Meniere’s disease

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What is Meniere’s disease?

Meniere’s disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. Meniere’s disease usually affects only one ear.

Attacks of dizziness 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. Some people with Meniere’s disease have vertigo so extreme that they lose their balance and fall. These episodes are called “drop attacks.”

Meniere’s disease can develop at any age, but it is more likely to happen to adults between 40 and 60 years of age. The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that approximately 615,000 individuals in the United States are currently diagnosed with Meniere’s disease and that 45,500 cases are newly diagnosed each year.

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What causes the symptoms of Meniere’s disease?

 The labyrinth in relation to the ear
The labyrinth is composed of the semicircular
canals, the otolithic organs (i.e., utricle and
saccule), and the cochlea. Inside their walls (bony
labyrinth) are thin, pliable tubes and sacs
(membranous labyrinth) filled with endolymph.
Credit: NIH Medical Arts

The symptoms of Meniere’s disease are caused by the buildup of fluid in the compartments of the inner ear, called the labyrinth. The labyrinth contains the organs of balance (the semicircular canals and otolithic organs) and of hearing (the cochlea). It has two sections: the bony labyrinth and the membranous labyrinth. The membranous labyrinth is filled with a fluid called endolymph that, in the balance organs, stimulates receptors as the body moves. The receptors then send signals to the brain about the body’s position and movement. In the cochlea, fluid is compressed in response to sound vibrations, which stimulates sensory cells that send signals to the brain.

In Meniere’s disease, the endolymph buildup in the labyrinth interferes with the normal balance and hearing signals between the inner ear and the brain. This abnormality causes vertigo and other symptoms of Meniere’s disease.

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Why do people get Meniere’s disease?

Many theories exist about what happens to cause Meniere’s disease, but no definite answers are available. Some researchers think that Meniere’s disease is the result of constrictions in blood vessels similar to those that cause migraine headaches. Others think Meniere’s disease could be a consequence of viral infections, allergies, or autoimmune reactions. Because Meniere’s disease appears to run in families, it could also be the result of genetic variations that cause abnormalities in the volume or regulation of endolymph fluid.

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How does a doctor diagnose Meniere’s disease?

Meniere’s disease is most often diagnosed and treated by an otolaryngologist (commonly called an ear, nose, and throat doctor, or ENT). However, there is no definitive test or single symptom that a doctor can use to make the diagnosis. Diagnosis is based upon your medical history and the presence of:

  • Two or more episodes of vertigo lasting at least 20 minutes each
  • Tinnitus
  • Temporary hearing loss
  • A feeling of fullness in the ear

Some doctors will perform a hearing test to establish the extent of hearing loss caused by Meniere’s disease. To rule out other diseases, a doctor also might request magnetic resonance imaging (MRI) or computed tomography (CT) scans of the brain.

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How is Meniere’s disease treated?

Meniere’s disease does not have a cure yet, but your doctor might recommend some of the treatments below to help you cope with the condition.

  • Medications. The most disabling symptom of an attack of Meniere’s disease is dizziness. Prescription drugs such as meclizine, diazepam, glycopyrrolate, and lorazepam can help relieve dizziness and shorten the attack.
  • Salt restriction and diuretics. Limiting dietary salt and taking diuretics (water pills) help some people control dizziness by reducing the amount of fluid the body retains, which may help lower fluid volume and pressure in the inner ear.
  • Other dietary and behavioral changes. Some people claim that caffeine, chocolate, and alcohol make their symptoms worse and either avoid or limit them in their diet. Not smoking also may help lessen the symptoms.
  • Cognitive therapy. Cognitive therapy is a type of talk therapy that helps people focus on how they interpret and react to life experiences. Some people find that cognitive therapy helps them cope better with the unexpected nature of attacks and reduces their anxiety about future attacks.
  • Injections. Injecting the antibiotic gentamicin into the middle ear helps control vertigo but significantly raises the risk of hearing loss because gentamicin can damage the microscopic hair cells in the inner ear that help us hear. Some doctors inject a corticosteroid instead, which often helps reduce dizziness and has no risk of hearing loss.
  • Pressure pulse treatment. The U.S. Food and Drug Administration (FDA) recently approved a device for Meniere’s disease that fits into the outer ear and delivers intermittent air pressure pulses to the middle ear. The air pressure pulses appear to act on endolymph fluid to prevent dizziness.
    Meineres-Disease_Aug2010-fig2.jpg
    Location of endolymphatic sac
    Credit: NIH Medical Arts
  • Surgery. Surgery may be recommended when all other treatments have failed to relieve dizziness. Some surgical procedures are performed on the endolymphatic sac to decompress it. Another possible surgery is to cut the vestibular nerve, although this occurs less frequently.
  • Alternative medicine. Although scientists have studied the use of some alternative medical therapies in Meniere’s disease treatment, there is still no evidence to show the effectiveness of such therapies as acupuncture or acupressure, tai chi, or herbal supplements such as gingko biloba, niacin, or ginger root. Be sure to tell your doctor if you are using alternative therapies, since they sometimes can impact the effectiveness or safety of conventional medicines.

