Meniere's Disease
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.
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.
