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Meniere’s disease generally progresses through three distinct stages of symptoms. However, you can’t predict the timing of stages and severity of symptoms at each stage for a particular individual – these vary from person to person. This can make diagnosis of Meniere’s disease complex. Symptom-free periods (remission) may also occur naturally. As well as making diagnosis difficult, all these variations make it difficult to judge the effectiveness of treatments in controlling symptoms. Stage 1: Vertigo – is a form of dizziness where your surroundings appear to “spin”. Vertigo is usually the main symptom at this stage and may be accompanied by severe vomiting. Vertigo attacks can last for hours – sometimes days – tending to occur in clusters. Balance returns after each attack but you can feel “washed out” for days after. Often, by the time you present for diagnostic tests, the ear has returned to normal. But because life style and dietary changes (eg reduced salt and caffeine intake) can lessen the long-term effects of Meniere’s disease, it is important to get an accurate diagnosis as soon as possible. Around half the people who are affected with this stage of Meniere’s may experience a remission of symptoms – that is, symptoms will “disappear”. This remission may last weeks, months or many years. Remission can occur even though you have experienced several attacks. Stage 2: It is easier to diagnose Meniere’s disease during this stage, as symptoms are “classical”:
• Tinnitus increase with attack of vertigo and becomes continuous
• The feeling of pressure or fullness in the ear may be worse before and during a vertigo attack
• Hearing fluctuates, but never returns to normal levels
Periods of remission (ie no symptoms occur) between vertigo attacks can vary from a few weeks to several years during this stage. About 50% of patients will progress to the next stage of the disease. Stage 3: This stage is often referred to as “burnt out Meniere’s”. Your hearing loss may be severe at all frequency levels to the point where it is difficult to recognize speech. There is no longer fluctuation in hearing levels as the hair cells of the inner ear have been destroyed. Although you may feel that your hearing is useless, it is rare for an ear to become completely deaf. The tinnitus (noise in the ears) remains but may seem less of a problem because you have got used to it. Attacks of vertigo (dizziness) occur much less frequently and eventually cease. Usually you no longer vomit and the nausea and dizziness is mild. Unfortunately when the ear has lost 50% of its balancing function, a persistent feeling of unsteadiness may replace attacks of vertigo. This lack of balance is more noticeable in the dark or where you cannot use your vision to orient yourself. A few people may experience “drop attacks” (Tumarkin’s crises) in which balance is lost for a few seconds and you fall to the ground – a particular concern for the elderly. Drop attacks occur without warning and with minimal vertigo. It’s usual for these attacks to continue happening for longer than one year.
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Diagnosis is based on a combination of the right set of symptoms (usually episodic dizziness and hearing
disturbance), hearing tests which document that hearing is reduced after an attack, and then gets better, and
exclusion of alternative causes.
The process of diagnosis usually includes hearing testing (audiometry), as well as a battery of diagnostic tests,
blood tests, and MRI scan of the head. TREATMENT OF MENIERE’S DESEASE
The best treatment for Meniere’s depends on what stage of the condition you are currently experiencing. It’s
important to seek qualified advice from an appropriate health professional before beginning any treatment.
Your first step in managing Meniere’s is to learn as much as you can about the disease and the various ways
you can manage it. The information below provides a starting point.
Talking to other people with Meniere’s can help answer many questions. Contacting and joining support
groups such as Meniere’s Australia can help put you in touch with others in the same boat. MANAGE YOUR STRESS LEVELS
Emotional or physical stress can result in fluid retention in your body. This can make Meniere’s symptoms
worse or act as a trigger for attacks of vertigo. It’s vital that you manage your stress levels.
MODIFY YOUR DIET
Meniere’s symptoms generally result from having excess fluid within your inner ear. This condition is called “endolymphatic hydrops”. Eating too much salt (sodium) increases the fluid, making your symptoms worse and even causing vertigo attacks. Cutting back on salt in your diet is a key strategy in managing Meniere’s. This includes the salt found in many processed foods – often you are not aware it is there and need to check the food labeling. Remember to inform your doctor before commencing a low salt diet, especially if you are taking prescribed medications eg diuretics. An acceptable level of sodium is no more than 120mg per 100g of food. Nearly all fresh foods are naturally low in salt. Many processed foods are not low in salt. Over 75% of our salt intake comes from the salt (or other forms of sodium such as baking powder) this is added to processed foods.
It is thought that the caffeine found in tea, coffee and cola drinks can constrict blood vessels and make tinnitus (ringing in the ears) worse. Cutting back on your caffeine intake can be an effective strategy in managing Meniere’s. Foods that contain caffeine – like chocolate – are also best taken in moderation.
Alcohol affects blood vessels and fluid balance in the body. Excess alcohol intake may make Meniere’s symptoms worse.
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TAKE MEDICATION IF NECESSARY
Caution: Seek your Doctor’s advice first. Commonly used medications include:
• Diuretics (fluid tablets eg Urea) – quickly reduce fluid in the body and therefore the inner ear
• Anti-emetics (eg Stemetil) – suppress vomiting and reduce nausea
• Vestibular sedatives (eg Valium) – suppress neural output; this is the confusing messages that the
affected ear(s) are sending to the brain.
• Vasodilators (eg Serc) – improve blood supply to the inner ear.
Remember to inform you Doctor if you are taking any “over-the-counter” or natural therapies as these could
interact negatively with prescribed medications.
Chronic vertigo or dizziness is a major symptom in the later stages of Meniere’s as the body’s balancing
(vestibular) mechanism becomes damaged.
Through a series of graded exercises you can re-train your body to balance effectively by re-training the
balance mechanism and/or by using alternative techniques like visual cues.
ALTERNATIVE OR NATURAL THERAPIES
There are many alternative therapies you can try to help manage the symptoms of Meniere’s. You should
always consult your Doctor or specialist about any alternative therapies or techniques you are using to manage
Some common therapies are:
• Psychological Therapies – counseling, psychotherapy, hypnotherapy
• Dietary Measures – nutritional therapy, working with a dietician
• Energy Therapies – acupuncture, spiritual healing, homoeopathy, flower remedies, Tai Chi, yoga,
• Physical Therapies – osteopathy, cranial osteopathy, chiropractic, massage, biodynamic massage,
shiatsu, kinesiology, Bowen massage therapy.
• Traditional Medicines – Chinese medicine, naturopathy, herbal medicine, aromatherapy
When Meniere’s symptoms cannot be managed by a combination of life style measures and medication,
surgery may be considered. The two types of surgery are non-destructive surgery and destructive surgery.
When considering any surgery it is wise to research the available options thoroughly, and, if necessary seek
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