Meniere's disease is an illness of unknown origin that causes dizziness, fluctuating hearing loss, ear fullness and ringing (tinnitus), most often affecting one ear. There is some evidence to suggest that the disease may be due to abnormal regulation of salts in the inner ear which control normal hearing and balance. Because the cause is not known the diagnosis is made on the basis of a classic set of clinical symptoms. The most troublesome manifestation is usually dizziness or vertigo where the patient feels like the room is spinning or that they are on a ship with a moving horizon. These spells typically last anywhere between 20 minutes to as long as 24 hours. These attacks can be extremely debilitating. The episodes of vertigo usually occur with noticeable changes in the hearing of one ear, fullness and ringing. The attacks can occur as often as daily or only a couple of times a year and are impossible to predict. About 30 to 50 percent of patients will eventually undergo remission and approximately 30-50 percent of patients will have disease affecting both ears. But again, doctors are not able to predict which patients will fall into these categories.
Treatment of Meniere's disease typically starts with implementation of a low salt diet (less than 2 grams of sodium per day). This may often be done in conjunction with a low dose water pill (diuretic) such as Hydrochlorothiazide (HCTZ). Patients with severe symptoms or those who do not respond to this treatment regimen may be offered steroids in high concentrations placed via a tiny needle directly into the inner ear (for more information on this click here). There is recent evidence to suggest that this may improve or alleviate all together the symptoms of vertigo in 80-90% of patients for anywhere from one to three months but may need to be repeated.
Other options for patients with severe unremitting vertigo can also include placing a shunt surgically in the middle ear. The thought is that this may allow equalization of pressure and of salts in the middle ear. If these techniques do not work the doctor may need to destroy the balance organ either chemically with a medicine called gentamycin or may do so with an operation where the nerve to the balance organ is cut, or the balance organ itself is obliterated. These procedures are necessary in only a minority of cases.
If you are having symptoms of Meniere's disease, please give us a call to come see one of our specialists.
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