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Ménière's disease is a disorder of the inner ear that causes a severe sensation of spinning (vertigo) typically lasting an hour to several hours or more. Patients experience fluctuating hearing loss and ringing in the ears (tinnitus). This can progress to permanent loss of hearing. Sometimes you can experience a feeling of fullness or congestion in the ear. Ménière's disease usually affects only one ear.
The attacks of vertigo may come on suddenly or after a short period of tinnitus or muffled hearing. Some people will have single attacks of dizziness separated by long periods of time. Others may experience many attacks closer together over a number of days. In some people the vertigo can be extreme enough to cause them to lose their balance and fall. These episodes are called "drop attacks."
Ménière's disease can develop at any age, but it is more likely to happen to adults between 40 and 60 years of age. It is considered a chronic condition but various treatments can help relieve symptoms and minimize the long-term impact on your life. It is estimated that approximately 615,000 individuals in the United States are currently diagnosed with Ménière's disease and that 45,500 cases are newly diagnosed each year.
A diagnosis of Meniere's disease typically requires:
If you're experiencing symptoms of Meniere's disease, your doctor will order tests to examine your balance and hearing and to rule out other causes of your symptoms. There is no one test that can be done to confirm the diagnosis absolutely.
A hearing test (audiometry) assesses how well you detect sounds at different pitches and volumes and how well you distinguish between similar-sounding words. People with Meniere's disease typically have problems hearing low frequencies or problems with both high and low frequencies but with normal hearing in the mid frequencies.
People who have Meniere's disease will have a reduced balance response in one of their ears. Between episodes of vertigo, sense of balance returns to normal for most people with Meniere's disease but some have ongoing balance problems.
Currently there is no cure for Meniere's disease, but a number of treatments can help reduce the severity and frequency of vertigo episodes. There are no treatments for the hearing loss that occurs with Meniere's disease. All of the treatments — some conservative, some aggressive — are to stop the spells of vertigo.
A low salt diet (2000 mg per day) is often recommended in conjunction with a diuretic - this is directed at reducing pressure in the inner ear - which is believed to be the primary cause of Ménière's disease. Medications for vertigo:
Your doctor may prescribe medications to take during a vertigo episode to lessen the severity of an attack. Motion sickness medications may reduce the spinning sensation and help control nausea and vomiting. Anti-nausea medications might control nausea and vomiting during an episode of vertigo. Your doctor may prescribe a medication to reduce fluid retention (diuretic). For some people, a diuretic helps control the severity and frequency of Meniere's disease symptoms. A diuretic is usually combined with a low salt diet (2000 mg per day) which can reduce pressure in the inner ear - which is believed to be the primary cause of Ménière's disease.
Intratympanic therapy (medicine placed behind the ear drum) is also used as additional treatment options. This can be done in the office setting with only ear drops for anesthetic. Steroids are most commonly used as a medication for this procedure, but in some cases gentamicin may be used for more severe and advanced disease.
Some people with Meniere's benefit from other noninvasive therapies and procedures, such as vestibular rehabilitation therapy, to improve their balance. Sometimes a hearing aid is used in the ear affected by Meniere's disease. Your doctor an audiologist can discuss what hearing aid options would be best for you.
For vertigo that's hard to treat, a Meniett device involves applying pressure to the middle ear to improve fluid exchange. The Meniett pulse generator applies pulses of pressure to the ear canal through a ventilation tube. Treatments are usually three times a day at home for five minutes at a time. Initial reports on the Meniett device show improvement in symptoms of vertigo, tinnitus and aural pressure, but its long-term effectiveness has not been determined.
More aggressive treatments.
Medications injected into the middle ear, and then absorbed into the inner ear, may improve vertigo symptoms. Gentamicin is an antibiotic that's toxic to your inner ear. It therefore reduces the balancing function of your ear, and your other ear assumes responsibility for balance. The procedure, which can be performed during local anesthesia in your doctor's office, often reduces the frequency and severity of vertigo attacks. There is a risk, however, of further hearing loss.
Steroids, such as dexamethasone, also may help control vertigo attacks in some people. This procedure can also be performed with local anesthesia applied by your doctor. Although dexamethasone may be slightly less effective than gentamicin, it is less likely to cause further hearing loss.
Intratympanic therapy (medicine placed behind the ear drum) is also used as additional treatment options. This can be done in the office setting with only ear drops for anesthetic.
Vertigo that does not respond to initial conservative therapy may be treated surgically in some cases.
Endolymphatic sac surgical procedure may alleviate vertigo by decreasing fluid production or increasing fluid absorption. The endolymphatic sac plays a role in regulating inner ear fluid levels. In surgical endolymphatic sac decompression, a small portion of bone is removed from over the endolymphatic sac. In some cases, this procedure is coupled with the placement of a shunt, a tube that drains excess fluid from your inner ear.
Vestibular nerve section involves cutting the nerve that connects the balance and movement sensors in your inner ear to the brain (vestibular nerve). This procedure usually corrects problems with vertigo while attempting to preserve hearing in the affected ear. It requires general anesthesia and an overnight hospital stay.
A Labyrinthectomy is the surgical removal of the balance portion of the inner ear, thereby removing both balance and hearing function from the affected ear. This procedure is performed only if you already have near-total or total hearing loss in your affected ear.
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