Q: I am a 77-year-old man in reasonably good health. I walk three miles every day and keep myself active at home and volunteering for community activities. I’m 5’8” tall and weigh 162 pounds. I take Diovan, Pravastatin, an 81 mg aspirin each day, niacin daily and Lipo-Flavonoid.
In October 2009 my right ear began to have a stopped up feeling. That went on for two weeks. Then I had a severe bout of vertigo for one day. That cleared up and two weeks later I had another bout of vertigo. I went to an ENT doctor and he ran a hearing test and examined my ears and prescribed two weeks of prednisone, thinking I might have a virus. The pressure in the ear continued and I had slight attacks of dizziness but not so bad that I couldn’t function. I went back to the doctor and he did an MRI that was okay but he was stumped because I was too old to have Meniere’s!!! In the meantime he called up the symptoms on the internet and I fitted them perfectly.
I then went to my GP who recommended an older ENT. During all this I still had the pressure, reduced hearing, and mild bouts of dizziness. The new ENT ran the same tests, looked at my MRI and told me I did have Meniere’s. He put me on niacin three times a day and said if I wanted to try Lipoflavonoid, it might help. He wants me to experience the “flush” from the niacin to improve blood flow to my ear. I, of course, have tinnitus in both ears – have had for years.
I have joined an internet support group and assume there is no cure. Does this last forever or does it eventually go away, leaving impaired hearing behind and are there prescribed medicines to take?
A: Meniere’s is a disorder of the inner ear that causes periods of vertigo, tinnitus (ringing in the ears), and hearing loss. Those most susceptible are in their 40s and 50s, although the condition can occur to anyone of any age. Vertigo can occur without warning and last anywhere from 20 minutes to 24 hours. Most episodes begin with a period of fullness and ringing in the ear, followed by dizziness and an inability to hear as well as usual.
While the exact cause of Meniere’s is not well understood, it likely correlates with an abnormal volume or composition of fluid within the inner ear. The outside of the inner ear is comprised of bone, while the inner ear is passages referred to as a labrynth. The inside is a soft structure that contains endolymph, fluid that is lined with hair-like sensors that respond to movement of the fluid. The fluid contained therein must be of a specific volume and chemical composition. When the volume is excessive, Meniere’s symptoms present.
Diagnosis is made through a medical history, complete examination, and mostly by excluding other causes . A hearing test known as audiometry may be performed which will test the ability or inability to hear specific tones at different volume levels. There are a number of tests to assist a physician in making a correct diagnosis but because the symptoms that present can mimic numerous other conditions, an ENT (ear/nose/throat specialist) may choose to order a CT, MRI or testing of the hearing nerves that can detect the presence of a tumor or other abnormality disrupting the function of the auditory nerves.
There is no cure for Meniere’s; however, symptoms can be managed through motion sickness drugs such as Antivert or Valium, anti-nausea drugs such as promethazine designed to control nausea and vomiting during an attack, and Dyazide to reduce the amount of fluid within the body that may help regulate the volume of fluid in the inner ear. Beyond this testing and for those individuals that do not respond well to conventional drugs, a hearing aid in the affected ear may provide improvement and middle ear injections such as Gentamicin, or steroids may help control attacks. When all else fails and the condition doesn’t improve, surgery may be appropriate.
On the home front, limit your salt intake to no more than 2,500 mg daily. Avoid monosodium glutamate (MSG) that can cause fluid retention in the body. Eliminate or greatly reduce your intake of coffee, chocolate, some soft drinks, and other food products that contain caffeine, as they can worsen symptoms. If you smoke, discontinue the habit. Lastly, avoid stress whenever possible. It is not completely known if stress is a contributing factor for Meniere’s; however, avoidance may lessen the severity of an attack.
