What is Meniere’s Disease?

Meniere’s disease is a syndrome which is notorious for causing episodes of severe vertigo. Vertigo is a sensation of spinning or motion which frequently causes nausea and vomiting. If a person develops episodic vertigo which lasts several hours in duration in association with a feeling of pressure in one ear, roaring noise in the same ear, and a fluctuating hearing loss, then it is likely that they have developed Meniere’s disease. It is unknown what specifically causes this condition. We do know that patients with Meniere’s disease have dilated inner ear fluid spaces which suggest that the fluid (endolymph) is under increased pressure. Many doctors and researchers believe that there is a role of autoimmunity in Meniere’s disease. Autoimmunity means that your own body’s’ immune system has decided for some unknown reason to attack an organ system or tissue in your body. One theory as to how Meniere’s disease develops is that a person comes in contact with something they are allergic to, and this substance (allergen) gets into the persons blood stream. This allergen is then found with an antibody forming what is called a Type 4 immune complex. It is theoretically possible that such an allergen-antibody complex could become lodged in the inner ear, and that a persons own immune system would become activated to try and destroy this substance. In the process of trying to rid the body of the substance the inner ear becomes irritated and results in elevated pressure and the symptoms of Meniere’s disease. There is no absolute proof that this is the cause but it is a possible cause. Meniere’s disease can be familial but it is not genetically inherited, which is to say that if you develop Meniere’s disease there is no certain percentage chance that any of your children would develop it.

Diagnosing Meniere’s Disease

Meniere’s disease is for the most part a clinical diagnosis. The Hallmark symptoms of episodic vertigo with ear pressure, tinnitus, and fluctuating frequency nerve hearing loss help to diagnose it. If a patient has these symptoms then it is very likely that they have Meniere’s disease. It may be necessary to undergo an MRI scan to ensure that there is no inner ear tumor present. It is necessary for patients with suspected Meniere’s disease to have hearing tests and advanced tests of hearing function, as well as advanced tests of the vestibular function of the inner ear. The ENG test measures the relative strength of the vestibular system in the inner ear and gives us an idea of how weak a person’s vestibular system is, and how this will affect their prognosis. Sometimes a patient will have the symptoms of Meniere’s disease but it is difficult for us to localize the disease to one ear or the other. This can be a problem especially when medical treatment is not successful.

Medical Treatment of Meniere’s Disease

In most cases, we can treat patients with Meniere’s disease with lifestyle changes and medicines and drastically reduce the frequency and severity of their Meniere’s attacks. We recommend to all of our Meniere’s patients that they choose a specific low salt diet plan of their preference, but that keeps their total sodium intake less than 2000-3000 mg per day. Tight control of sodium intake can help with Meniere’s symptoms to an astonishing level. It is also recommended that patients eliminate caffeine and nicotine from their diet, and it is important for patients to realize that alcohol can irritate the inner ear as well. There are a variety of medications that we can prescribe to help with Meniere’s by increasing blood flow to the inner ear or acting as a diuretic. Any patient who has Meniere’s disease and the slightest allergy symptoms should be screened with allergy testing and begin immunotherapy (allergy shots). Research has shown that immunotherapy greatly helps control the attacks of Meniere’s disease. A certain type of medicine called vestibular suppressant helps to stop the dizziness when it occurs. We use Valium in a very low dose to help control Meniere’s attacks and to stop them when they occur. The dose is quite low and it is extremely rare that a person has side effects such as “feeling drunk” or drowsiness. Occasionally we may use oral steroids in an attempt to break up a cycle of attacks if a person is having a sudden burst of attacks. All of these medications generally help control the vertigo, but unfortunately they do not have much of an effect on the pressure, tinnitus, and fluctuating hearing loss.

What Can be Done For the Hearing Related Symptoms of Meniere’s Disease?

