Meniere's Syndrome (Meniere's Disease, Endolymphatic Hyrdops)
Meniere’s disease consists of a triad of fluctuating hearing loss, tinnitus (ringing), and vertigo. Some patients also have ear “pressure-pain” sensations. These symptoms will occur episodically together or separately. Each patient’s symptoms vary somewhat different in severity. Unfortunately, the vertigo symptom can become incapacitating.
The cause of Meniere’s disease is not completely known. Meniere’s disease rarely occurs in children, but usually begins in both men and women in early middle-age. It appears to be due to an increase of the inner ear fluid pressures. It is not known if this is from lack of resorption or too much fluid production. It appears that the excess fluid pressure within the inner ear causes periodic rupture of some inner ear membranes. This leads to the troubling episodes of vertigo and hearing loss. Most patients with Meniere’s have certain trigger substances. These are known to be sodium intake, caffeine, tobacco, alcohol, and also stress. Sodium intake is the main trigger. Dietary modification of the “triggers” result in 80% of patients having relief of symptoms. Additionally, some patients with Meniere’s disease have an immune disorder of the body where the patient’s own body produces antibodies which attack the inner ear. These patients need medicinal treatments.
Overall, for the 20% of patients who do not respond to dietary and medical treatment, then a surgical procedure may be necessary to help them with their vertigo symptoms.
There are many other causes of dizziness such as cardiovascular, neurologic, and microvascular ischemia (hardening of the arteries). These diagnoses are usually ruled-out by the family doctor prior to sending the patient to see the Otologist ear doctor.
The diagnosis of Meniere’s disease usually depends on a careful history of the symptoms. Comprehensive testing may be used in order to confirm the impression. The hearing test (audiogram) is a major part of that and sometimes also MR scanning. Other tests such as ENG (electronystagmography balance test), electrocochleography (ECOG), auditory brainstem response testing (ABR/BSER), and lab tests may be needed.
The mainstay of all Meniere’s treatment is initially dietary. Salt (sodium) intake is of primary importance. Most patients start with a 2 gram sodium diet per day. Most American consume over 10 grams of sodium per day. Patients keep track of everything they eat for several days, and then go to the bookstore and buy a sodium guide. The foods are listed with the sodium content. Thus, a banana may have 8 mg and a Big Mac may have 1,500 mg. Once the total intake is know, then the patient knows that they have cut back to appropriate levels of 2,000 mg (2 grams). Usually, within several weeks this diet will cause 80% of patients to remit from their Meniere’s vertigo symptoms.
Outside of the dietary restriction, tobacco, alcohol, and stress may give rise to Meniere’s symptoms. Therefore, these should be monitored and modified.
Most medications generally do not directly benefit the Meniere’s patients other than covering the symptoms. Medicines such a Meclizine and Diazepam are these types of medications. Sometimes diuretics like Dyazide (triamterene) are used. In some cases, a short burst of steroid is used.
There are three types of surgery which aid Meniere’s. The surgeon starts with the most conservative surgery to try to help the patient. If the initial procedure does not perform well for the patient, then escalation of surgery types may be needed to remove the disabling vertigo.