This will help find any changes in hearing related to disease in the middle ear or other causes. Balance test Magnetic resonance imaging MRI scans.
An MRI is done to determine if a tumor is present. Electrocochleography ECOG. This test measures electrical activity of the inner ear. Your healthcare provider will figure out the best treatment based on: How old you are Your overall health and medical history How sick you are How well you can handle specific medicines, procedures, or therapies How long the condition is expected to last Your opinion or preference Treatment may include: Surgery.
Medicines may be given to control allergies, reduce fluid buildup, reduce dizziness, or improve the blood circulation in the inner ear. Change in diet.
Eliminating caffeine, chocolate, alcohol, and salt may reduce the frequency and intensity of symptoms. Behavior therapies. Reducing stress may lessen the severity of the disease symptoms. Hearing Aids to treat hearing impairments. It causes symptoms such as vertigo, nausea, vomiting, loss of hearing, ringing in the ears, headache, loss of balance, and sweating. Treatment choices may depend on the severity of the disease and you should talk with your healthcare provider about what choices are right for you.
Often, strictly keeping to a low-sodium diet is enough for patients to fend off future attacks. If a patient is strict about sodium intake and symptoms persist, further treatments can include a Meniett device — a small tube placed in the inner ear that delivers ultrasonic pulses to help offset pressure buildup — as well as steroid and antibiotic injections. For patients with no hearing remaining in an affected ear, a last resort is often a transmastoid labyrinthectomy — a surgical procedure to "literally drill out the inner ear," according to Basura.
Patients requiring this level of treatment need postsurgical physical therapy to train their brains to compensate for the loss of balance perception within the ear. Treatments in development center on individualized gene therapy. But while a cure is not imminent, there is more understanding about diagnosis and treatments. The guidelines, endorsed by the Academy of Otolaryngology—Head and Neck Surgery, will be released next summer.
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Thus, the bottom line is that in most patients with Meniere's disease in , the underlying cause of Meniere's disease is unknown. It is most often attributed to viral infections of the inner ear, head injury, a hereditary predisposition, and allergy. Migraine may cause symptoms that overlap with Meniere's disease, or in some, may even be identical to Meniere's disease, at the level that we can resolve disorders in the clinic i.
What damage is done by Meniere's Disease? Hair cell death: Conventional thought is that repeated attacks of Meniere's kills hair cells in the inner ear. This is a gradual process over years, but frequently resulting in unilateral functional deafness.
Cochlear hearing hair cells are the most sensitive. Vestibular hair cells seem more resilient but there is also a slow decline in the caloric response in the diseased ear over roughly 15 years Stahle et al, Mechanical changes to the ear. Mechanical disruption of the inner ear is also likely with dilation of the utricle and saccule of the ear being a well known pathological finding. The saccule may dilate so that in later stages, it is adherent to the underside of the stapes footplate.
This mechanical disruption and distortion of normal inner ear structures may result in the gradual onset of a chronic unsteadiness, even when patients are not having attacks.
The periodic dilation and shrinkage of the utricle is also a reasonable explanation for periodic attacks of another inner ear disorder, BPPV. Finally, it also seems likely that there may be rupture of the suspensory system for the membranous labyrinth, related to vestibular atelectasis. This might create some mechanical instability of the utricle and saccule and consequently some chronic unsteadiness.
Some investigators suggest that experimental Meniere's disease kills the cochleovestibular nerve through neurotoxicity in mice and guinea pigs Megarian et al, However, the evidence is against this being the main mechanism in human beings see Kitamura et al, ; Nadol et al, Rather, it seems that Meniere's disease damages both hair cells and nerve fibers in humans. Studies of humans are handicapped by the possibility that Meniere's is the final common pathway of a variety of illnesses of the ear.
This is roughly the same prevalence as multiple sclerosis MS. The majority of people with Meniere's disease are over 40 years of age, with equal distribution between males and females. At the present time there is no cure for Meniere's disease, but there are ways to manage the condition and help control symptoms. Some recently refined treatments are i. While some have suggested that Meniere's may "burn out", research studies suggest that this is not likely Havia and Kentala How does the doctor know I have Meniere's disease?
Diagnosis of Meniere's is based on a combination of the right set of symptoms usually episodic dizziness and hearing disturbance , hearing tests which document that hearing is reduced after an attack, and then gets better, and exclusion of alternative causes. Several committees have offered diagnostic criteria -- these are reviewed in the link. In spite of more recent additions, we continue to favor the AAO criteria for "definite" Meniere's disease.
