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Meniere’s Disease

Meniere’s disease affects approximately 150 per 100,000 Americans per year. The disease can incapacitate an individual by repetitive episodes of vertigo, hearing loss and tinnitus.
A French physician, Prosper Meniere first described Meniere’s disease in 1861. Meniere’s disease is a disorder of the inner ear that causes attacks of vertigo, ringing (tinnitus), a hearing loss (often fluctuating), and/or a feeling of fullness (pressure in the ear). Although the complete cause of Meniere’s disease is still unknown, the symptoms are believed to be caused by an increase in the amount of inner ear fluid. Two types of fluids are present in the inner ear. These fluids are known as perilymph and endolymph. The inner ear is divided into two chambers; one chamber is filled with endolymph and another with perilymph. The chamber of perilymph surrounds the chamber of endolymph. In Meniere’s disease, it is believed that there is excess endolymph fluid. Therefore, another term for physiologic changes of Meniere’s disease is endolymphatic hydrops (i.e. excess endolymph).

Normal cochlear chambers

Chambers of a normal cochlea

Endolymphatic hydrops of cochlea

Cochlea with dilation of chambers from endolymphatic hydros

A Meniere’s attack can produce incapacitating vertigo with violent spinning, nausea and vomiting. During these attacks one may feel that the room spins, objects seem to whirl, or that one has the feeling of being pulled to the side or through a tunnel. The attack may last a few minutes to several hours. Following a severe attack, most people are exhausted and sleep for several hours. Although the attacks can be severe, Meniere’s disease is not life threatening.
Meniere’s disease follows no recognizable pattern and, therefore, affects each person differently. At times, Meniere’s attacks may occur at regular intervals. Other attacks may occur in clusters, within a very short period of time. In other cases, individuals may be free from symptoms for months or years at a time. Sometimes the attacks reoccur, the intensity and duration lasting less than the initial attack. In between attacks, most people are free of symptoms. A Meniere’s attack may be preceded by symptoms that occur before the spinning. These symptoms include a fullness or aching in the affected ear, a ringing (tinnitus), and/or fluctuation in hearing.
Variations of Meniere’s disease exist. In some cases, individuals experience only dizziness without any hearing problems. At other times, individuals experience hearing loss, tinnitus, and ear fullness without any dizziness.

Treatment of Meniere’s Disease

Treatment of Meniere’s disease may be medical or surgical. Both treatments have the goal reducing the frequency or eliminating the episodes of vertigo. Medical treatment of Meniere’s disease varies depending on the individual. In approximately 80% of cases medical treatment is effective in alleviating the attacks of dizziness.

Medical Treatment

The goal of controlling the fluid pressure changes of the inner ear is accomplished by lowering the fluid level in the inner ear itself. To do this, patients are placed on a low sodium diet with the goal of achieving a 2,000 – 2,500 mg. sodium intake per day. It is suggested that no sodium be added to the food either while cooking or at the table.
Sometimes medications that make the balance system less susceptible to dizziness are used. These medications are known as labyrinthine or vestibular suppressants. Some of these medications include Meclizine (Antivert), Promethazine (Phenergan), Prochlorperazine (Compazine), and Diazepam (Valium). Vestibular suppressants are taken on an as needed basis. Specifically, vestibular suppressants are taken when a patient feels that an attack of vertigo is about to begin or shortly after the start of an attack of vertigo.

Betahistine is an oral medication that is sometimes used to prevent episodes of vertigo from Meniere’s disease. Betahistine is a partial H1 receptor agonist and potent H3 receptor antagonist and is widely used in Europe and rest of the world in the treatment of Meniere’s disease. The Food and Drug Administration has not approved Betahistine, so Betahistine is not available in the United States through traditional pharmacies. Betahistine is, however, available through compounding pharmacies in the United States. Betahistine is known to increase cochlear (inner ear) blood flow and is well tolerated at doses of 16 to 48 mg daily with no reported significant adverse events.

Intratympanic Therapies (i.e. Middle Ear Perfusion)

A. Intratympanic Steroid Perfusion

Steroid middle ear perfusion involves the placement of a steroid solution into the middle ear. From the middle ear, the medication will work it’s way (diffuse) into the inner ear. This procedure is done in the physician’s office. After the ear drum is anesthetized, the steroid solution is placed into the middle ear through a small opening made in the ear drum. The medication is typically given on several occasions over the course of one to two weeks, with the goal of eliminating the attacks of vertigo due to Meniere’s disease.
Intratympanic steroid perfusion may prevent further attacks of vertigo in approximately 70% of cases. There is a less than 1% chance of further hearing loss as a result of this treatment. In addition, the steroid solution does not damage the inner ear balance mechanism. There is an approximately 1% chance of a persistent opening in the eardrum with this treatment. If an opening persists, the opening can often be closed with an in-office procedure whereby a patch placed on the eardrum.
If vertigo persists after the completion of the steroid perfusion treatments, then a different treatment for vertigo control may be recommended by your physician. If vertigo goes away for a period of time after steroid perfusion, and then returns, a new series of steroid perfusion treatments may be recommended.

B. Intratympanic Gentamicin Perfusion (or Chemical Labyrinthectomy)

Intratympanic gentamicin perfusion involves the placement of medication (gentamicin) into the middle ear. Gentamicin is known to destroy the balance portion of the inner ear. This procedure is done in the physician’s office.
The goal of intratympanic gentamicin perfusion is to partially or completely destroying the balance function of the treated ear. The fluid placed into the middle ear is an antibiotic (called gentamicin) that is also known to destroy the balance portion of the inner ear. After the eardrum is anesthetized, the antibiotic solution is placed into the middle ear through a small opening made in the eardrum. The medicine is often given at least twice, one month apart between treatments.
Gentamicin middle ear perfusion may prevent further attacks of vertigo in up to 85% of cases. If further episodes of vertigo occur after the second treatment, further gentamicin may be given. If vertigo episodes continue after several gentamicin treatments, then surgery may be recommended to prevent further attacks of vertigo.
Surgical Treatment
Surgical treatment of Meniere’s disease is reserved for those cases that do not respond to the medical treatments listed above. Fortunately, in 80% of cases of Meniere’s disease, medical management will control the episodes of vertigo. Surgical treatment for Meniere’s disease is performed to prevent the symptom of vertigo. For more information regarding surgical procedures used to treat the vertigo of Meniere’s disease, please see our “Meniere’s Disease Surgery” section.