456-7017 or click
here to request an appointment via the
to UC Irvine Neurotology and Skull Base Surgery