Meniere's Definition

What they call the "classical Meniere’s", affects both the hearing and balance systems. There is also, Meniere’s that affects only the Cochlea (hearing organ) and only Vestibular system (balance).
In the early stages, many people experience sudden attacks of dizziness, nausea, ear ringing (tinnitus), and ear or head pressure. There may be fluctuating or permanent, hearing loss. The dizziness may take the form of vertigo (spinning), or it may be a feeling of lightheadedness, or an "about to faint" feeling. There may be a sudden loss of balance, sometimes referred to as a "drop attack". However the Meniere’s patient never actually passes out in most cases. These attacks may come and go, like they have a mind of their own. They may also accompany or trigger an anxiety attack. This may result in a variety of symptoms. There do seem to be common symptoms, with Meniere’s. But not everyone will have all of the symptoms. Also, the duration and severity of the attacks will vary greatly from one patient to another. There may be remission periods of no symptoms. These periods have been known to last for hours, or even many years.
The lightheadedness (inner ear dizziness) may take the form of disorientation or what many people refer to as "Brain fog". This can be a period of time where it is difficult to think clearly and one's sense of time and direction can become distorted. These periods of time may be quite long and may be triggered by high ceilings and flourescent lighting (like in big stores), or it may appear for no apparent reason. The patient gets a signal from the brain that "something is wrong here!", but does not know exactly what it is. I believe this may trigger panic or anxiety attacks, as I have experienced them firsthand and talked to many others that have also.
Periods of time like this may be extremely frustating to the Meniere's patient as they may find themselved in the Emergency Room, only to be told that, "we cannot find anything wrong". This seems to be a common theme, especially in the earlier stages, where the patient is unaware as to what his(her) problem may be.

In about 75 percent of the cases it only affects one ear. There is no real known cause for Meniere’s. There are many theories, though. At least 10 percent of the time, it is an autoimmune response. The body’s own immune system attacks the inner ear.
Medical science does know, that the Meniere's attacks are caused by too much pressure in the inner ear systems. There may be several reasons for this;
1. Too much fluid produced
2. Spasms within the inner ear structure
3. hypovascularity (temporary reduced fluid flow, like a restriction)
4. Malfunction of the fluid sac. The sac regulates the fluid pressure. It absorbs and reabsorbs fluid.
5. unknown (idiopathic)
All of these reasons may have a number of different causes. So you see why it is so difficult for your doctor to know what is going on.

Diagnosis is sometimes very difficult. If Meniere’s is suspected, one should see a specialist (otologist, neurotologist), or at least an ENT. To look for a neurotologist in your area click here. Much testing may be necessary, because dizziness may be a sign of a more serious condition. Cardiovascular ( heart) disorders and tumors, must be ruled out. Also blood tests for other disorders, like blood sugar problems, thyroid, etc., should be done.
There are many tests that you may undergo;

MRI or C-T Scan - This lets your doctor know that there are no tumors or Central Nervous System problems, by looking at your brain and surrounding area. You may be sent to a neurologist for a complete “brain” examination. This is a normal procedure and does not mean anything is wrong.

ENG - Electronystagram, used to asses the balance system function. You may be asked to look at a series of things, including lights. Cool and warm water is inserted into each ear to over-stimulate the balance system (causing vertigo) the patient’s reaction time to the vertigo is then measured. many people do not like this test, but it is a very good way to assess balance system function.

Platform Balance Test - The patient is strapped into a harness, and the floor and background are moved. A computer analyzes your balance function and reaction to the changes.

Rotation Chair Test - Patient is put in a round room in a special chair. You may be asked to look at a light, while in the dark. The chair is rotated and the patient’s reaction is measured.

ECOG - short for electrocochleaography. This tests checks for excess pressure within the cochlea (hearing organ). The patient lies on a table, an electrode is hooked to the ear drum. The patient then listens to a series of clicking noise. It is relatively painless.

Hearing Tests - Since hearing loss is very common with Meniere’s, this may be a good way to diagnose, especially if hearing is lost in the affected ear.

There are a variety of treatments for Meniere’s. Some work for some people, but none work for all people. Here are the major ones;

1. Lifestyle changes
a. reduce salt intake
b. reduce caffeine intake
c. stop smoking
d. avoid any foods that may trigger symptoms
e. eat a well balanced diet, exercise, avoid stress, and rest properly

2. Medicines
a. Diuretics (water pills), to help reduce fluid build up. Dyazide is a common drug used.

b. Central Nervous System sedatives
Benzodiazepenes ( Valium, Klonopin, Ativan, Xanax, Tranxene, etc.) Used as a Central Nervous System sedative to help dizziness symptoms. A relatively low dose is all that is needed for them to be effective. One must be careful about developing a drug tolerance and dependency, if taking moderate or high doses.
There are other CNS sedatives like Benadryl and even Magnesium supplements. Results vary.

c. Allergy treatments - Some people are helped, possibly due to an allergy response. Antihistamines, allergy testing and treatments (like injections) may help some people.

