MEDICAL SURFARI: MENIERE'S DISEASE AFFECTS HEARING AND BALANCE

In 1861 a French physician, Prosper Meniere, first described an abnormality of the inner ear causing severe dizziness, a roaring or ringing sound in the ears, fluctuating hearing loss, and a sensation of fullness or pain in the affected ear. This condition now bears his name, but in medical terms it is referred to as endolymphatic hydrops.

The normal balance and hearing mechanism in the ears relies upon an intricately coiled maze of tubes within the bone at the base of the skull, just inside of the ear. This complex arrangement of tubes is filled with a fluid called endolymph that moves when your head moves, causing nerve receptors to send signals to the brain about your body's motion. An increase in endolymph may cause ballooning or expansion of part of this system, resulting in Meniere's disease.

The typical attack of Meniere's disease often begins by a sense of fullness or aching in one or both ears, and hearing may fluctuate with associated a ringing or roaring sound in the affected ear. The average attack lasts for about two to four hours and nearly always involves a feeling of severe spinning, imbalance, nausea and vomiting. These attacks can be very exhausting, requiring a considerable amount of rest afterwards. These attacks may cluster and occur many times over a short period, or they may be separated by long periods of time. Even years may pass between episodes. Between attacks, most people are free of symptoms, or they may only experience mild imbalance. About 75 percent of the cases involve only one ear, and the rest affect both ears. Although these attacks can be incapacitating, the disease is not fatal.

Physicians and scientists have investigated many possible causes. However, despite several theories, no specific cause for the disease has been found. Although there is no cure for Meniere's disease, there are several treatments that are often helpful in managing the uncomfortable symptoms of Meniere's disease. If you have such an attack, lie down on a firm surface and stay as motionless as possible, keeping your eyes open and fixed on a stationary object. Do not drink or sip fluids, as you may vomit. Stay in this position until the severe spinning passes, and then get up to move very slowly. If you are unable to take fluids, or if you have vomiting that lasts more than 24 hours, see your physician to prevent the effects of dehydration.

There are a variety of medical, behavioral and surgical therapies available to patients with Meniere's disease. Surgical solutions are generally only considered if this condition is reoccurring, and unresponsive to other measures. Some physicians recommend dietary modifications to relieve the frequency and intensity of attacks in some people. Eliminating caffeine, alcohol and salt, as well as tobacco, and taking measures to reduce stress levels may lessen the severity of the symptoms. Also, properly using medications to help control allergies may reduce fluid retention in the ear and lessen the symptoms of Meniere's disease.

Proper diagnosis of Meniere's disease requires an evaluation by your physician, and this will likely include hearing and balance tests, and possibly medical imaging. If you have experienced recurring attacks of symptoms that fit the description of Meniere's disease, be sure to see your family physician, or your ear nose, and throat specialist for relief.

World Wide Web Resources

The Vestibular Disorders Association

www.teleport.com/~veda/index.shtml

The Vestibular Disorders Association (VEDA) provides information and support to people suffering from inner-ear balance disorders, including Meniere's disease.

American Academy of Otolaryngology

www.netdoor.com/com/entinfo/menraao.html

This Web page provides a good overview of Meniere's disease, including symptoms, diagnosis and treatment options.

National Institute on Deafness and Other Communication Disorders

www.nih.gov/nidcd/meniere.htm

The National Institutes of Health sponsors this Web page, which provides basic information on Meniere's disease and also additional resources available for those interested.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63701.