Hearing Loss: Meniere’s Disease
Guest: Dr. Ted Meyer – Otolaryngology/Head & Neck Surgery, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Ted Meyer, who is Assistant Professor of Ear, Nose, and Throat, or Otolaryngology, here at MUSC. Dr. Meyer, let’s talk about Meniere’s disease. That’s a rather common disease. What are the symptoms of Meniere’s disease?
Dr. Ted Meyer: Meniere’s disease typically has four symptoms. The first is hearing loss. Usually one ear is affected, so it’s a unilateral hearing loss. This is a sensory neural type of hearing loss. Patients with Meniere’s disease will often have tinnitus in that particular ear, and the tinnitus, or ringing, in the ear is often described as a low pitch, or a humming. Patients may describe it as putting a seashell to their ear, or the sound of a refrigerator running. Although tinnitus can be high pitched in patients with Meniere’s, the low pitch tinnitus is common with Meniere’s disease, and uncommon with other disease processes. The hearing loss can be fluctuating. The tinnitus can be fluctuating as well.
The difficulty with Meniere’s disease is that patients get vertigo, and not generalized dizziness, but true room spinning around; make you nauseated, vertigo. And the spells of vertigo that they get can be devastating. They typically last between 15 minutes and several hours; sometimes even many hours.
The fourth symptom is fullness in the affected ear. So, they describe a pressure, or a fullness, along with the tinnitus and hearing loss.
Dr. Linda Austin: What causes Meniere’s?
Dr. Ted Meyer: That’s a good question. Meniere’s disease is thought to be caused by either an overproduction or an under absorption of one of the fluids in the inner ear called endolymph. Endolymph is a very special fluid that’s only found in the inner ear. Metabolically, it’s different than any other fluid in the body, and there’s very little of it. So, if you have very little, plus a little bit, that’s too much. And these patients can have a great deal of difficulty.
Dr. Linda Austin: Any ideas, though, of what is behind that? For example, does it tend to run in families, or does it just kind of pop up for no particular reason?
Dr. Ted Meyer: In general, it tends to pop up. But you do see some patients with family members who also have Meniere’s disease.
Dr. Linda Austin: And what is the most common age of onset?
Dr. Ted Meyer: Meniere’s can happen at any age. It most commonly presents itself, in my practice, in the young adult. Both sexes appear to be affected equally. You don’t tend to see Meniere’s disease in children, although I do have a nine-year-old patient who, I’m absolutely certain, has Meniere’s disease. I have not seen an onset of Meniere’s disease in the very elderly population, but that can occur also.
Dr. Linda Austin: And then once it comes on, do you have it for life, or does it ever spontaneously go away?
Dr. Ted Meyer: Meniere’s disease fluctuates. In some patients, it will just go away, and in some patients, it will continue forever as an unrelenting course. The hearing loss will fluctuate; good days and bad days. The spells of vertigo will come and go, often with associated hearing loss; hopefully the hearing loss recovers after a spell. But, eventually, patients tend to have a pretty significant hearing loss in the affected ear. If you watch patients long enough, as many as 25 to even 50 percent of patients can develop Meniere’s disease in the other ear. In my practice, I would guess that five percent of patients have bilateral Meniere’s disease.
Dr. Linda Austin: How do you treat it?
Dr. Ted Meyer: Standard treatment for Meniere’s disease is control of salt intake and placement of the patient on a diuretic, or a water pill. These are often used for patients with kidney problems, or with hypertension. I restrict patients’ salt intake quite extremely. Americans eat five to ten times the amount of salt in their diet that they actually need. And I restrict patients to 1,000 to 1,500 milligrams of sodium per day, and I start them on a diuretic. That’s actually a quite difficult lifestyle to maintain for many patients. Sometimes patients with exacerbations of Meniere’s disease benefit from steroids in the short term. And then there are other medical, as well as surgical, interventions.
Dr. Linda Austin: Can you describe those?
Dr. Ted Meyer: Gentamicin injection into the middle ear has become a very common way to treat patients with Meniere’s disease. That’s an easy procedure to do. It can be done in the office. Numbing up the eardrum burns a little bit; but takes very little, and then injecting approximately one milliliter, or 1cc, of buffered gentamicin into the ear takes care of the vertigo in a lot of patients who have Meniere’s disease.
Other procedures actually require surgery, from an endolymphatic sac decompression to a labyrinthectomy, which is drilling away the inner ear for patients who don’t hear in that particular ear, to transecting the vestibular nerves.
Dr. Linda Austin: So, clearly, there’s really a wide array of choices. And I would imagine that, clearly, the choice of treatment must depend upon what you’ve already tried and how severe the illness is.
Dr. Ted Meyer: Yes. And conservative treatment, in my opinion, is a good way to go with almost everything. Destructive procedures, which, gentamicin can be destructive; you are taking an ototoxic antibiotic, or an antibiotic that is toxic to the inner ear, and injecting that into somebody’s ear. You hope that it doesn’t cause hearing loss. You hope that doesn’t disturb the vestibular system in its normal day- to-day function a great deal. You hope that it damages it enough to stop the spells of vertigo.
Surgery such as an endolymphatic decompression is actually a standard ear surgery. A labyrinthectomy is also a fairly standard ear surgery. But cutting the vestibular nerves is a significant procedure to go through, with associated risks and a recovery period.
Dr. Linda Austin: Dr. Meyer, thanks so much for talking with us.
Dr. Ted Meyer: Thank you.
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