Symptoms typically include fullness, pressure, ringing in the ears with accompanying vertigo. However, not all patients will begin with these symptoms and some may never have all of the symptoms. Typically the symptoms present will worsen during the course of an attack and may resolve completely after the attack. The vertigo present during an attack frequently lasts several hours while the entire episode lasts approximately 24 hours.
The disease frequently affects middle-aged females but can occur in other groups as well. It typically runs a course measured in years. The number of patients who develop bilateral disease varies and has been reported to vary from 20-60%.
Control of dietary salt to a level of 1500-2000 milligrams per day has been shown to effectively control most patients' symptoms. The reason is because of its effect on water balance in the inner ear. In patients with significant symptoms, a mild diuretic is also prescribed (Dyazide or generic equivalent). This further helps reduce water in the body in general and in the ear specifically.
This is a very mild diuretic, but a banana or other food high in potassium should be taken 2-3 times per week. Intake of caffeine and alcohol should be curtailed, at least initially, as well. If good control of symptoms is achieved, periodic hearing tests, used to follow the course of the disease, will show preservation of hearing in the affected ear.
In some cases, where control of dietary factors is not successful and symptoms require it, surgery is performed. There are several surgical options – endolymphatic sac (decompression and/or shunting) and vestibular nerve section. Endolymphatic sac procedures have about a 70-80% chance of control of vertigo and stabilization of hearing in appropriate patients and is relied on heavily in the management of this disease.
In patients with limited hearing in the affected ear, a labyrinthectomy can be performed. These surgical procedures have varying effects on hearing and other factors related to the disease. The specifics will be discussed, if relevant, as needed.
In summary, most patients on relatively simple dietary and medical therapy will find that they can tolerate the disease with few interruptions to their lifestyle. However, all patients are different and some will need further procedures to control the problem. Typically the great majority of patients find this a disease they can handle with minimal disruption to their lives.