Providing patients with state-of-the-art diagnosis and treatment options for Meniere's Disease
Meniere’s disease affects the inner ear. It can cause severe dizziness, a roaring sound in your ears called tinnitus, hearing loss that comes and goes and ear pressure or pain. It usually affects just one ear, however, over time some patients can develop Meniere's in both ears, usually many years apart.
Attacks of dizziness may come on suddenly or after a short bout of tinnitus or muffled hearing. Some people have an occasional attack. Others may have many attacks close together over several days. Some people have “drop attacks” during which the dizziness is so bad, they lose their balance and fall without warning. This is also known as spells of Tumarkin.
Meniere's often runs in families. Please see our frequently asked questions section below for more information.
Source: National Institute on Deafness and Other Communication Disorders
What to expect during an evaluation
The Department of Otolaryngology at The Ohio State University Wexner Medical Center has its own dedicated testing staff to perform the most advanced testing. That helps ensure you are properly diagnosed so that your treatment can be as effective as possible and you can get faster results.
Testing for Meniere’s at OSU Wexner Medical Center
Dynamic vestibular testing (VNG or ENG) of the inner ear is a thorough screening that takes about an hour to complete. Observing and recording eye movements and brain function may help detect the condition. Testing will also include positional testing of semicircular canals and caloric tests which use cold and warm air to test for weakened inner ear response. Audiology tests are also done during this initial evaluation.
The right treatment for your condition
Treatments include medicines to control dizziness. Limiting salt in your diet and taking water pills improve the condition in about 80 percent of patients. More aggressive treatments include steroid injection. Antibiotic injection can stop vertigo by affecting the auditory nerve; however, it usually can cause hearing loss. If all else fails, severe cases may require surgery.
Why Choose Ohio State
Why seek treatment at The Ohio State University Wexner Medical Center?
The Department of Otolaryngology at OSU Wexner Medical Center has been successfully evaluating and treating patients with ear-related issues for decades. Many of our patients are referred to us by local ENTs due to our outstanding reputation.
Our own dedicated testing staff
We have dedicated, knowledgeable, highly experienced audiologists who conduct our patient hearing testing, which provides a solid base of information to assist with the patient’s diagnosis.
OSU Wexner Medical Center specialists
Among our physicians are a group of neurotologists who are highly skilled in treating all diseases of the ear, medically or surgically. Many of the neurotologists in the state of Ohio are found here.
OSU Wexner Medical Center is recognized by U.S.News & World Report as one of the nation’s best hospitals for care of the ear, nose and throat.
Frequently Asked Questions
What is Meniere’s disease, and why do I have it?
Meniere’s syndrome is caused by an abnormality of the fluid in your inner ear – either the amount of the fluid or the composition of the fluid. We don’t always know why people develop this condition, but it has been known to run in families and has also been associated with viral infections, abnormal immune responses or head trauma. It can occur at any age, but is seen mostly in the range of 20-60 years of age.
What are the symptoms?
Although Meniere’s is frequently referred to as a disease, it is actually a syndrome or a collection of four different symptoms:
1) Spells of visual whirling vertigo typically lasting anywhere from 20 minutes to several hours
2) Loud tinnitus (ear noise) in one ear
3) Intense pressure in one ear (aural fullness)
4) Fluctuating hearing loss in one ear that may progress to more permanent hearing loss
Most patients have nausea and vomiting during these episodes and are essentially disabled during the peak of the spell. Some patients may feel off balance for a day or two following the most severe portion of the spell. Sometimes Meniere’s patients have some warning of an impending spell as they will develop the ear noise, ear pressure or drop in hearing hours or even a day or so before the vertigo starts.
How do I know if I have Meniere's syndrome?
Meniere’s can usually be diagnosed by the description of your symptoms and can sometimes be confirmed by a hearing test performed in the time period that your hearing is affected. Meniere’s will often cause a low frequency hearing loss, although it has been known to affect other frequencies as well. Meniere’s is often diagnosed after you have established a pattern of the symptoms.
Although we may suspect Meniere’s after just one attack, it usually takes more than one attack for a diagnosis of Meniere’s to be made definitively. There is no specific test to be performed that will diagnose Meniere’s; however, we frequently order balance testing (VNG) to further assess your inner ear and help guide us in your treatment plan. Sometimes a CT or MRI scan will be ordered to rule out other problems that can cause dizziness and hearing loss.
