Meniere’s Disease

Meniere’s disease is a symptom complex that includes fluctuating hearing loss, tinnitus (ringing or buzzing in the ear), fullness in the ear, and dizziness. The typical episodes of dizziness that the affected individual experiences is where the environment or the individual themselves feel as though they are moving when they are not. The usual duration is several hours.

The site of origin of this disorder is the inner ear. It is felt that Meniere’s disease is a disorder that arises secondary to the presence of excessive fluid within the inner ear.

The left diagram shows the Inner ear with a normal amount of fluid. The inner ear on the right is swollen with excessive amount of fluid as seen In Meniere’s disease.

This causes a displacement of the usual margins of the inner ear producing disturbances such as changes in hearing and balance. The attacks can be triggered by a variety of occurrences such as exposure to things one is allergic to, stress, atmospheric pressure changes, etc. Occuring predominantly in middle age, the adage “the only thing predictable about Meniere’s disease is its unpredictable course” certainly applies.

Treatment for Meniere’s disease

The treatment of Meniere’s disease begins with modifications of diet. As Meniere’s disease is thought to occur as a result of a fluid overload within the inner ear, a diet that has reduced salt content is beneficial. Individuals are also asked to minimize alcohol, tobacco, and caffeine intake. Often, individuals are also prescribed a diuretic ( a water pill) to facilitate the removal of water not just from the inner ear but from the body itself. This is successful for the majority of affected individuals.

When lifestyle and medications do not successfully control the symptoms of Meniere’s disease, a “treatment ladder” approach is used. Depending on the circumstance of the individual that has failed medical therapy, additional treatment options are available, primarily surgical. Our typical treatment ladder for the individual in whom medical therapy was not successful would lead to the consideration of surgery to decompress and shunt the fluid containing portion of the inner ear (endolymphatic shunt surgery).

Other options exist including the injection of gentamicin into the middle ear through the eardrum. This places gentamicin, a substance that preferentially neutralizes the balance center in that particular inner ear, near a point where it can diffuse into the inner ear. The Meniett device also exists where, after a pressure equilization tube is placed through the eardrum introduces positive pressure air through the ear drum and to the inner ear “milking” the inner ear fluid away from the areas involved in balance and hearing.

Further up on the treatment ladder for Meniere’s disease are the surgical procedures to cut the balance nerve to the inner ear and the surgical procedure to completely remove the inner ear where hearing is no longer present.