MENIERE'S SYNDROME FAQ

Question 1: Is is true that Ménière's disease tends to "burn" itself out. Does something change that tends to stop the vertigo attacks from happening as often?

Answer 1: In patients who chose not to undergo surgical treatments, it was found that over 50% reported complete control of vertigo at two years after the onset of symptoms. 71% of these patients reported complete control of vertigo after 8 years. Thus, it is true that for most patients the attacks of vertigo will subside with time. The term "burn-out" is appropriate as this reduction in vertigo is not due to a recovery of the balance system. Rather it is because the balance portion of the inner ear becomes irreversibly damaged, so that it no longer functions. This "natural" time course of events makes the evaluation of clinical treatments extremely difficult. The estimated benefit of any given procedure or treatment must take into account the likely decline of vertigo with time.

Question 2: In my case the acute vertigo attacks seem to have stopped, but the fullness, tinnitus and loss of hearing persist. Will these symptoms subside in the future?

Answer 2: Your description describes the usual progression of Meniere's. Although the attacks of vertigo may decline with time, the hearing loss and tinnitus generally persist.

Question 3: I have been recently diagnosed as having Menieres disease. One of the things that my doctor recommended was for me to lower my intake of salt. He said it, along with caffeine, cigarette smoke, and alcohol, only worsens the situation. As, cutting salt out of my diet seems to be one of my biggest challeges, where can I find a listing of foods, main courses, snacks, drinks, etc., that are low in salt?

Answer 3: Reduction of salt intake is widely recommended for patients with Meniere's disease. We have now added a Web page to help you achieve a low-salt diet.

Question 4: I have heard Meniere's referred to as "glaucoma of the ear". Is it equivalent and can treatments used for glaucoma be used to treat Meniere's?

Answer 4: Meniere's disease is absolutely not equivalent to glaucoma of the eye. Endolymph has a totally different composition to the fluid in the anterior chamber of the eye and is maintained by completely different mechanisms. In addition, glaucoma is usually associated with high pressure in the eye, which may impair blood flow to the retina. Endolymphatic hydrops develops without any increase in endolymph or perilymph pressures, so there is no pressure-induced disturbance of cochlear blood flow. Comparing Meniere's with glaucoma is like comparing roast beef and apple pie.

Question 5: Has anybody come across a procedure called a cochleosacculotomy? In this procedure, a small curette or wire loop is used to reach into the vestibule of the inner ear and remove the fluid-filled saccule. An investigator at the Massachusetts Eye and Ear Institute in Boston has found that this operation relieves symptoms of vertigo.

Answer 5: This procedure was championed by the former Chief at Massachusetts Eye and Ear, Harold Schuknecht, M.D.. Dr. Schuknecht is now retired, but he has made many major contributions to otology, and is one of the "stars" in the otology firmament. Others have been consistently unable to achieve his good results with this procedure, and it is only rarely performed now.

Surgical treatment for Meniere's Disease is controversial (as is medical treatment). Destructive surgery is generally felt to be highly effective in relieving vertigo. Labyrinthectomy is a procedure which has been around for 30 years: the inner ear is 'disconnected'. Result: no hearing, less tinnitus, less fullness, virtually no vertigo (>98% success rate). The down side is that this surgery PRODUCES TOTAL, PERMANENT DEAFNESS IN THE OPERATED EAR It is performed only on those patients with no useable hearing to begin with. Also, the patient is forced to rely on the health of the balance system in the opposite ear. If Meniere's should develop in the only connected ear, symptoms can be much worse than before labyrinthectomy.

Question 6: I was diagnosed with Meniere's Disease and my doctor has put me on Niacin. I have yet to find any information on this as a treatment for the Meniere's symptoms.

Answer 6: In a search of the MEDLINE database for papers in the last 5 years for the words "Meniere's" and "niacin", there were no citations which included both words. In a recent symposium on Meniere's disease the use of niacin as a treatment was never mentioned. From this we would conclude that niacin therapy is not widely used to treat Meniere's. Niacin (nicotinic acid) lowers the level of lipids circulating in the blood. LDL-cholesterol is reduced and HDL-cholesterol is increased. If tests show abnormal blood lipids, niacin may be used to treat this, rather than being directed at Meniere's disease itself.

Question 7: I have Menieres in my right ear. What are the chances of getting it in the left ear also?

Answer 7: The figure usually quoted is that about 20-25 % of patients will eventually be affected by Meniere's disease in both ears. The good news is that means you have a 75-80% chance of it NOT affecting the other ear. In addition, it may be many years before the second ear is affected.

Question 8: What is the likelihood that scuba diving or flying brings on a vertigo attack?

Answer 8: During scuba diving and flying it is possible your entire body will be exposed to larger-than-normal pressure fluctuations. There is no reason why these changes should affect the endolymphatic compartment of your inner ear, since the pressures in your head routinely vary with posture, sneezing, lifting objects, etc.Some Meniere's patients are uncomfortable flying because they may become nauseous. However, this is an incredibly complex issue and involves more factors than pressure alone. Both flying and diving may also be associated with increased vestibular stimulation (if you are looking around under water) and, depending on the individual, may involve considerable stress as well. Any one of these could represent an increased "risk factor" and may increase the probability of an attack. On the other hand, many Meniere's sufferers fly and some scuba dive without problems. One notable Meniere's sufferer, Alan Shephard, flew to the moon and back. The conclusion is that it depends on the individual, how much they really want to dive or fly and how severe their symptoms typically are. A doctor cannot tell you that all will be fine because of the resulting law-suit if you are not. It is up to you to establish your own limits depending on your outlook to life. It may seem OK for a doctor to say "go for it, have fun!", but only you know the characteristics of your symptoms. If you do decide to try then common sense would suggest that you start shallow, for a short period and have a buddy to assist in the event of problems.. If all is fine, increase the duration and then increase the depth according to how you feel. If excessive concern over having an attack makes your dive stressful, then you may want to find another pastime. On the other hand, maybe the fish and the coral will take your mind off your ears.

