Affecting men and women equally between the ages of 20 and 50 years old, Meniere's disease is a disorder of the inner ear that causes the following symptoms: Meniere's disease is caused by an overproduction of fluid within the inner ear. Excessive fluid pressure interferes
with the function of the hair cells located in that area. Sudden increases in pressure make the ear feel stopped up and cause vertigo. Most cases of Meniere's disease have no known cause. In some cases, it can be associated with head trauma or middle or inner ear infections. Allergies and autoimmune disorders may also bring about the onset of this condition. At Mount Sinai, our hearing and balance experts have been treating patients suffering from Meniere’s disease for more than 50
years. Our team has vast expertise with all forms of treatment, and we personalize each patient’s treatment plan. Diagnosis and Treatment for Meniere’s DiseaseAbnormal results of a caloric stimulation test of eye reflexes can indicate a sign of Meniere’s disease. An electrocochleography, MRI scan or electronystagmography (ENG) may also be recommended to decipher Meniere’s disease from other forms of vertigo. The vertigo associated with Meniere's disease can usually be controlled with medications and dietary changes. If those measures do not work, gentamicin injections might give lasting relief. Surgery is an option when other measures fail. Medications Medications that are effective for Meniere's disease include:
Low-salt Diet Cutting back on salt will help keep the inner ear fluid low and help prevent vertigo. For most patients, 2000 mg of sodium a day is the target value. When symptoms are severe, 1500 mg a day is advisable. A low-salt diet consists of: not adding salt to food, avoiding prepared foods, and tallying the sodium intake by reading food labels. Injection Therapy for Meniere’s Disease Gentamicin is an antibiotic that is toxic (poisonous) to the cells of the inner ear. By selectively targeting the specialized cells of the balance organ, gentamicin can reduce the incidence of vertigo while preserving hearing in the ear. The effect of gentamicin injections is permanent—once the balance function (or hearing) is lost in that ear it does not return. The medication is administered in the office. The injections are performed at monthly intervals until either dizziness, imbalance, or hearing loss occur. Most patients receive between one and three treatments, although the number may vary depending on the response. The results of Gentamicin are: relief of vertigo spells in 70 percent of patients, permanent hearing loss in 30 percent. Patients may also experience imbalance or unsteady gait. This is usually temporary, but may occasionally require treatment with physical therapy. Dexamethasone is a strong form of cortisone that can be injected into the inner ear. It is sometimes effective in treating severe Meniere’s disease, but the effect is not permanent. Surgical Procedures for Meniere's DiseaseIf the incidences of vertigo are not controlled by medications, surgery may be recommended. Surgical procedures can eliminate the frequent spells of vertigo that occur in Meniere's disease; however, no surgery has been found to improve the hearing loss. The decision about which operation depends on the patient's age and health, medical condition, and hearing status. Endolymphatic sac, or shunt, surgery strives to decompress the inner ear fluid by making an incision in the endolymphatic sac. The procedure is safe, and the recovery is usually quick. In our experience, endolympahtic sac surgery has a rate of cure of vertigo of about 70 percent and a risk of hearing loss of about 5 percent. Vestibular nerve section is a highly effective operation that relieves vertigo attacks while preserving the hearing. In this operation, the balance nerve is isolated under the microscope and cut. The operation provides excellent relief in most patients, with minimal side effects. Vestibular nerve section is performed through an incision behind the ear. The balance nerve is identified as it travels between the ear and the brain. Under the microscope, the balance fibers are separated from the hearing nerve fibers and are cut. Vestibular nerve section is very effective. More than 90% of patients will have complete relief of their vertigo. Hearing is preserved at the preoperative level about 80% of the time. Patients usually stay in hospital 2 to 3 days after surgery, and the balance usually recovers over 3 or 4 weeks. Labyrinthectomy is the operation with highest rate of cure of vertigo, but always causes a total loss of hearing in the operated ear. It is only recommended to patients who have very poor hearing. In this operation, the balance canals are destroyed and so the source of the vertigo is permanently removed. The recovery after surgery is similar to vestibular nerve section. |