Meniere's Disease

GENERAL INFORMATION:

What is Meniere's disease?

• Meniere's (me-NYARZ) disease is a condition that affects the inner ear. The inner ear contains the nerve of the ear and small organs that help you hear and maintain your balance. The inner ear is filled with fluid that acts as a sensor when you change the position of your head. When you move your head, the fluid also moves and stimulates the nerves in the inner ear. The nerves then send messages to the brain about your body position and motion.
  
  
• With Meniere's disease, there is a problem within the canals of the inner ear. Too much fluid may b produced or there may not be enough fluid properly absorbed back into the body. This causes swelling and an increased pressure in the inner ear. The nerves get irritated and tell the brain that you are moving even though you are not. The brain then sends messages letting you know something is wrong. These opposing signals cause different sensations (feelings) that lead to the signs and symptoms of Meniere's disease.

What causes Meniere's disease? It is not known what exactly causes the extra ear fluid in the inner ear of Meniere's disease. The following are possible factors or conditions that may increase the risk of having Meniere's disease:

• Age: Meniere's disease usually affects those between 40 and 60 years of age.
  
  
• Alcohol: People who drink alcohol too much and too often may have Meniere's disease. Alcohol may be found in beer, liquor (vodka or whiskey), and other adult drinks.
  
  
• Autoimmune disease: The immune system is the part of your body that fights infection. When you have an autoimmune disease, your body attacks itself.
  
  
• Diet: Certain foods and drinks, such as those with increased salt or caffeine, may increase your risk. Caffeine may be found in coffee, tea, soda, and some sports foods and drinks.
  
  
• Stress and emotions: This may include fear, anxiety, or depression.
  
  
• Other diseases: Having ear problems, viral infections, or migraines may also cause Meniere's disease.

What are the signs and symptoms of Meniere's disease? Signs and symptoms may last from a few hours to a few days. This may happen every week or only once every few years. Meniere's disease includes all of these four signs and symptoms:

• Aural pressure: Having a feeling like your ears are plugged, full, or have too much pressure.
  
  
• Hearing loss: You may lose more hearing in one or both ears with each attack.
  
  
• Tinnitus: Ringing, roaring, or buzzing in one or both of your ears, which is called tinnitus. Tinnitus usually affects only one ear.
  
  
• Vertigo: This is a feeling that everything around you is moving, swirling, or spinning. You may also feel like you are being pulled downwards toward the floor or toward your side. Symptoms may occur after changing positions, such as turning over in bed or moving your head or neck. In Meniere's disease, vertigo may last for minutes to several hours.

• Nausea (upset stomach) or vomiting (throwing up).
  
  
• Nystagmus (abnormal fast movement of the eyes). You may not feel or know this movement is happening.
  
  
• Sweating too much.
  
  
• Trouble keeping your balance when you are standing up.

How is Meniere's disease diagnosed? Your caregiver will take a detailed health history from you. This may include information on what triggered your signs and symptoms, when they started, and how long they lasted. You may also be asked to provide information about past diseases, travel history, activities, trauma, and medicines you are taking now and in the past.

• Physical exam: Your caregiver will do a complete physical exam on you. He may do positional testing by moving your head in different directions. This test will check to see if a problem in the inner ear is causing your condition. You may be asked to do some exercises that could make you dizzy.
  
  
• Tests: Different tests may be done depending on the disease or condition that your caregiver thinks may be causing your Meniere's disease. This may be based on your health history or the presence and pattern of your signs and symptoms. It may also be based on the findings he may get from your physical exam. You may have any of the following:
  
  
  • Auditory brainstem response (ABR) test: This test plays a series of clicks through headsets on your ears. A special machine is used to measure how your cochlea and nerves react to the clicks.
    
    
  • Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
    
    
  • CT scan:
    
    
    • This is also called a CAT scan. A special x-ray machine uses a computer to take pictures of your brain. It may be used to look at bones, muscles, brain tissue, and blood vessels.
      
      
    • You may be given dye before the pictures are taken. The dye is usually given in your IV. The dye may help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.
    
    
  • Electronystagmography: This test is also called an ENG. An ENG is done to test for problems you may have with balance or dizziness. Sticky pads with wires are placed on the skin around your eyes. The wires are connected to a special machine that records information during your ENG. Warm and cool air or water is put into your ears while your eye movements are recorded. Do not drink alcohol or eat a heavy meal before this test. You may feel dizzy or sick to your stomach after the test.
    
    
  • MRI: This test is called magnetic resonance imaging. During the MRI, pictures are taken of your head. An MRI may be used to look at the brain, muscles, joints, bones, or blood vessels. You will need to lay still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.

How is Meniere's disease treated? Treatment will depend on the condition causing your Meniere's disease. It aims to prevent, decrease, and manage your signs and symptoms. Your caregiver may suggest resting, avoiding certain activities, and changing your diet, such as decreasing salt intake. You may also have any of the following:

• Medicines: Medicines may be given to relieve your signs and symptoms, such as nausea, dizziness, vomiting, and headache. Your caregiver may also inject antibiotics into your ears.
  
  
• Surgery: Surgery to correct certain problems in the ears may be done. This may include removing some bones or cutting a nerve in your inner ear. Excess fluids may also be sucked out.
  
  
• Vestibular and balance rehabilitation therapy (VBRT): This is a form of exercise therapy that may be used to help decrease your dizziness, improve your balance, and prevent injuries. It may be done in a special center or at home. VBRT includes movement exercises while sitting or standing. These exercises will make you dizzy, but can also help your brain adapt to the triggers that are causing your vertigo. Over time, this therapy may decrease the number of times you have vertigo and can help improve your balance. A change to a more active lifestyle may also be needed. Ask your caregiver for more information on vestibular rehabilitation.

Where can I find support and more information? Having Meniere's disease may be life-changing for you and your family. Accepting that you have Meniere's disease may be hard. You and those close to you may feel sad or frightened. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. You may also want to join a Meniere's disease support group. This is a group of people who may also have vertigo. Contact the following for more information:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• American Hearing Research Foundation
  8 South Michigan Avenue, Suite 814
  Chicago, IL 60603-4539
  Phone: 1-312-726-9670
  Web Address: http://www.american-hearing.org
  

• Vestibular Disorders Association
  P.O. Box 13305
  Portland, OR 97213-0305
  Phone: 1-503-2297705
  Phone: 1-800-8378428
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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