Dizziness and Vertigo from Ménière’s Disease and Treatment

• Ménière’s disease cannot be cured, but the symptoms patients present can mostly be controlled with medication and by taking the correct course of action.
• In addition to dizziness, other symptoms include tinnitus, not hearing clearly, intermittent feelings of fullness in the ear, and roaring in the ear.
• Ménière’s disease may cause the nerves in the ear to degrade, which if left, can result in a decline in the level of hearing, and even complete hearing loss.

Ménière’s disease is an abnormality of the inner ear, where there is an abnormally large amount of fluid present.
Our inner ear contains nerve cells whose functions relate to our hearing and balance. Normally, the amount of fluid within our ears is sufficient enough for the nerve cells to function and control our balance and hearing. The fluid is able to flow and circulate, as is usual when we move our head, stimulating the nerve cells and sending signals to the brain about the body’s movements. Whenever there is an abnormality with the fluid’s circulation, such as reduced absorption of the fluid causing excess (endolymphatic hydrops), it will affect the nerve cells which control our balance and hearing, causing these cells to function abnormally and thus presenting symptoms of this condition in the patient:

1. Degradation of ear nerves can cause patients to lose their hearing (sensorineural hearing loss), ringing in the ears, unclear hearing, and intermittent feelings of fullness in the ear. At times, hearing may improve, while at others it may worsen.
   In the early stages, there tends to be damage in the low-frequency ear nerves first. In the long-term, however, hearing will become progressively impaired and this may continue until hearing is lost completely. Furthermore, only the ear on one side is likely to be affected, to begin with, although in later stages symptoms may affect both sides, with earaches or headaches in the affected side.
2. Tinnitus This disease can be found across all ages but is frequently found in the 30-60 year age group, in both men and women. In most cases, symptoms tend to appear around the age of 30—although epidemiological information on this disease in Thailand is still low—and they mostly affect the ear on one side (just 30% of cases affect both sides). Symptoms usually present immediately and may occur on a daily basis or with long periods between occurrences, making it difficult to say when each symptom will arise. Furthermore, symptoms may last short periods, a matter of minutes, or for much longer periods, perhaps some hours. Patients may present minimal symptoms, while others may have a variety. Other symptoms include headaches, stomachaches, and even diarrhea.

Diagnosis can be made by reviewing the patient’s medical history to identify the three main symptoms mentioned above, assessing the patient’s nervous system and balance, performing a hearing test, performing a diagnostic radiography, as well as testing blood and urine samples to distinguish the diagnosis from other conditions.

1. Symptom relief through medication
   • Taking diuretic medication may cause the fluid in the inner ear to reduce. Patients’ symptoms may improve after taking medication to relieve dizziness, nausea, or vomiting
   • Taking histamines will help to improve circulation of the fluid in the inner ear.
2. Surgery to drain the fluid in the inner ear is performed when symptoms cannot be improved through the use of medication, especially the symptom of dizziness, and when the patient’s quality of life is severely affected.
   • Destroying the organ in the inner ear which controls hearing and balance (labyrinthectomy) is effective at controlling dizziness; however, the patient will lose hearing on that side. This procedure tends to be performed on patients who have lost a great deal of their hearing ability on one side already but still have severe dizziness.
   • Cutting the nerve responsible for balance in the inner ear (vestibular neurectomy) is usually performed on patients who experience severe dizziness, but who still have good hearing.
   • Injecting medication with properties that are toxic to the ear’s nervous system and balance, into the middle ear, so that it may be absorbed into that area. Medication such as gentamycin, an antimicrobial of the aminoglycoside group, destroys the balance nerve system, causing dizziness to reduce, but may also lead to hearing loss.

Even though Ménière’s disease cannot be cured, the majority of patients’ symptoms can be controlled with medication and by taking the correct course of action.