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Described by French ear specialist, Prosper Meniere, in 1861, Meniere's Disease is characterized by three symptoms:
Many
patients, however, do not develop the three typical symptoms of
Meniere's Disease at once, but may first suffer from attacks of
either hearing loss or vertigo. These patients usually go on to
develop the classic combination of symptoms months or years
later. There are
rarer variations of the disease, including one during which hearing
actually improves. Another variation is characterized by drop
attacks, during which patients suffer such sudden, intense vertigo
that they fall to the ground. The severity, frequency, and length
of Meniere's Disease attacks are extremely variable. Some people
experience several episodes a day while others have them only once
every several years. The other
variable in Meniere's Disease is its progression. Research has
revealed that about two thirds of all patients go into a
spontaneous remission. This means the disease disappears for an
extended period of months or years with or without treatment. The
disease may the flare up for several weeks or months and disappear
again. For most patients, though, the hearing in the
affected ear gradually deteriorates over a period of months to
years and is eventually lost. More than 15 to 20 percent of
patients develop the condition in both ears. However, it is unusual
for these patients to develop active Meniere's in both ears at the
same time. In fact, Meniere's Disease charts a slow,
intermittent course in most patients. It bothers them for weeks or
months and then disappears for extended periods. Only a minority of
patients have severe vertigo or rapid hearing loss. The inner ear is a complex series of chambers
within the base of the skull. These chambers are filled with fluid
and are further subdivided by thin membranes. Although the exact
cause of Meniere's Disease is uncertain, researchers believe that
it results from an imbalance in fluid pressures between the
different chambers. The composition of the fluid In the chambers
is quite different, and if one of the membranes bursts from unequal
pressure, fluid from the different compartments will mix. This
causes a breakdown of the hearing and balance systems, and
Meniere's symptoms result. Once the fluid drains and pressure is
restored, the leak in the membrane heals. Normal fluid composition
is restored and the balance and hearing functions gradually return
to normal. There are
several conditions which cause Meniere's like symptoms but have
known
causes and can be successfully treated. These conditions, called
Meniere's Syndrome, range from untreated syphilis to head injury.
In many cases, when the underlying conditions are treated, the
Meniere's symptoms disappear. There are
literally hundreds of causes of dizziness. It is not a condition.
but a symptom, and anyone who develops dizziness, should have his
or her balance system, hearing and blood tested to rule out any
treatable conditions. Medical Treatment Surgical Treatment The first
operation is called a labyrinthotomy or cochleo-sacculotomy. This
is a brief surgical procedure done using local anesthesia. During
the operation, an opening is made between two of the fluid chambers
of the inner ear to allow the pressure to equalize. About half the
patients who have this operation suffer some loss of high tone
hearing in the affected ear. From the first year after the
operation, however, 90% of them will be free of vertigo. Three
years after surgery, 70% are still free of vertigo. This is a very
effective procedure for patients with severe vertigo, who still
have useful hearing in the affected ear. The second operation is called a sac decompression. During this
two to three hour procedure, pressure is relieved in the sac where
the fluid of the inner ear drains into the spinal fluid space. This
helps inner ear fluid drain more easily, and prevents the high
pressure which researchers believe causes Meniere's. About two
thirds of the patients who have this surgery seem to get better and
the complication rate is extremely low. The third operation, called a vestibular
nerve section, has a high success rate but is the most complex.
During the procedure, the surgeon will cut the vestibular nerve,
which carries the balance signal from the inner ear to the brain.
The success rate for eliminating dizzy spells using this procedure
is about 95%. Because the balance nerve is cut, patients are
usually quite dizzy for a period of days or weeks following
surgery. Gradually, the balance system on the other side of the
head, compensates and the dizziness disappears. The fourth operation to control dizziness from Meniere's Disease
has a 98% success rate, but guarantees a total loss of hearing in
the affected ear. The procedure is called a labyrinthectomy and is
only for patients who have little or no hearing left in the
affected ear. During the procedure all of the membranes of the
inner ear are removed. Like patients who have undergone vestibular
nerve sections, labyrinthectomy patients are usually dizzy for a
period of days or weeks until the other side compensates. The
dizziness, however, is usually not as severe in labyrinthectomy
patients. In summary,
Meniere's Disease is a disorder of the inner ear which produces
episodes of vertigo and progressive nerve deafness. A thorough
examination by a qualified ear, nose and throat specialist is
needed to make the diagnosis and exclude other treatable or
dangerous causes of these symptoms. symptoms of Meniere's disease
tend to alternately flare up and then subside over the years. Those
infrequent cases with incapacitating vertigo can be relieved with a
variety of surgical procedures. We hope that this brochure has been helpful. If you have specific
questions which are
not answered here, please feel free to call the Infirmary's
General Ear, Nose, and
Throat Service at (617) 573-4101. Or, if you would like to
schedule an appointment for an examination by an Infirmary
otolaryngologist, a physician who specializes in the
medical and surgical treatment of the ear , nose, and throat,
please call our Physician
Referral Service at (617) 523-6334.
See also our online fact sheet on
meniere's
Meniere's Disease Progression
Do You Have Meniere's Disease?
Treatments for Meniere's Disease
There have
been a variety of medical measures proposed for treating Meniere's
Disease such as salt restricted diets and diuretics. Research has
revealed, however, that there is no benefit from those treatments
for any great length of time. There are medications available which
can temporarily relieve the dizziness associated with Meniere's
Disease. One commonly prescribed drug, meclizine, is similar to
Dramamine, a common over-the-counter drug taken for motion
sickness. Neither drug has a true effect on the balance center of
the brain, and does not stop the spinning. However, it sedates, the
patient and suppresses nausea. A drawback to this treatment is that
the pills take about 40 minutes to work, and by that time most
Meniere's attacks have subsided. Some patients can sense an attack
is coming, however, and can sometimes benefit from taking the
medication in advance.
There are a
variety of surgical treatments which have been proposed for
Meniere's Disease, but no treatment has ever been shown to preserve
hearing. Treatment is therefore directed toward control of vertigo,
which can be dangerous. There are four common operations for
Meniere's Disease. Each is directed toward the relief of dizziness,
but will not arrest progress of the disease or hearing loss in the
affected ear. Each operation has different levels of benefit and
risk. You and your physician will decide if surgical treatment is
best for you, and if so, which operation would help
most.
Additional Information
page updated: 9/16/05
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