Question 9: I was diagnosed with Meniere's syndrome some 3 years ago (though I've had the symptoms longer). In my case, there seems to be a distinct correlation between severity and frequency of the symptoms and levels of stress. Is this a common observation?

Answer 9: The correlation of Meniere's symptoms and stress is commonly reported although I am not aware of any scientific studies which directly address this. It is often the case that Meniere's sufferers are "type A" personalities (easily stressed, self-motivated over-achievers). Stress is known to have profound effects on the body, changing levels of some of the fluid control hormones (adrenal steroids). However, the link between stress and Meniere's symptoms is a long way from being proven scientifically. If you think stress is a major factor causing Meniere's symptoms, then this should be treated with an "anxiolytic" (anxiety-reducing drug) such as a benzodiazapine (Diazepam:valium). These agents may reduce the subjective effects of symptoms or may, by reducing stress hormone levels, possibly reduce the problem in the inner ear. Anxiolytics may be especially helpful since Meniere's disease itself provides a major stress to the individual, which by "positive feedback" may make symptoms worse.

Question 10: Can you provide any information about how likely is it that a recently-diagnosed sufferer is to be able to lead a mostly-normal life?

Answer 10: Meniere's disease is tremendously variable. Some patients may find their symptoms can be brought under control just by careful dietary control, in which case they may not appear in the physicians office again for a long period. At the other extreme, others have incapacitating attacks which have to be brought under control by more agressive therapy before a normal life can continue. Treatments are established on a case by case basis, depending on the patients symptoms, the patients attitude (whether they want conservative or aggressive therapy) and the physicians experience with the wide range of therapies available. Most physicians start with dietary manipulation (low salt) and diuretics, then step through more aggressive therapies as required. The goal, of course, is to set the therapy at a level which allows the patient to lead a mostly normal life. Until there is a "cure" for Meniere's, the physicians role is to reduce the severity of symptoms so that a normal or near-normal lifestyle can continue.

Question 11: 8 years ago I was diagnosed as having unilateral Meniere's affecting my left ear. My doctor performed a vestibular nerve section to control the attacks. Recently I have been told that it has progressed to my right ear. The new doctor I am seeing has told me that there really is nothing they can do for this ear. Medication did not control the first attacks I had before my first surgery and they have put me on the same types of medication this time. Can they do a second nerve section on my right ear or would this interfere with my balance.My new physician is telling me that he does not know anyone that would perform a second nerve section?

Answer 11: You are correct, doctors are reluctant to cut off balance information from the second ear by performing a second nerve section. The reason is that the balance system plays an important role in how your eyes stay focussed on an object. If someone looks at an object and rotates their head side-to-side, the object will stay clearly in focus. This is because the balance system is telling the eyes how much the head has rotated, allowing the eyes to be adjusted exactly to keep the image in the same place. If balance on one side is destroyed, the system will still work using balance information from the one good side. If both balance organs are destroyed, vision may then become blurred when head movements occur. Also, a condition called oscillopsia (a sensation that the visual field is oscillating back and forth) may develop. These problems will always be present (not just as periodic attacks) and may overall be a bigger problem than the vertigo attacks. As an alternative to nerve section surgery, some doctors administer intravenous streptomycin to suppress the balance system in the remaining ear. By titrating the dose, the goal is to suppress the vestibular attacks without totally destroying the entire balance system. The question of whether, and how, to ablate the second labyrinth is controversial, because the outcome for the patient is often not good.

Question 12: Have you ever heard of any correlation between barometric pressure and the onset of vertigo attacks? I have noticed that during days where the air is "heavy" I tend to have more symptoms. I also recently spent a vacation up in the mountains and I was miserable the whole time. I was at a high altitude and it was an extremely humid week in the summer.

Answer 12: Yes, I have heard many patients report that slow pressure changes can make symptoms worse, whether it is from driving up a mountain, the passing of a weather front or those occurring during flying. As yet there is no scientific explanation of this phenomenon. It could be that the ear with Meniere's cannot compensate for pressure changes as well as a normal ear in some way. However, since the inner ear is fluid-filled, and fluids are incompressible, there is no reason why atmospheric pressure changes should change the degree of endolymphatic hydrops (thought to be related to the symptoms). On the other hand, there are also other pressure-sensitive systems in the body involved in the maintenance of normal blood volume. These systems operate by releasing hormones which affect kidney function, which release or retain fluid thereby regulating the overall blood volume. It is possible that the ear is sensitive to either the blood electrolyte changes generated by the kidneys or directly to the hormone itself in some way that increases the liklihood of symptoms. In our current research projects, we are investigating how slow pressure changes affect the ear and how some of the fluid-balance hormones affect the ear. Maybe this work will lead to an explanation for your observations, and perhaps an appropriate treatment to relieve them.