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What is the outlook for someone with Meniere’s disease?

Scientists estimate that six out of 10 people either get better on their own or can control their vertigo with diet, drugs, or devices. However, a small group of people with Meniere’s disease will get relief only by undergoing surgery.

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What research about Meniere’s disease is being done?

Insights into the biological mechanisms in the inner ear that cause Meniere’s disease will guide scientists as they develop preventive strategies and more effective treatment. The NIDCD is supporting scientific research across the country that is:

  • Determining the most effective dose of gentamicin with the least amount of risk for hearing loss.
  • Developing an in-ear device that uses a programmable microfluid pump (the size of a computer chip) to precisely deliver vertigo-relieving drugs to the inner ear.
  • Studying the relationship between endolymph volume and inner ear function to determine how much endolymph is “too much.” Researchers are hoping to develop methods for manipulating inner ear fluids and treatments that could lower endolymph volume and reduce or eliminate dizziness.

Natural Treatments:

Vitamins C and vitamin E - strong antioxidants provide extra ‘fighting power’ to the immune system, neutralizing free radicals and acting as very strong anti-inflammatories, drawing away unneeded fluid from the cells. A daily dose of a vitamin B complex consisting of vitamin B1, vitamin B2, vitamin B6 and vitamin B12 will help keep your stress under control. People with Meniere's disease use the supplements to decrease their tinnitus symptoms, according to MayoClinic.com. The National Institutes of Health warns that zinc supplements may affect the way antibiotics and other medicine works. Talk to your doctor about the safety and efficacy of zinc supplements for Meniere's disease.

Herbs such as Ginkgo biloba and Rosmarinus officinale support the circulatory system, increase energy levels and promote mood balance. 

Ginkgo biloba promotes proper circulatory functioning and helps keep your blood vessels protected. Consuming ginkgo biloba may improve blood flow to your brain and cognitive functioning. This herb also helps to diminish symptoms associated with tinnitus and vertigo as well. It can take four to six weeks to note the benefits associated with ginkgo biloba; take 120 mg of ginkgo biloba a day in divided doses.

Side effects may include rash, headaches and gastrointestinal upset. Pregnant women and breastfeeding females should not use ginkgo biloba. Stop using ginkgo three days before surgery to reduce any risks associated with excessive bleeding. Ginkgo biloba may interfere with certain medications like carbamazepine, valproic acid, fluoxetine, sertraline, paroxetine, escitalopram and phenelzine. It may also interfere with medications like nifedipine, aspirin, clopidogrel, dipyridamole, heparin, ticlopidine, ibuprofen, thiazide diuretics and trazadole. Diabetics should speak with a doctor before taking ginkgo biloba because it can increase insulin levels in the blood.

Rosemary helps to improve circulatory and cognitive processes. Take 4 to 6 g of dried rosemary and brew it in 2 cups of hot water for 15 minutes. Strain the mixture and consume 3 cups a day to improve your circulatory processes and tinnitus. Possible side effects include nausea and vomiting, and in extreme cases, coma and pulmonary edema can result. Pregnant women may miscarry if using rosemary, and breastfeeding females should also avoid the herb. If you have Crohn's disease, hypertension, ulcers or ulcerative colitis, avoid consuming rosemary. Do not consume rosemary oil orally because it is toxic. Rosemary can interact with warfarin, clopidogrel, aspirin, captopril, enalapril, lisinopril, fosinopril, diuretics like furosemide and hydrochlorothiazide, lithium and diabetic medications.

Lysine. A naturally occurring amino acid, lysine is popular in France for treatment of vertigo (Rascol et al, 1995). COMMENT: Possibly useful for vestibular neuritis.

Manganese - 1000 mg. of magnesium will relieve the ringing in your ears as well as protect the ears from permanent hearing loss and damage.

Methylsufonylmethane (MSM) restores tissue health in the middle ear. It will also reduce the possibility of allergic reactions, making this vitamin regime more effective and agreeable to your systems.

Vertigoheel is available with prescription (Cocculus Compositum is the same composition available without prescription). 
Vertigoheel is a homeopathic concoction. Vertigoheel works in the brain, not the inner ear. It apparently helps the brain deal with confusing balance signals coming from the Meniere’s-diseased ear. This treatment will eliminate confusion from aberrant balance signals, and it will offer immediate relief. Any symptoms of dizziness, imbalances, and motion sickness will find immediate relief from Vertigoheel or Cocculus Compositum. Has to be taken under the tongue, consistently for 2-3 days without a break.

 

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Disclaimer: This information is intended as a guide only.   This information is offered to you with the understanding that it not be interpreted as medical or professional advice.  All medical information needs to be carefully reviewed with your health care provider.

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