The differential diagnosis is broad and includes perilymph fistula , recurrent labyrinthitis , migraine , congenital ear malformations of many kinds , syphilis , Lyme disease, tumors such as acoustic neuroma , multiple sclerosis, posterior fossa arachnoid cysts, and other rare entities. Symptoms similar to Meniere's fluctuating hearing, tinnitus, vertigo can also be caused by impending strokes in the distribution of the anterior inferior cerebellar artery Lee and Cho, Bilaterality of hearing fluctuation suggests a vascular cause such as migraine.
Occasionally a " wrong way " irritative nystagmus is seen in Meniere's disease. Essentially, the nystagmus jumps towards the bad side. This is a highly specific finding to Meniere's disease. Potential reasons are an exitatory nystagmus, Bechterew's phenomenon recovery nystagmus , Meniere's involving the opposite ear, and stronger vestibular responses on the side with hydrops due to hydrodynamic factors associated with hydrops.
Newer variants of MRI are currently an emerging technology for diagnosis. Electrocochleography ECochG is often helpful, although it remains controversial. As aural fullness can be caused by eustachian tube malfunction , tympanometry is sometimes useful.
The "glycerol test" is an older diagnostic test that depends on detecting improvement of hearing, 4 hours after oral administration of glycerol Basel and Lutkenhoner, This test is not commonly used. Hearing tests often begin with showing a fluctuating low-frequency sensorineural hearing loss figure 3a.
Over years, this gradually progresses to a "peaked" pattern with both low and high-tone reduction figure 3b , and finally a "flat" pattern, typically 50 dB loss dB would be completely deaf. After about 10 years of Meniere's disease, hearing often looks like that of figure 3c, where the "peak" has become a flat sensorineural loss. Perhaps this means that the low-frequency SNHL is not due to cochlear damage. Recently, it has become possible to test ones hearing with cell-phone apps.
This may help with the diagnosis process. While some people have hearing that fluctuates like this without any further symptoms of dizziness or tinnitus, in most cases, this does not progress to Meniere's disease Schaaf et al, Some authors have suggested that the pattern and severity of the hearing deficit does not correlate with the duration of illness Mateijsen et al, , but this does not match are very large our experience.
It seems more likely that the Meniere's hearing pattern is variable and that these authors simply did not study enough patients. Those who present to the doctor with more severe hearing impairments at onset, usually do worse than those who have milder hearing impairments Sato et al, Occasionally patients with Meniere's and hydrops will have an "air-bone gap" at low frequencies -- i. Sugimoto et al, The air-bone gap is a sign found mainly in conductive hearing loss , but also found in patients with superior canal dehiscence.
This phenomenon so far is unexplained. The study above shows it is correlated with hydrops. A set of tests from the same patient showing classic Meniere's is shown here. A longer discussion of the information to be gained in testing of persons with Meniere's disease is found here.
This is the way that we manage acute attacks at Chicago Dizziness and Hearing. Additional information about prevention of vomiting is found here. During an acute attack, lay down on a firm surface. Stay as motionless as possible, with your eyes open and fixed on a stationary object. Do not try to drink or sip water immediately, as you'd be very likely to vomit. After the attack subsides, you'll probably feel very tired and need to sleep for several hours. If vomiting persists and you are unable to take fluids for longer than 24 hours 12 hours for children , contact your doctor.
Meclizine Antivert , lorazepam and clonazepam are commonly used vestibular suppressant medication s and Compazine, Phenergan or Ondansetron are commonly used medications for nausea. In our practice in Chicago , we commonly prescribe an "emergency kit", consisting of a small prescription of lorazepam and ondansetron, to be taken sublingually for an acute attack.
Maxide is used when a smaller dose than found in Dyazide is needed it is scored. Van Deelen and Huizing studied the use of diuretics in Meniere's disease in a double-blind, placebo controlled trial, and reported that it reduces vestibular complaints, but has no significant effect on hearing Thirlwall and S.
Kundu were unable to come to a conclusion as to efficacy as no papers published up to were adequate for meta-analysis. Crowson et al reported that all studies were of "low evidence level" and that they consistently report reduction in vertigo. While these authors appear to be "bashing" diuretics, it is important to remember that lack of evidence is not the same as evidence of lack. This is similar to nearly any medication for Meniere's, suggesting that there may be some heterogeneity.
Mori et al and Miyashita et al suggested that the mechanism for the good effect of salt reduced treatment is increased aldosterone. Others however have questioned the association Mateijsen et al, Notes: as triamterine is a folate antagonist, pregnant women should take folate supplements if not otherwise contraindicated. Occasionally persons on long-term acetazolamide develop kidney stones. All of the above diuretics have sulfa in them, which persons with sulfa allergies may be unable to tolerate.
Note that we have four chemical groups of diuretics here -- sodium channel blockers triamterine, amiloride , loop diuretics ethacrynic acid , carbonic anhydrase inhibitors acetazolamide , and aldosterone antagonists spironolactone.
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