Meniere's Disease


Medical treatment
Medical treatment of Meniere's disease is based upon decreasing the amount of fluid in the inner ear. Using a low salt diet and taking a diuretic accomplish this. The use of diuretics reduce total body sodium and it may take some time to see their effects. In addition to a low sodium diet and a diuretic some physicians recommend the use vestibular suppressants. These suppressants can be from a number of different families including antihistamines, Benzodiazepines, and central nervous system agents. These medications primarily change the brain chemistry to prevent the brain from interpreting the abnormal signals from the disease can inner ear.

Surgical treatment
Surgical treatment is considered only if medical treatment has failed and the patient is suffering from incapacitating symptoms. Every effort should be made to try conservative treatment before reaching a surgical decision. There are several different surgical and semi-surgical approaches. There is an excellent chance of preventing attacks with one of the more conservative operations. However, the more serious procedures result in a higher chance of success.

Endolymphatic sac
This surgery is designed to both preserve hearing and improve balance problems. An incision is made directly behind the ear and some bone is removed over the natural drainage point from the inner ear. This procedure will minimize the symptoms of dizziness. Over time, the surgery tends to have reduced effectiveness. There is approximately a 50 -- 60 percent chance of controlling the attacks of dizziness. A small number of people may actually have worsening dizziness, hearing loss, and even potentially facial paralysis. Complications from the procedure are rare. Most individuals have the operation in the morning, and go home on the same day. Occasionally individuals have an impact of dizziness immediately following the surgery. This does not mean that the procedure has failed, it can indicate that the procedure will be successful but at a later time.

There are many ways to reduce balance function from the inner ear. One way is to inject an antibiotic solution into the middle ear space. These injections can be carried out with an antibiotic called Gentamicin. Anywhere between one and 15 injections are necessary to reduce the abnormal stimulations coming from the diseased ear. The injections may be repeated a number of times a year or may be repeated years following the initial injections. Gentamicin is toxic to all the cells in the inner ear and will probably result in some hearing loss. Most of the time the hearing loss is insignificant. Approximately one-third of the patients who take this medication experience increasing tinnitus. High-pitched frequencies may experience higher levels of hearing loss.

Another approach is to use a surgical procedure that will remove the inner ear. Immediately following the operation patients will experience increased levels of dizziness for several days and potentially several weeks. There are individuals who take months to fully recover. The operation will result in hearing loss in the operated ear. Following a labyrinthectomy, dizziness control is very high. As many as 90 percent of individuals who undergo the operation will experience resolution or significant improvement in their symptoms of dizziness. Long-term results tend to be lower because it is possible to develop the disease in the opposite ear.

This surgery is designed to preserve hearing and completely eliminate balance function like a labyrinthectomy. An incision is made further behind the ear and into the skin of the neck. The operation creates an opening into the covering of the brain. This opening provides a surgeon with exposure to the hearing and balance nerves. The two nerve branches are separated and only the balance nerve is cut. There is a small chance of total deafness and a chance of hearing loss following the procedure. There is a small chance of weakness or paralysis of the face. The operation has an excellent chance to improve balance control while giving the patient an opportunity to preserve hearing function. Those individuals who undergo the operation also accept a small risk of central nervous system injury.

Additional treatments
One option for Meniere's disease patients is physical therapy. The treatment with vestibular rehabilitation can be quite helpful. Although exercise cannot cure Meniere's disease, this treatment gives patients the ability to manage their symptoms better. Specific exercises are designed to 1) decrease dizziness, 2) increase balance function and 3) increase general activity and strength. The exercise programs retrain the brain to use other functions beside the inner ear to establish balance and re-establish balance when positions and conditions change.

Autoimmune mechanisms
Some individuals may have Meniere’s disease as a result of an immune related process. This was suggested first about 20 years ago. While most doctors agree that this disorder exists there are debates about how best to diagnose and treat it. Many doctors believe that the use of steroids, given either orally or by injection into the ear, is the best way to diagnose and treat this condition. Once the diagnosis of autoimmune Meniere’s disease is made, other drugs may be used for treatment. These drugs include methotrexate and immuran. These are serious drugs with serious side effects.


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