Treatments of Meniere's Disease

 

There are many alternative treatments available for Meniere's Disease including accupuncture, chiropractic and homeopathic remedies. To find out more information on these treatments you should start by asking your doctor if these services are available and where you would go to obtain them. Some doctors might not give you the information you require, therefore, the internet is a good source of information and can be verified for its authenticity.

Treatment is directed towards decreasing the frequency of attacks and managing the episodes when they occur. Medical management can lead to symptom in control in the majority of patients.

Lifestyle changes are crucial to sufferers of mm. Avoidance of tobacco, alcohol, caffeine and sodium are of great benefit. Regular exercise, adequate rest, and control of other medical problems may be helpful as well. If food or respiratory allergies play a role, the environment should be modified accordingly.

Meniere's Disease may be triggered by stress, so stress reduction when possible is important. Some patients may require help with relaxation techniques or psychiatric help.

Vestibular (balance) rehabilitation programs may be useful in adjusting to the loss of balance function that is seen in more advanced cases of mm.

Medication may be prescribed to reduce the severity of the symptoms and possibly decrease the severity and frequency of attacks. Diuretics can help remove excess fluid from the inner ear, anti-vertigo medications or tranquilizers can provide temporary relief by may be sedating or habit forming. Steroids, such as prednisone can help reduce the severity of acute attacks but have significant side effects if taken for any length of time. Occassionally vasodilators or vitamins are of help, but their results are less predictable.

Below are links to treatments and surgeries for Meniere's Disease:

Transtympanic Gentimicin Treatment

Surgical Treatments of MM

Meniette Machine

 

Chemical Labrynthectomy (with antibiotics gentamycin and streptomycin)

An alternative, less invasive method to destroy the vestibular system is by the use of certain antibiotics which are known, in high enough concentrations, to destroy the vestibular hair cells. By destroying these cells, the brain is no longer sent "incorrect" information that the head is rotating.

The techniques rely on the fact that for antibiotics such as gentamycin, the sensory cells of the vestibular system are more sensitive to damage than are the cells of the cochlea. This gives the opportunity at the right does, for vestibular function to be reduced without damaging hearing. The antibiotic is usually injected into the middle ear space through the ear drum and enters the inner ear through the round and oval windows. This method can be effective, but in practice it is difficult to achieve vestibular ablation without causing some damage to hearing. The most common approach is to use just enough of the antibiotic to alleviate the vertigo without necessarily destroying all the vestibular function.

Surgery

Surgery is not the cure all for this disease, so before deciding on any type of surgery it is a good idea to research all the avenues of any given surgery and also to talk with others who've had the surgeries for testimonials. There are risks involved not to mention the costs of surgery.

Endolymphatic Sac Decompression

This operation is performed by making an incision behind the involved ear and exposing the mastoid bone. The mastoid is opened, and the facial nerve is identified in its course through the mastoid. The bone over the endolymphatic sac is then exposed and once identified, the sac is opened. A non-reactive sheet of silastic or a valve is inserted into the sac to allow for future drainings, when fluid reforms. The operation takes about an hour.

In theory, the endolymphatic sac operation should decompress the excessive fluid within the inner ear chambers and allow the inner ear to re-equilibrate, taking pressure off the nerve endings of hearing and balance. Studies have shown little positive effect on hearing from drainage of the endolymphatic sac. ESD often does NOT cure Meniere's sufferers. Vertigo subsides after surgery in about 70 percent of Meniere's cases, but vertigo symptoms recurr with the same severity as before in a significant number of individuals within three years of surgery.

Labyrinthectomy

Historically, ear surgeons have tried many procedures to cure vertigo. In individuals with complete or near complete hearing loss in one ear due to Meniere's, a surgical procedure termed a labrynthectomy is usually curative. Using the same approach through the mastoid bone as the older procedure (EDS), the inner ear balance organ (the labrynth) is exposed. The semicircular canals are then carefully drilled away exposing the nerve of balance which is completely removed.

Following surgery there is often severe vertigo for a day ot two. This can be controlled with medication. After a week the patient experiences a period of moderate imbalance without vertigo while the opposite ear takes over the command of the entire balance function and assumes full control.

The two inner ear balance centers can be thought of a gyroscopes. The gyroscope of each ear helps to control balance by sending signals of the position we are in to the brain. If one gryoscope is faulty, as is the case in Meniere's, the brain has trouble adapting since it is intermittently getting wrong signals mixed with correct ones. However, if the inner ear balance nerve is completely shut off on one side and the "faulty gyroscope" removed, the brain will adapt to this new situation, since it now receives only correct signals from the one remaining gyroscope (inner ear) which will control the entire balance function. This is the reason the labrynthectomy is successful.

Vestibular Nerve Section (VNS)

This procedure involves the discrete sectioning of the nerve of balance where it comes out of the brain. The hearing portion of the nerve is thus preserved. Ninety to 95 percent of vestibular neurectomies will result in the cure of vertigo.

Hearing is preserved at the level experienced before surgery in most cases. The operation is a team effort performed by an ear surgeon and a neuro-surgeon. Since the nerve must be identified as it exits the brain, the vestibular neurectomy is an intracranial operation.

Recovery from the vns is similar to that of the labrynthectomy. However, because it is an intracranial (brain) operation, closer post-operative monitoring will be the order of the day. Younger people (those who are less than 60) who are in good health are offered this operation as the most definitive operation both to cure vertigo from Meniere's and preserve hearing. This minimally invasive operation takes less than two hours. A hospital stay of three to four days or longer is usually necessary.

After Surgery

Patients who have surgery to correct Meniere's Disease will sometimes notice temporary double vision or unsteady vision in the immediate post-operative period. These persons may have nystagmus. As they look to the side they have trouble focusing. The eye will drift slowly back to the centre of vision a very small amount and then suddenly away from it. The visual symptoms after surgery usually subside over a few days or weeks as the visual and balance system become better integrated. Patients do not require special treatment or exercises as the normal healing process tends to take care of the problem. During the recovery period, the patient should avoid activities that stimulate side vision and concentrate as comfortable with central vision tasks. Failure to follow these guidelines will not cause permanent damage but it will however, lengthen the recovery period.

 

 

 

Home

Dr. Hamersma's Article - 1999

Next Page

Back