Over the last several years major breakthroughs have occurred in using steroid injections into the ear to treat a variety of problems. Originally these intratympanic steroid injections were used in an attempt to control vertigo episodes in patients who have Meniere’s disease. What has been discovered is that these injections oftentimes do not help with the vertigo, but in many cases can help with the pressure, noise, and hearing loss of Meniere’s disease. This has been confirmed with several different centers across the country and discussed in the medical literature. At this point when we accept a Meniere’s patient into our practice, we strive to control their vertigo episodes as this is the most obviously incapacitating part of the syndrome for them. Once their vertigo is under good control, we can offer a patient intratympanic steroid injections in an attempt to make them more comfortable with regard to their hearing or their hearing symptoms. In most cases a patient will have a notable decrease in the noise within the tinnitus and pressure, and in a significant number of cases patients may have an improvement in their hearing. Sometimes this improvement in hearing will last a long time only to resort back to the previous level of hearing loss. With regard to steroid injections I will label a patient “steroid responsive” or a “steriod non-responder”. Steroid responsive patients have demonstrated a positive response to the steroids and if it works once it is liable to work again. We do have some patients that come in 2 or 3 times a year for steroid injections, as needed to help with their ear symptoms of Meniere’s. The steroid injection is a minor procedure which is almost always covered by your insurance.

Surgery for Meniere’s Disease

Despite the success of medical and lifestyle changes as treatment for Meniere’s disease, some patients will not improve. Other patients may not be a candidate for medical treatment, and some patients may have such a great deal of anxiety regarding their Meniere’s disease that they seek a more immediate control or possible cure for the condition. All of these patients are candidates for surgical procedures for Meniere’s disease.

Nondestructive Procedures

The endolymphatic mastoid shunt: This is an outpatient operation that requires general anesthetic. The patient is put to sleep and an incision is made behind the ear. The bone is drilled and the endolymphatic sac is identified. This structure is responsible for absorption of the inner ear fluid. The goal of this surgery is to decompress and open this structure to relieve pressure on the inner ear system. In 70% of cases, patients report a marked decrease in frequency and severity of their attacks. Some patients are completely cured by this procedure. It is possible that a person can have this procedure and then 1-2 years later have a recurrence of their symptoms. At that point all other options would be available including further medical treatment or surgical treatment. This is a very solid, advisable choice as an initial surgical intervention should medical treatment fail.

Destructive Surgical Procedures

Labyrinthectomy: Labyrinthectomy surgery generally requires a 1 night hospital stay and a general anesthetic. Again an incision is created behind the ear. The bone is drilled and the inner ear structure is identified. These structures are drilled out and the vestibular function is destroyed along with hearing. This is a good option for a patient who has no useful hearing in their ear. Approximately 90% of patients having this procedure will be cured of their vertigo attacks from Meniere’s disease.

Vestibular Nerve Section: This operation would involve a 3-4 day hospital stay and requires a general anesthetic. This operation involves drilling the bone behind the inner ear and entering the cranial cavity. The vestibular nerve, which takes information from the vestibular system to the brain, is identified and cut. Despite the fact that we are only cutting the vestibular nerve this procedure entails an approximately 5% chance of total nerve hearing loss. It can cure the vertigo attacks of Meniere’s disease in 95% of patients. There is a slight chance of a spinal fluid leak with this operation and this may require further surgery to stop.

Intratympanic Gentamicin

Another destructive procedure that does not involve surgery or general anesthetic is the injection of gentamicin into the middle ear space. This medicine will be absorbed into the inner ear. Gentamicin is a medicine that is toxic to the vestibular system and slightly toxic to the hearing system. Patients who undergo this procedure face a 10% chance of sustaining hearing loss. Usually 2-3 injections are necessary to destroy the vestibular system using gentamicin injections. It is possible for the symptoms to recur a year or two later after having had gentamicin injections. The injections can be somewhat painful. This is a good choice for a person who would be risky to put under general anesthetic due to other health problems.

Summary of Meniere's Disease

Meniere’s disease is a rare condition that many times is poorly understood. In our practice, we see a very high volume of patients with Meniere’s disease. We are used to seeing unusual presentations of this illness and feel that we can offer a comprehensive management strategy to help people cope with the disease. Some references cite that Meniere’s disease will run its natural course over a period of 5 years or so. In many cases it is true that a patient will have a predominance of their dizziness complaints in the initial part of their struggle with Meniere’s disease, and later have more problems with the hearing symptoms. Although it can be a very frightening problem to have, Meniere’s diseases can be effectively controlled if managed properly.

The Physicians of Owens Ear Center work closely with Audiologists and Otologic Technicians to accurately assess each patient's hearing condition. Contact us today with your Meniere’s disease questions, on symptoms, and treatment. We are conveniently located in Dallas, Fort Worth, and Plano, TX.