According to the American Academy of Otolaryngology, the causes of Meniere's syndrome are unknown. Problems from the disease seem to result directly from build-up of fluid in the inner ear.The parts of the inner ear are responsible for hearing and our ability to maintain balance.
The hearing portion of the inner ear is known as the cochlea, a snail-shaped structure that contains fluid and thousands of tiny cells. The cells pick up sound vibrations from the middle ear and convert them to nerve impulses that are then transmitted along the auditory nerve to the brain.
The three semicircular canals of the inner ear are responsible for balance. Those canals are at right angles to each other, and each contains fluid. When the head moves, the fluid within the canals also moves.
When the cochlea and the semicircular canals have excessive fluid, both balance and hearing are thrown off.
The symptoms of Meniere's syndrome can come and go in its early stages. They include some hearing loss in the low pitches, ringing and a feeling of fullness in the ear and occasional feelings of dizziness.
Hearing loss can worsen as the disease progresses. And the occasional dizziness can turn into violent bouts of vertigo, with the resultant nausea and vomiting.
Patients suffering from vertigo are often unable to perform their normal chores at home or at work.About 80 percent of patients with Meniere's syndrome have the problem in only one ear.
Various tests can be performed for the diagnosis of Meniere's syndrome, according to the Academy of Otolaryngology. Attending physicians may ask medical-history questions related to mumps, allergies and problems with the autoimmune system, syphilis or past ear surgery.
A doctor may also ask for a balance and a hearing test.
One special exam may be ordered to test for increased ear fluid and either computerized tomography or magnetic-resonance imaging may be used to rule out the possibility of a tumor on the hearing and balance nerve.
Treatment for Meniere's syndrome comes in various forms. A low-salt, caffeine-free diet is a good start, according to the academy. Use of a diuretic and such anti-vertigo medications as Antivert or Valium can also help.
Patients should try to avoid stressful situations, which could trigger dizziness or vertigo.
Dr. Douglas Chen, director of hearing and balance at Pittsburgh Ear Associates, said he has used histamine to treat Meniere's syndrome. (See related story)
Surgery is another possible treatment. According to the University of Washington's Otolaryngology Clinic, different types of surgery could be used for the different problems faced by meniere's patients.
Endolymphatic sac surgery typically is able to preserve hearing and helps patients who face bouts of dizziness and vertigo. Through the operation, fluid absorption within the inner ear is reduced. Labyrinthectomy is an attempt to eliminate the major spells of dizziness. Surgery on the ear leaves it with no hearing or balance function. Another surgical option is vestibular nerve section, which in most cases preserves hearing and controls problems with vertigo. In the operation, the doctor cuts the balance nerve as it leaves the inner ear and goes to the brain. The operation involves a five- to seven-day hospital stay. Risks include meningitis and a leak of spinal fluid.According to Chen, Meniere's syndrome afflicts 10 out of every 100,000 people. One out of every 10 cases requires surgery.
The type of surgery that is needed can depend on a number of factors, Chen said, such as the degree of hearing loss and the patient's age.
"It really depends on the patient's preference," Chen said.
For instance, in both a vestibular nerve section and labyrinthectomy, a surgeon cuts the balance nerve leading from the affected ear to the brain. Balance would then be controlled from the nerve in the other ear.
The surgery is irreversible, Chen noted - a condition that some patients might not be comfortable with.
"It means that you are burning a bridge behind you."
Chen did say that surgery for Meniere's syndrome patients has had a high rate of success.
"We have had a 90 percent success with patients who have been treated with surgery."
In his Pittsburgh practice, Chen has prescribed histamine for Meniere's syndrome. Histamine is helpful, Chen said, because it opens up the blood vessels and increases circulation, thus alleviating the feelings of dizziness.
Chen's clinic dilutes the liquid histamine that it uses for its Meniere's patients.
"There is not a big market for (histamine.) It is hard to find. It has to be prepared (and) not many offices will take the time to prepare it," Chen said.
He estimated that his clinic serves several hundred patients in Pennsylvania, Ohio and West Virginia.
"We have patients who have been on it for 20 to 30 years."
On the Web: The Ménière's Page
