Introduction
Meniere's Disease is a disease which causes hearing and frequently balance symptoms. It is thought to be caused by fluid overload in the inner ear. The disease can begin with a variety of symptoms.
Symptoms
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 which are present will worsen during the course of an attack and may even resolve completely after the attack. The vertigo present during an attacks frequently last several hours while the entire episode last approximately 24 hours.
This 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 which develop bilateral disease varies and has been reported in the scientific literature to vary from 20-60 percent.
Pathophysiology
The inner ear in Meniere's patients has been shown to be the site of the problem. The inner ear is filled with fluid and separated into two compartments - the endolymphatic space and the perilymphatic space. Within the endolymphatic space the hearing and balance organs are found.
Disorders of the fluid in the endolymphatic space can disturb or destroy the function of the hair cells. The endolymphatic space in Meniere's is larger than normal indicating an excess water condition. Since water must always accompany salt in the body, it has been proposed that altered salt chemistry in the inner ear plays a major role in this disease. Control of salt intake therefore indirectly controls water in the inner ear and diminishes the burden of excess water on inner ear function.
Treatment
Control of dietary salt to a level of 1500 - 2000 mg sodium per day has been shown to effectively control most patients symptoms. The reason, as discussed above is because of it's 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 in specific.
This is a very mild diuretic but a banana or other food high in potassium should be taken two to three 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 effected ear a labyrinthectomy can be performed. These surgical procedures have varying effects on hearing and other factors related to the disease and the specifics will be discussed, if relevant, by Dr. Ator 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 which they can handle with minimal disruption to their lives.
Dr. Ator is at the Hearing and Balance Center of the University of Kansas, a multidisciplinary center presently being establish to further the clinical and scientific study of disorders of the hearing and balance systems.
Gregory A. Ator, M.D., FACS
Neurotology, Otology, and Skull Base Surgery
Disorders of Hearing, Balance, and the Facial Nerve