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Medical Edge Newspaper Column from Mayo Clinic

MENIERE’S DISEASE: TURNED AROUND BY YOUR EAR

Dear Mayo Clinic: I am 90 years old and developed Meniere’s disease about five years ago. My doctor has prescribed meclizine three times daily, but it doesn’t seem to prevent my dizzy spells. What other treatment options are available? Is there a cure? — Wirt, Minn.

Answer: Meniere’s disease is a condition characterized by sudden, severe episodes of vertigo — which is the sensation that one’s surroundings are moving or spinning — often accompanied by nausea and vomiting. These attacks, which can last several minutes or as long as several hours or even most of a day, usually also include tinnitus (ringing in the ear), ear fullness or pressure, and hearing loss. The disease generally occurs in only one ear.

Although the attacks associated with Meniere’s disease can certainly be frightening, disabling and even depressing, the condition itself is not life-threatening. Most patients do well between episodes, which usually occur only once in a while. Between attacks, patients may have residual hearing loss and tinnitus that worsen over time.

The cause of Meniere’s disease is poorly understood and may vary among patients. The symptoms are thought to derive from an increase in inner-ear fluid, called endolymph. The higher pressure from this excess fluid can produce abnormal signals that tell your brain you’re in motion even though you are actually stationary. The excess fluid can cause fluctuations in hearing as well.

In treating Meniere’s disease, it is important to first confirm the diagnosis —through history, audiogram and perhaps an MRI study of the head — so that your doctor is sure that this is indeed your problem and not something else. The strategy for treatment is then a stepwise approach ranging from the most conservative to the most invasive. Options include dietary/lifestyle modifications, oral medications, injections and surgical procedures.

Most physicians first recommend a diet that excludes caffeinated beverages, alcohol, nicotine and stimulants such as chocolate, which may aggravate symptoms. They also recommend a low-sodium diet (less than 2,000 mg of sodium per day) in order to reduce fluid retention. And because stress or anxiety may aggravate the condition, or play a role in precipitating attacks, modifying or reducing stress in one’s life and getting adequate rest may also reduce the frequency and severity of episodes.

Typical medications for Meniere’s disease include drugs such as meclizine (Antivert), diazepam (Valium) or promethazine (Phenergan), which combat the spinning sensation. Prochlorperazine (Compazine) can control nausea and vomiting, and alprazolam (Xanax) may help relieve the anxiety that often accompanies a serious attack. Antihistamines and relatively short courses of oral corticosteroids, such as prednisone, are also sometimes used to treat patients who are having frequent and severe episodes.

The above medications are used for symptomatic relief — they do not necessarily prevent attacks. Diuretics such as triamterene combined with hydrochlorothiazide (Dyazide), on the other hand, reduce fluid retention, thereby addressing a potential cause of episodes.

If attacks continue despite dietary/lifestyle changes and oral medications, your doctor may suggest more aggressive therapy. This may include local injection of gentamicin, an antibiotic that is toxic to the inner ear. This reduces the balancing function of the inner ear, forcing the other ear to assume responsibility. Injection of steroids such as dexamethasone can have a similar effect, perhaps by reducing inflammation.

A portable machine called the Meniett device is another treatment option. The device transmits a series of pressure pulses into the affected ear and is used two or three times per day for five to ten minutes at a time. This process, which requires that a ventilation tube be present in the eardrum, is said to reduce buildup of inner-ear fluid pressure.

More extensive surgical procedures are usually a last resort. Options include endolymphatic sac decompression (which reduces the pressure caused by endolymph buildup), vestibular nerve sectioning (which cuts the nerve that controls balance in the affected ear), and labyrinthectomy (complete removal of the entire inner-ear sense organ).

Fortunately, less-extreme treatment options, together with self-care tactics, can help most Meniere’s disease patients manage the disorder.
— Charles W. Beatty, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Otorhinolaryngology (ENT)
Types of Balance Problems
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.