Menieres Disease

Meniere's disease is an abnormality in the inner ear that causes a number of symptoms—dizziness, tinnitus (see page 401), hearing loss that comes and goes, and pressure in the affected ear. The symptoms of Meniere's disease appear suddenly and can occur daily or as seldom as once a year. The dizziness can lead to nausea, vomiting, and sweating and can become so severe that the person has to lie down. Meniere's disease usually affects only one ear and is a somewhat common cause of hearing loss. At first the person's hearing returns to normal between episodes, but over time the hearing worsens. Meniere's disease affects 403

about 3 million to 5 million people in the United States, with about 100,000 new Ears cases diagnosed each year. The cause of the disease is unknown.

A part of the inner ear known as the labyrinth is necessary for hearing and balance. The labyrinth contains a fluid called endolymph. When you move your head, the fluid moves within the labyrinth, causing nerves in the labyrinth to send signals to the brain about the movement of your body. Symptoms of Meniere's disease occur when excess fluid builds up in the labyrinth.

To diagnose Meniere's disease, a doctor first takes a medical history and performs a thorough physical examination. The doctor is usually able to diagnose the condition on the basis of the person's symptoms. Hearing tests (see "Diagnostic Procedures," next page) and balance tests help to confirm the diagnosis and rule out other possible causes of the symptoms. The most common hearing test used to diagnose Meniere's disease is audiometry, in which a person's ability to hear sounds of varying frequencies and volumes is evaluated.

To assess the person's balance, the doctor may perform a test that includes flooding the person's ears with water. This produces rapid eye movements that help the doctor evaluate balance. Because a brain tumor can produce symptoms similar to those of Meniere's disease, the person may need to have a scan of the brain to rule out a possible tumor.

There is no cure for Meniere's disease, but certain treatments can help manage the symptoms. Some doctors recommend dietary changes. Eliminating salt (sodium), caffeine, and alcohol relieves the frequency and intensity of episodes in some people. Stopping the use of tobacco (see page 107) and reducing stress (see page 118) also may lessen the severity of symptoms. Your doctor may prescribe diuretics to help your body eliminate excess fluid, thereby decreasing the severity and frequency of episodes. Medications that control allergies also can be helpful. The dizziness typically stops after 10 to 20 years, but the hearing loss will persist.

Three types of surgery have been developed to correct the disorder, but their effectiveness has been difficult to establish. Another important factor to consider is that all surgery on the ear carries a risk of hearing loss. The most commonly performed surgical treatment for Meniere's disease is insertion of a shunt (a tiny tube) into the inner ear to drain excess fluid. In another type of surgery, called vestibular neurectomy, the nerve responsible for balance is cut so it can no longer send distorted messages to the brain. Because this nerve lies close to the nerves that are responsible for hearing and facial muscle control, this type of surgery carries a risk of loss of hearing or facial movement. Older people often have difficulty recovering from this type of surgery. During a third type of surgery called a labyrinthectomy, the surgeon removes the membrane inside the labyrinth to eliminate the dizziness caused by Meniere's disease. This procedure is irreversible and produces a total loss of hearing in the affected ear. People

404 considering this type of surgery need to know that their other ear may someday

Common also be affected by Meniere's disease, which means that total deafness is a pos-

Health sibility in the future. In rare cases, labyrinthectomy and vestibular neurectomy

Concerns may cause permanent balance problems, especially in older people.

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