 
| |
Meniere's Syndrome / Meniere's Disease / Endolymphatic
Hydrops
See E-Medicine Chapters on Meniere's written by Dr. Li
Medical
Treatment / Surgical
Treatment
What is Meniere's syndrome? Meniere's syndrome and
endolymphatic hydrops both refer to a condition of excess pressure accumulation
in the inner ear. Symptoms include:
 | Fluctuating hearing loss (hearing that is good sometimes
and bad sometimes)
| Occasional vertigo (usually a spinning sensation,
sometimes violent)
| Tinnitus or ringing in the ears (usually low tone roaring)
| Aural fullness (pressure sensation in the ears) |
| | |
What causes it? What is Happening? Presumably, there
are two fluids that fill the chambers of the inner ear. Too much pressure from
these fluids will stretch these nerve-filled membranes and may cause hearing
disturbance, ringing in the ears, vertigo, imbalance and a pressure sensation in
the ear. Inner ear inflammation or infection: Autoimmune disease, (Lupus,
Rheumatoid dz), Syphilis, Allergy, High Cholesterol or Triglyceride in the blood
stream, Thyroid hormone disease Diabetes.
How is it diagnosed? Many test may be required.
| Hearing test: to document the patient's present hearing
acuity and subsequent fluctuations. Sometimes the patient does not notice a
loss in the high frequencies.
| Blood tests: "EAR-LABS". To rule out obvious
salt/sugar chemical imbalances, infections, hormonal problems. Allergy
testing: This is usually done by blood test initially, and the confirmed by
skin testing.
| ENG: Test of the inner ear functions - particularly the
semicircular canals. The ENG measures their response to warm and cold water.
The test should be done on an empty stomach, and after discontinuing
Antivert, antihistamines and sedatives for two weeks (these drugs may alter
the results of the test). It may make the patient somewhat dizzy or
nauseated. The test tells whether the inner ears are weak.
| ECOG: A test specific for distortion of the
nerve-containing membranes of the inner ear, presumably due to pressure
fluctuations of the perilymph. It is most accurate when Meniere's is active.
| ABR: A test to see if there is anything that slows the
transmission of sound impulses to the brain along the hearing nerve.
| MRI Scan - Brain scan that looks for abnormal masses or
abnormal anatomy. Please note tumors are rarely found but very important to
rule out. |
| | | | |
How is it treated? Treatment Strategy Depends on :
| Severity of Symptoms Hearing Balance function
| Ability to identify affected ear
| Age / Medical condition
| Type of employment Roofer vs. desk job personnel
| Dietary Management i.e. Avoid: foods with high sodium
content. foods with high cholesterol or triglyceride content foods with high
carbohydrate content chocolate, excessive sweets-candy, etc. caffeine and
tobacco |
| | | |
| Medical Treatment of Symptoms The goal of these
medications are to mask the vertigo. Antivert: 1 tablet every 8 hours or as
needed. Droperidol: 1-2 drops under the tongue. Compazine: 1 rectal
suppository for nausea (use when too sick for pills) Medical Treatment of
Pressure Build Up Dyazide: l "water pill" a day in the mornings.
Neptazane: glaucoma drug 50-100 mg 3 times a day. Steroids: Taper as
directed |
Surgical Treatment:
| Dexamethasone Perfusion: It would seem to make
sense that if oral steroids work, they may work even better through the
inner ear. This is done via the same method as Streptomycin Perfusion
but using steroids instead. |
| Streptomycin Perfusion: An antibiotic that
specifically affects the balance nerve is placed through a small
puncture in the eardrum. A small amount is also given intravenously.
This antibiotic essentially deadens the balance nerve and usually (90%)
spares the hearing. Success has been reported to be about 90% although
relapses are possible. |
| Endolymphatic Sac Decompression: Decreases the
pressure build up of the endolymph by removing bone that encases the
endolymph reservoir sac. This allows the sac to expand more freely and
allows the pressure to dissipate. This has approximately a 65-80% chance of
(1) controlling vertigo (2) stabilising hearing acuity. It is a relatively
low risk procedure that can preserve hearing. |
| Vestibular Nerve Section: For patients with useful
hearing in both ears, cutting the diseased balance nerve can often cure the
symptoms. This has the advantage of a high cure rate (about 95 %) and can
preserve hearing in the operated ear. The surgery involves both an otologist
and a neurosurgeon and is more complex than the endolymphatic sac
decompression.
| Labyrinthectomy: Has the advantage of a high cure
rate, (greater than 95 %) and is useful in the patient whose hearing on the
affected side has already been destroyed by Meniere's. It involves removal
of the diseased inner ear organs but does not require entry into the cranial
cavity and is thus less complex than the vestibular nerve section. |
|
Other Options
| Vestibular Rehabilitation Balance retraining is
important for many reasons. Improved preparedness for impending attacks.
Improved tolerances of attacks Overcoming damage to the inner ear system
after attacks.
| Electrical Stimulation for Meniere's A certain
subset of tinnitus patients have Meniere's syndrome. These patients, in a on
going study done by Dr. Li, have shown a tremendous amount of success in
reducing: Tinnitus, Aural fullness, and Vertigo with interesting improvement
rates! |
| Meniett Device |
|
|