How is it treated?
There is no known cure for Meniere’s, although research is being performed here at OSU and at other major medical institutions. However, there is treatment available for the vertigo symptoms:
Low salt diet
A low salt diet is very important for Meniere’s patients as too much salt can alter the amount of fluid in your inner ear and trigger further attacks. Meniere’s patients should have no more than a total of 1500-1800 mg (milligrams) of salt per day. Typically it is the hidden salt in our foods that adds up. You will need to start reading food labels to control your sodium intake and in general avoid highly salted foods.
¼ teaspoon = 575 mg of sodium
½ teaspoon = 1,150 mg of sodium
¾ teaspoon = 1,725 mg of sodium (range for Meniere’s patients)
1 teaspoon = 2,300 mg of sodium
Other dietary changes may include avoiding caffeine, chocolate, alcohol and MSG.
Other dietary changes
In addition to the low salt diet, a water pill (diuretic) is often prescribed to keep excess fluid from settling in your inner ear. Our office most commonly prefers to prescribe Dyazide or Maxzide (a combination of Triamterene and hydrochlorothiazide) as this particular diuretic has been studied the most when it comes to Meniere’s patients. Also, it has two components – one that is potassium-sparing and the other sodium-depleting, which is a safer combination overall and has fewer side effects than some other diuretics. However, other diuretics may be prescribed for some patients, as other existing health problems may play a role in what type of diuretic we recommend. We may suggest you work with your primary care physician in adjusting this medication for your needs.
Sometimes an injection of a steroid through the eardrum after it is numbed will temporarily settle down a period of increased Meniere’s activity. This can be done in our office by your ENT specialist.
Another type of injection performed in the office is called a Gentamicin injection (“gent injections”), which is used to chemically destroy the inner ear. Gentamicin is a strong antibiotic given through an IV that is used for patients who have life-threatening infections. This antibiotic has a side effect known as ototoxicity (poisonous to the ear), but this side effect has been found to be helpful in Meniere’s patients when it is injected directly through the numbed eardrum and allowed to travel into the inner ear structures of the Meniere’s patient’s ear. Some patients require numerous gent injections over a period of many weeks or months, and frequently, a severe attack occurs as a result of the inner ear “dying off,” which is the intended goal of the treatment. The gent injections will not improve hearing, tinnitus or ear fullness and is intended only to control vertigo. Gent injections are not recommended for all Meniere’s patients and if it is recommended in your case you should discuss the pros and cons of this treatment with your physician.
The most common surgical procedure in our practice to treat Meniere’s is an endolymphatic sac decompression and shunt surgery. This is usually performed as an outpatient surgery, in which you go home the same day. The surgery itself takes about two hours. The inner ear is approached via an incision behind the ear and through the mastoid in order to place a shunt or drain inside the inner ear to regulate your inner ear fluid. Most people are off work two to three weeks after the surgery. Many people must still continue their low salt diet and water pill after surgery. This surgery is designed to help control vertigo spells. Although you may have some improvement in your other symptoms, its main goal is to control your vertigo. The length of time this surgery remains effective varies between patients. As with any surgery, there are possible complications, and if this surgery is recommended to you, an informed consent listing those possible complications will be provided to you. There are several other surgical procedures that are performed less commonly, including vestibular nerve section and labyrinthectomy.
What if I have Meniere's in both ears?
There are varying opinions in regards to the percentage of patients who will develop Meniere’s in both ears. Opinions state that anywhere from 10 to 30 percent of Meniere’s patients will go on to develop bilateral Meniere’s syndrome. Our specialists keep those statistics in mind when recommending a treatment plan for you.
Will I feel better immediately after treatment?
It can take weeks or months to start feeling better after initiating a low sodium diet and a diuretic. Steroid injections usually provide faster relief but are only temporary. Gent injections are not effective immediately as it takes time for the inner ear to break down after being exposed to the Gentamicin. We tell patients who have had a gent injection to expect a severe spell seven to 10 days after an injection, but many start to feel better after that initial severe spell passes. We will decide if you need any further gent injections based on your response to the first injection. If additional injections are required, they may be spaced weeks or months apart based on your progress. Additional vestibular/balance testing may be performed during this treatment period in order to measure your inner ear response. After undergoing a shunt surgery, recovery time is variable, but it may take up to a week before you start feeling better from a dizziness standpoint.