Alternative names: Vertigo Disease, Endolymphatic Hydrops.
Thousands of people suffer from this troublesome disease that affects the inner ear. Major symptoms include constant ringing in the ears and vertigo (dizziness). The disease is caused by overproduction of fluid in the inner ear but the reason for this is not understood. Theories include food allergies and spasms of the blood vessels, and problems with the immune system.
Meniere's disease affects about 8% of close relatives of those affected, but only 0.1% of the general population. The disease affects one ear in 85% of patients and both ears in 15%.
Meniere's disease is caused by excess fluid in the inner ear (labyrinth) which contains the balance (vestibular) system. The labyrinth contains a complex system of canals and chambers, near to which is a thin-walled membranous sac that is filled with a fluid called endolymph and surrounded by another fluid called perilymph. These two fluids bathe the vestibular and hearing organs and enable a person to maintain their balance and normal hearing.
In cases of Meniere's disease, there is too much endolymph and pressure inside the sac increases until it bursts. The subsequent mixing of endolymph and perilymph sends confusing messages down the vestibular nerve to the brain, resulting in severe spinning vertigo, nausea, hearing loss, tinnitus, and a feeling of fullness in the ear.
As well as the causes listed below, excess inner ear fluid can be caused by Autonomic Nervous System (ANS) imbalances, blockage of or damage to the endolymphatic structures, viral infection.
Meniere's disease has been treated with antihistamines, motion sickness drugs, anti-dizziness drugs, diuretics, and vasodilators with very little relief of symptoms. Patients often end up in surgery to get relief. It is common to have remissions and exacerbations of the symptoms; Meniere's Disease treatment severely challenges doctors.
Although the precise cause of Meniere's disease is unknown, there are various known triggers of vertigo: stress, allergies, excess salt intake, caffeine, and migraine headaches and barometric changes in pressure.
Following a proper diet is important. Some 80% of patients with Meniere's Disease can have their vertigo controlled if they follow a strict diet and take a daily water pill (or diuretic). Patients should avoid foods that trigger attacks or exacerbate the disease; they should also maintain proper dietary salt intake. Sodium and potassium are essential for the proper function of nerve cells in the brain and inner ear, but too much sodium can make the inner ear more sensitive or reactive, and thus more susceptible to an attack of Meniere's Disease.
Caffeine, tea and chocolate contain compounds that are believed to constrict blood vessels in the brain and inner ear; decreased blood flow in the inner ear is believed to interfere with endolymph absorption, resulting in endolymph buildup and the symptoms of Meniere's Disease.
As the disease progresses, hearing loss increases and the patient's confidence plummets as these attacks are frustratingly unpredictable. In 50% of cases, the attacks will subside within two years; in 70% of cases, they will disappear within eight years.
Circulatory irregularities can cause excess fluid in the inner ear.
Several studies demonstrate a strong link between food allergies and Meniere's Disease.
Several studies have found a strong connection between inhalant allergies and Meniere's Disease.
Among individuals with Meniere's disease who replaced refined carbohydrates in their diet with high-fiber, complex carbohydrates, tinnitus frequently improved or disappeared. [Hyperlipoproteinemia, hyperinsulinism, and Meniere's disease. South Med J 1981;74: pp.1194-7]
The active ingredient in alcoholic drinks is ethyl alcohol, which is rapidly absorbed into the blood. Once it reaches the brain and inner ear, it dissolves into the inner ear membrane and makes it 'leaky', allowing various minerals and salts to pass in or out, possibly triggering an attack of Meniere's Disease. Ethanol can also interfere with the metabolism of drugs used to treat Meniere's Disease, causing harmful levels to build up. Chronic alcohol use can also permanently injure the brain, eyes, and peripheral nerves, all of which are necessary for proper balance.
While originally developed to treat allergy symptoms, most Meniere's disease patients are now prescribed antihistamines to treat vertigo. Antihistamines are believed to suppress vertigo symptoms by blocking certain chemical pathways in the brain. However, not all antihistamines are effective in suppressing vertigo: Antihistamines that do not have a sedative effect do not cross the blood-brain barrier and, therefore, cannot penetrate the inner ear or balance centers enough to be helpful.
Nicotine can affect the brain and inner ear by stimulating nerve cell receptors that constrict blood vessels, thereby triggering nausea and vomiting. Smoking can also block the effects of certain drugs that are used to treat Meniere's Disease, and injure parts of the inner ear.
Histamine diphosphate therapy at 2.75mg in 500cc of 5% dextrose solution given in a slow intravenous infusion can relieve an episode of severe dizziness and nausea due to Meniere's disease. Periodic infusions can lengthen the interval between these episodes. At the University of Maryland Medical System's Looper Clinic, this therapy is performed on 4 to 6 patients each week. ["IV Histamine for Meniere's", Guyther, J. Roy, M.D., Cortlandt Forum, May 1994;78 75-8]
If medical treatments fails to stop vertigo, hearing loss, ringing in the ear and pressure in the ear then there are several surgical options that may improve the condition. The original surgical treatment (in the sixties) was total destruction of the inner ear which, though effective in almost all cases, resulted in total hearing loss (!) A second surgical option was introduced in the 1970s which cut the balance nerve to the brain, preserving hearing and relieving vertigo in 95% of cases. However, because the procedure involves operating near to the brain, it is reserved for the most serious cases.
All Meniere's disease patients should be skin-tested for inhalant and food allergies. Around 50% are found to have allergies that can be treated through injections.
B6 supplementation may be effective in vertigo, including Meniere's syndrome. One study found that 15 of 47 patients with Meniere's disease who had failed to respond to previous treatments improved with B6 (pyridoxine). Three patients failed to improve and others gradually improved but it was uncertain whether pyridoxine supplementation was responsible. Furthermore, 23 patients with vertigo due to unknown causes received pyridoxine and many of them responded. Intravenous administration relieved symptoms more rapidly than oral administration [Lewy A., Fox N. Clinical notes; New instruments and techniques: pyridoxine (B6) used in the treatment of vertigo. Arch Otolaryngol November, 1947, pp.681- 3]
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