Meniere's disease is a disorder caused by increased fluid pressure in the inner ear. The fluid chamber of the inner ear that has increased pressure is called the endolymphatic chamber and therefore the disease is also known as endolymphatic hydrops (increased fluid pressure in the endolymphic chamber). The exact cause of the disease is unknown, though genetic and environmental causes are thought to contribute to its development.
There are 4 main symptoms associated with Meniere's disease. These are: episodic vertigo (spinning dizziness), tinnitus (roaring or ringing in the ears [usually just one ear]), fluctuating hearing loss, and pressure sensation in the ear. An episode of Meniere's usually starts with a pressure sensation in the ear with increasing roaring sound in the ear and hearing loss and a sudden attack of vertigo. The vertigo generally lasts at least 30 minutes and may last up to or greater than 24 hours. Once the vertigo stops, the patients generally experience some imbalance which takes days to weeks to resolve. The hearing generally returns, but over time, the hearing and balance function are lost with each attack of the vertigo. Some patients may just have fluctuating hearing loss without vertigo or episodic vertigo without hearing loss. These are termed cochlear hydrops and vestibular hydrops respectively.
There are some known triggers of a Meniere's attack, which include, high salt foods, too much caffeine, drinking alcohol, and stress. While the triggers differ between patients, the above 4 triggers are found most commonly.
Approximately 60% of patients with Meniere's disease stop having attacks after a few years (also called the disease burning out). The rest continue to have problems. Of these, a high percentage (60%-80%) are controlled with a very strict control of their diet and lifestyle changes and sometimes medications. The strict diet includes limiting your diet to a daily sodium of 1500 mg, eliminating all caffeine (not even decaf coffee, which has caffeine), and no alcohol. The lifestyle change includes reduction of stress by biofeedback, meditation, yoga, daily exercise, etc.
Some people (20%-30%) may develop the disease in the other ear after a few years. A small percentage of the patients will continue to have episodes which may occur every day to once a few months or years. When despite maximal medical therapy and lifestyle changes the patients continue to have frequent episodes of Meniere's disease and the disease is affecting their daily life, then surgery is considered for treatment.
The treatment of Meniere's disease follows a stepwise fashion from diet and stress control to medical treatment to surgical treatment. The dietary/lifestyle changes for treating Meniere's Disease are discussed above. The next step is taking medications which are believed to decrease the inner ear fluid pressure. The medicines that cause reduction of fluid pressure in the inner ear also make you lose extra water from the kidneys. These medications, called diuretics, include Dyazide, methazolamide, furosemide, among others.
For controlling the dizziness or imbalance, medications such as meclizine (Antivert), Robinul, scopolamine patches, among others is used. These medications decrease the abnormal signal that the diseased inner ear sends the brain.
Other treatments include the use of the Meniett Device. The Meniett device is a device that is used after placing a small tube in the ear drum. It is used in the ear 3 times a day for 5 minutes each time. It is successful in controlling the symptoms in ~50% of patients. Unfortunately it is not always covered by health insurance companies and the cost is ~$3000.
The newest treatment for Meniere's disease is the placement of medications behind the ear drum. In a recent study, over 90% of patients with Meniere's disease were found to have significant control of their symptoms with intratympanic steroid (anti-inflammatory medications placed behind the ear drum). The injections (using dexamethasone or methylprednisolone [Solu Medrol]) are generally given after a local anesthetic in the office and are repeated every 2 to 4 weeks until the attacks stop. In our experience at UC Irvine, most patients with Meniere's undergoing intratympanic steroid treatment have only required 2-3 injections for full control of their symptoms. We recommend it for patients prior to doing any surgery or in those with a history suggestive of autoimmune Meniere's disease or those who are unable to take steroids by mouth.
These injections are different from gentamicin injections that cause destruction of the inner ear balance cells. We rarely use gentamicin injections in the ear for Meniere's disease due to the destruction of the inner ear it causes. Gentamicin injection is reserved for patients with end stage Meniere's disease with very little hearing or balance function.
Since starting intratympanic steroid therapy for Meniere's disease a few years ago, we have not needed to use any surgical treatment for patients suffering from Meniere's disease.