What is Meniere's disease?
It is a disease caused by increased fluid pressure in the inner ear, which is characterized by dizziness, nausea or vomiting, a feeling of fullness in one ear, buzzing and fluctuating hearing loss that lasts for hours.
How is the diagnosis made?
After evaluating the frequency, duration, severity and character of your attacks, a doctor will determine the duration of your hearing loss, whether it has changed, whether you have a tinnitus or a feeling of fullness, whether it is unilateral or bilateral. You may be asked if you have had syphilis, measles, or other serious infections in the past, if you have an eye infection, if you have an immune system disorder or allergy, or if you have had ear surgery in the past. You may also be asked about your general health, whether you have diabetes, blood pressure, high cholesterol, goiter, neurological or emotional problems. In some cases, tests for these problems can be done. Physical examination of the ear and other structures of the head and neck is normal except for attacks.
Audiometric examination, which is a hearing test, shows hearing loss in the affected ear. Speech discrimination in the affected ear (patient's inability to distinguish between similar words such as "go" and "bit") may be affected. ENG (electronystagmography) can be applied to evaluate balance function. This is done in a dark room. The recording electrodes are placed close to the eye. Wires from the electrodes are connected to a machine that looks like a heart monitor. Warm and cold water, or air, is gently applied to both ear canals. Since the eyes and ears work together thanks to the nervous system, the measurement of eye movements is used in the measurement of the balance system. About 50% of patients have decreased balance function in the affected ear. Other balance tests, such as the rotation test or the balance plane, may also be used to evaluate the balance system.
Other tests that may be applied:
Electrocochleography (EcoG) may show increased fluid pressure in the inner ear in some Meniere's patients. Auditory brainstem response (ABR) is a computerized test of the auditory nerve and brain pathways.
CT (computerized tomography) and MRI (magnetic resonance imaging) may be required to identify the tumor occurring on the auditory and balance nerve. These tumors are rare but cause symptoms similar to Meniere's.
What treatments will the doctor recommend?
Diet and treatment:
A low-salt diet and a diuretic (drug that removes water from the body) can reduce the frequency of attacks in Meniere's patients. In order to get the full effect of the diuretic, it is very important to limit salt and take your medication regularly as directed.
Avoid caffeine, cigarettes and alcohol! Get regular sleep and eat well. Be physically active but avoid unnecessary fatigue. In Meniere's disease, stress can cause dizziness and tinnitus. Stay away from stress.
If you become dizzy without warning, do not drive because failure in vehicle control can be dangerous to you and others. You may have to forego swimming, ladders, scaffolding for safety.
In the study we conducted in our clinic, it was observed that cortisone injection into the middle ear reduced the attacks and their severity. Our study is still continuing.
When is surgery recommended?
If the dizziness attacks cannot be controlled with conservative solutions and the attacks limit daily activities, one of the following surgical procedures may be recommended:
1) Endolymphatic shunt (evacuation of inner ear fluid) or decompression (reducing pressure) is an ear surgery that preserves hearing. In 1/2-1/3 of the cases, vertigo attacks are controlled. However, this control is not permanent in any patient. It takes less time compared to other processes.
2) Vestibular neurectomy is the process of cutting the balance nerve where it leaves the inner ear and enters the brain. The majority of vertigo attacks can be treated with this surgery, and hearing is preserved in most cases.
3) Labyrinthectomy and cutting of the auditory nerve: It is the destruction of hearing and balance mechanisms in the inner ear of one side. This method may be preferred if the affected ear of the Meniere's patient has very little hearing. Dizziness attacks are usually controlled.
Other surgeries and treatments may also be recommended in some cases. If surgical treatment is deemed necessary, you should discuss the risks and benefits with your surgeon. Although there is no cure for Meniere's disease, dizziness can be controlled in almost every case.