Managing Ménière’s disease

Ménière’s disease is characterized by intermittent and sudden attacks of vertigo (a spinning sensation), often accompanied by tinnitus (typically a ringing or roaring sound) and a feeling of fullness in the ear. Fluctuating hearing loss that can become permanent over time is also a feature, along with hypersensitivity to sounds and sound distortion. It usually affects only one ear.

People who develop Ménière’s—typically in their forties or fifties—will attest to its physically and emotionally distressing nature. Plus, vertigo can lead to falls and other accidents, as well as anxiety and depression.

Prosper Ménière, a 19th-century French physician, was the first to link the symptoms to a problem in the inner ear. Much about the disease remains elusive, however, including its underlying cause. The prevailing theory is that there is a problem with endolymph, the fluid in the inner ear that’s essential for hearing and balance. This may have a genetic component or may possibly result from a viral infection or inflammation (for example, from allergies or autoimmune problems).

Though the course of the disease can vary, generally there is a decrease in bouts and severity of vertigo over time, but an increase in tinnitus and hearing loss. In some people, the condition may eventually affect the second ear and lead to bilateral hearing loss, while other people may experience a single classic episode, with the symptoms never returning.

If you think you have Ménière’s, your doctor can make the diagnosis based on your symptoms in conjunction with an audiometry exam and testing of your vestibular system (balance). The workup usually involves an MRI to rule out a tumor or stroke. Often, though, the diagnosis is missed because it may take years for the constellation of symptoms associated with Ménière’s to develop. Diagnosis is also challenging because the condition is highly variable, characterized by periods of acute symptoms and spontaneous remissions.

There’s no cure for Ménière’s, but its symptoms can usually be managed. Much of the focus is on easing vertigo.

  • The single best measure is to identify and then avoid, if possible, whatever triggers attacks: It might be alcohol, caffeine, chocolate, nicotine, sodium, or stress. Treating seasonal or other allergies can also help.
  • For acute episodes of vertigo, you can try anti-nausea and motion sickness medications, antihistamines, or tranquilizers. For chronic management, your doctor may prescribe diuretics (to reduce fluid retention in the inner ear) or administer steroids into the middle ear (to reduce inflammation).
  • Many doctors routinely recommend limiting sodium, though there are no published studies to support this. Still, a low-sodium diet has other health benefits.
  • You may also be referred for “vestibular rehabilitation” to retrain your body to properly process balance information. This involves various exercises, such as those with eye and head movements.
  • Some people get relief from devices that send low-pressure air pulses into the ear to stimulate endolymph flow. Used for a few minutes several times a day, the electronic Meniett device has been shown to decrease vertigo in several studies—but it is expensive (more than $3,000) and not all insurance plans will cover it. Another device, the P100, was found in one study to be as effective as the Meniett and costs much less (about $60) because it is manually operated.
  • Though many people turn to alternative or complementary remedies—including acupuncture, homeopathy, the Alexander technique, chiropractic manipulation, tai chi, shiatsu, and dietary supplements—there’s little or no evidence that they help.
  • Surgery can be of value for the small percentage of people who have incapacitating vertigo that doesn’t respond to other treatments. But it generally doesn’t address the other symptoms, plus some procedures carry the risk of further hearing loss.

[Via: berkeleywellness.com]

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