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By Marvin Baker, a new weekly column in The Kenmare News

 

The balancing act of Meniere's...

Posted 2/07/17 (Tue)

Meniere’s disease is a malady of the inner ear that is caused by an abnormality of the composition and amount of fluid in the inner ear.

There are two tiny canals in the labrynth or inner ear. One is filled with a potassium fluid and one is filled with a sodium fluid. Sometimes those cell walls burst, the fluids intermingle and dizziness occurs.

However, science doesn’t know exactly what causes this phenomenon other than the cell walls may be weak or allergens may trigger it.

People, including doctors, get confused about Meniere’s and simply call it vertigo. It turns out, vertigo is one of four symptoms of Meniere’s, but the treatments are much different.

The most common cause of uncontrollable dizziness is benign paroxysmal positional vertigo.

Doctors know there are tiny calcium deposits in the inner ear that somehow get dislodged and since the inner ear is where our balance is established, dizziness results.

Doctors will always ask if the patient has had head trauma. Did you ever get hit in the head with a baseball bat, were you in a car accident, or did you hit your head on an icy sidewalk?

There are various exercises that can be done to put the calcium deposits back to their rightful place to cure the dizziness.

Meniere’s is quite different but uncontrollable dizziness is the most intense symptom.

In fact, Meniere’s has four symptoms; vertigo, tinnitus (ringing or hissing in the ear) hearing loss that may come and go and a feeling of pressure in the inner ear.

Doctors will generally assume you have benign paroxysmal positional vertigo, but when exercises don’t work, they go through a process of elimination to officially diagnose Meniere’s.

This is also where treatments become more invasive and more expensive. And there’s a sequence of protocol in how doctors treat Meniere’s.

First, the patient gets a diuretic, then a shot, into the inner ear with a steroid called dexamethasone that is designed to strengthen the cell walls.

If that doesn’t work, the next step is a powerful antibiotic called gentamicin that is injected into the inner ear. Doctors call it a destructive procedure designed to kill the balance cells in order to stop the vertigo. In 100 percent of the cases, some hearing loss results because the gentamicin destroys tiny hairs in the inner ear assisting in hearing.

Gentamicin may be used more than once, about a month apart, and if for some reason it doesn’t work, the next step is endolymphatic sac decompression. That’s when doctors remove a small piece of bone in the inner ear, insert a shunt designed to drain the fluid away that causes pressure, and in turn, the dizziness.

Labrynthectomy is the next step. A portion of the inner ear is surgically removed. This takes away all balance issues and all hearing in the affected ear.

The final, and most drastic measure is called vestibular nerve section. This is where doctors will actually cut the vestibular nerve that sends balance signals to the brain.

This procedure is most invasive because the envelope of the brain has to be opened in order to cut the nerve. It’s a last-ditch effort to rid the patient of vertigo but keep their hearing.

Meniere’s disease is named for Prosper Meniere, a French physician who first reported that vertigo was caused by inner ear disorders in an article published in 1861.

Following are some statistics, according to the Harvard Medical School.

• It is estimated that 750,000 people in the United States have had Meniere’s disease with 60,000 diagnosed annually. Ninety-five percent of patients can control it with medicine.

• There’s about 15 percent of those diagnosed that have Meniere’s in both ears.

• Meniere’s typically effects people 50 and older but has been diagnosed in patients as young as 20.

• Only 5 percent of patients have severe enough symptoms to warrant the invasive therapies.

• Worldwide, 12 of every 1,000 people develop Meniere’s annually.

• Twenty percent of patients may have a genetic component and those with viral illness or respiratory infection, are at greater risk.

• Meniere’s was rare in Japan until after World War II when there was a rapid increase in cases.

•  A total of 1.6 percent of the U.S. population has benign paroxysmal positional vertigo.