d. Anti-dizziness medications - Antivert (Meclizine) and Dramamine, seem to help most with nausea, rather than dizziness. They seem to be more effective for sea sickness, as is the Scopolamine patch (worn behind the ear). However, some people are helped substantially, depending on the case.

e. Vasodilators (drugs that relax or dilate blood vessels) It is thought that increasing blood flow to the inner ear may help certain individuals. Drugs like Ethatab, Pavabid, niacin, Gingko would fall in this category.
Jan 02, 2002 UpDate
Recently (Thanks to Carrie)there has been news about a promising vasodilator herb called Vinpocetine. Click here for some more info.

f. SERC (Betahistine) This drug is supposed to increase inner ear circulation, by means of a histamine action. Results vary. SERC is not approved for use in the US by the FDA, after many years of use in other countries. Feb 16, 2001 UpDate
One can get SERC in a special prescription called a "compunded one". This is where a doctor makes a special request to a pharmacy. For further information see Bob's SERC Page.
I also have been informed recently that at least one doctor is using histamine injections to help Meniere's patients. There is an article in the Indiana Gazette. Many thanks to Bobbi in Kentucky for sending me this article, and to Carolyn for her SERC info.

g. Vertigoheel (Cocculus Compositum) This medication is supposed to help dizziness and related symptoms by stimulating the Central Nervous System. Poison hemlock is one of the ingredients. It has been FDA approved for dizziness treatment

h. Immune system suppressants - If the problem is an autoimmune response, many people are helped with oral steroids(Prednisone), or injections directly into the middle ear, soaking into the inner ear (Dexamethasone).

i. Antiemetics - Drugs specifically for nausea, associated with dizziness. Some people use things like Compazine or even Ginger.

j. Antidepressants, (Elavil, Prozac, Zoloft), antidepressants may help the patient cope, and in some cases help the vertigo symptoms.

k. Bioflavionoid A lot of people claim some relief with certain supplements. In particular, one called Lipoflavinoid or Cholinoid® Capsules. You can read about it at WebMD and also at Clinical Phramacology Online

Shunt surgery - The shunt surgery is done to decompress the fluid system. This helps to release the excess pressure or fluid within the system. Most shunts last from 2 to 4 years. There may be exceptions. I believe that the body’s ability to heal itself eventually causes the shunts to fail. In most shunt surgeries, a mastoidectomy is done. This is an incision behind the ear, through the mastoid bone. The fluid system is then punctured and a tube is usually inserted. In some cases the tube may run into the subarachanoid (spinal) area.
I believe that most shunt surgeries are done to relieve dizziness, and prevent further damage to the inner ear systems, without any destructive procedures.

Vestibular Nerve Section - During this surgery, the balance nerve is severed from the brain. This eliminates dizziness and balance function in the affected ear. If the other ear is good, then within a few weeks, it’s balance system will eventually take over balance. This operation is a cure, if the other ear is good. It also preserves hearing. Like all operations there are risks. This operation is classified as brain surgery.

Labrynthectomy - This operation is basically, removing the inner ear. Since it also destroys hearing, it is only done when there is little or no hearing left in the affected ear. This operation is also a cure, provided the other side is not affected. Eventually the balance system from the other side is supposed to take over balance.

Gentamicin - A strong antibiotic that is toxic to the balance system is injected into the ear, through the ear drum. Most times it is a series of injections. Results vary with this procedure. The desired effect is to disable the balance system on one side, without surgery.

DMZ - Dexamethasone, a steroid, is injected into the ear. This procedure is for people with an autoimmune response. The desired effect is to suppress the immune system, from attacking the inner ear. The direct injection is supposed to have less effect on the entire immune system(systemic)and more localized to the inner ear.As with all Meniere’s treatments, results vary.

Physical Therapy - Helps some people to cope and live with a not so perfect balance system.

Eply maneuver - This therapy seems to work better with BPPV ( benign positional proximity vertigo). That is dizziness without actual Meniere’s disease, in most cases. The head and neck are manipulated, in certain positions.

Chiropractic, acupuncture, homeopathic - Results with these things vary also. It really depends on the patient and situation.

Psychological - Some people find they need additional counseling to cope with Meniere’s and it’s problems. In some cases, a psychologist or psychiatrist is recommended.

Support Groups - Many people find comfort talking to and relating to people with the same problems. In many cases, the patients friends, co-workers, and even family, may not believe that there is anything wrong with them. Support groups may be actual meetings or Internet.

Prognosis for Meniere’s is very difficult to predict, because it can affect people so differently. There is the possibility of being disabled, due to balance system damage. Deafness is also a real possibility. Certain procedures can be a cure, under the right conditions. It is also possible, that a person can live with Meniere’s and still function normally.
As a webmaster with a Meniere’s website, I encounter many people that are not sure what to do. The symptoms can be very frightful. Seeing a specialist and knowing about your condition, is very important in learning to deal with it. I suggest a neurotolgist, if possible. It is also very helpful to talk to people that know what you are going through.
Meniere’s in itself is not a fatal condition. Things could be much much worse. Knowing this and understanding your limitations may go a long ways in coping, and living a happy and productive life.

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