Meniere’s Disease is a congenital anatomical problem in the inner ear affecting how fluid flows in the inner ear. There’s a decrease of the size of the endolymphatic sac in patients who present with Meniere’s disease. The major phase of Meniere’s Disease occurs when there’s a decreased fluid removal from the cochlea and inner ear structures or there is a decrease in fluid production. Meniere’s Disease will build up pressure in the inner ear and cause damage to the cochlea organ. It will also damage the inner ear and cause a sudden decrease in hearing, an increase in vertigo and tinnitus during this phase. It usually takes a few hours or days for the damage to repair itself.
Once it’s repaired, the patient is left with an acute and pretty significant weakness of the inner ear and its functions. They will also experience some hearing loss. However, these things tend to resolve themselves and get better. These are the two separate and distinct phases to Meniere’s Disease, the original fluid issue and the subsequent weakness of the inner ear.
In order to understand how the two phases interact and how Meniere’s Disease can easily be confused, you should keep in mind the primary function of the inner ear. Many think the inner ear deals exclusively with helping to keep the body upright. That’s vision. The inner ear is a tracking mechanism to help vision work properly. It’s a reflex to keep our eyes focused and to be able to track and move. Your head moves, the inner ear fluid senses it and then it goes down the balance nerve (vestibular) to the brainstem. The brainstem sends a signal to the eyes and allows them to focus and change and keep pace with the movement. The speed of this process is variable from person to person. It’s called the vestibular ocular reflex. When the reflexes get weak, the doctor can then detect a deficit with testing.
In Meniere’s Disease, you get an acute attack that scrambles everything which is why most people struggle with vertigo that can last for hours or days. All kinds of wild signals are going through the brain telling the eyes to move in all sorts of abnormal directions. You are sitting still and the world is whirling around you. This is the first phase of Meniere’s Disease and it can last for hours or days. After that, you are left with a weakened inner ear that lasts a lifetime. Problems are less intense, but continue for the rest of the patient’s life.
At Austin Ear Clinic, we do everything we can to stop the acute phase. If that never occurs, the inner ear won’t be weakened. Usually, the first level of treatment is using a low-salt diet and a diuretic. This is effective in about 60% of the population. We can also do a series of steroid injections in the inner ear. We start using that with fullness and pressure symptoms. It does a great job in about 70% of patients improving hearing, tinnitus and the full feeling. Even people who have just dizziness can find relief from steroid injections.
The next level of treatment involves putting in an endolymphatic shunt. This is an outpatient surgical procedure. This does not destroy the inner ear but allows us to drain the inner ear fluid. This keeps people vertigo-free for at least a year. Other treatments may damage the ear and are considered risky. We suggest you talk with Dr. Slater before agreeing to these treatments so that you may thoroughly understand them. In some cases, they are necessary to prevent the vertigo and balance issues.
It’s important for a patient to understand the difference between the acute cochlear fluid buildup and injury phase versus the vestibulopathy phase dizziness and how both can present with vertigo. They are each treated substantially differently. This is why you need an ENT to properly diagnose you and the stage you are in. You can help your doctor by learning to break your dizziness down into the fundamental aspects of when you get dizzy, how you get dizzy, what makes you dizzy, how long it lasts and if it is vertigo or just wobbliness. They’ll also want to know if it’s associated with anything. Is there a precursory event, for example.
Generally, when we get Meniere’s patients stable on diuretics or low-salt diets or a surgical intervention, we follow up with an audiogram and history and physical in about 2 months. Then, we see them yearly after that. If we can find a subtle change in hearing, it can give us a better idea which ear is involved and helps us to make a firmer diagnosis and figure out options for treating the illness.
If you have any questions on Meniere’s Disease, please feel free to contact us at 512-454-0341. We are happy to help.