Meniere’s Disease Treatment in Detroit, MI

Introduction and Symptomatology

John J. Zappia, MD
Michigan Ear Institute

In 1861, Prosper Meniere reported a condition with episodes of vertigo attacks, and the disorder has been associated with his name since then. Meniere’s disease is characterized by:

1. Hearing loss in one ear, usually fluctuating and more in lower frequencies.
2. Tinnitus (constant or intermittent), often increasing before or during vertigo attacks.
3. Vertigo attacks lasting minutes to hours, irregularly occurring with nausea and vomiting. A sense of fullness in the ear is also felt.

The hearing fluctuations often coincide with vertigo attacks, leaving patients tired and unstable for 1-3 days afterward. Diagnosis can be challenging because symptoms may not develop simultaneously, and some patients may not experience the full range of symptoms.

Meniere’s disease has variations like Meniere’s variant, vestibular Meniere’s, and cochlear Meniere’s, based on symptomatology. Endolymphatic hydrops is a more comprehensive term, acknowledging varying manifestations and severity.

The disease has unpredictable exacerbations and remissions. Over time, vertigo symptoms may decrease, and hearing loss stabilizes. Onset is typically in the 40s, but it can occur at any age, although it’s less common in children. There’s a risk of it affecting the other ear, often within 2-5 years of the first ear’s symptoms.

Pathogenesis

The inner ear has two fluid compartments: perilymph and endolymph. In Meniere’s disease, there’s excessive pressure and fluid in the endolymphatic space, but the exact cause is unknown. Special cells in the inner ear produce endolymph, which normally drains into cerebrospinal fluid through the endolymphatic duct and sac. The disorder may result from excess endolymph production or impaired drainage, leading to fluid buildup. Despite extensive research, the precise answer remains unknown.

Genetic and hereditary factors may contribute to Meniere’s disease, with a higher incidence among family members. Additionally, differences in the size and shape of inner ear structures, such as the endolymphatic sac and vestibular aqueduct, may play a role.

Testing

Diagnosing Meniere’s disease often relies on historical information and a physical examination, but additional tests can help confirm the diagnosis and rule out other disorders. Standard audiometric testing reveals characteristic hearing loss during aural symptoms. Basic and comprehensive balance tests like electronystagmography (ENG) are typically abnormal, indicating various irregularities.

Two specific tests for Meniere’s disease or endolymphatic hydrops include:

1. Glycerol dehydration test: The subject ingests glycerol or mannitol (dehydrating agents), and changes in symptoms and measurable hearing improvement are observed.
2. Electrocochleography (ECoG): This test records electrical information from the inner ear while presenting sound. Normal patients show a characteristic electrical response, but in Meniere’s disease, this response is altered.

These tests not only help establish the diagnosis but also distinguish Meniere’s disease from other potential disorders.

Treatment

The primary treatment for Meniere’s disease involves dietary changes and diuretics. Restricting salt intake reduces water retention in the body and inner ear. Stimulants like caffeine and nicotine can exacerbate symptoms, while diuretics like Dyazide, Lasix, and hydrochlorothiazide help eliminate excess salt from the inner ear. Various medications, including vasodilators, antihistamines, and steroids, have been explored.

Symptomatic relief includes medications like Antivert and Valium to reduce vertigo severity. Anti-emetics may help with nausea. In cases where vertigo is uncontrollable, antibiotics like gentamicin can weaken the inner ear, and surgical options become relevant.

Surgical interventions include:

1. Endolymphatic sac surgery: Effective for patients with active hearing fluctuations, it aims to reverse inner ear problems by decompressing or opening the endolymphatic sac.
2. Labyrinthectomy: Successful for those with poor hearing in the affected ear, it involves removing the entire inner ear to eliminate faulty balance function.
3. Vestibular neurectomy: Suitable when hearing is good, it involves cutting the vestibular nerve to preserve the inner ear but stop faulty balance signals from reaching the brain.

Meniere’s disease varies in severity and duration among individuals. Research is ongoing to better understand and address this complex disorder.