By Judy Rupp, commentary
July 02, 2007 11:01 pm
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Martha, 57, knew what it was like to be dizzy, but the attacks she had been experiencing were another matter. “It was like being on the Tilt-A-Whirl ride at the carnival,” she said, “except there wasn’t a chance to get off and make the spinning stop.” Sometimes the whirling lasted an hour or more at a time, leading to nausea and vomiting. Martha also noticed fullness in her left ear, “like the feeling you get when an airplane or elevator descends too quickly.” But swallowing didn’t help. And her hearing on that side was severely diminished.
The severity and duration of Martha’s episodes and the combination of dizziness, fullness in the ear, tinnitus (roaring or ringing in the ear) and hearing loss suggested Meniere’s disease — a suspicion that was confirmed through a physical examination and hearing and balance tests.
Crucial to both hearing and balance, the labyrinth part of the inner ear is filled with a fluid known as endolymph. It’s believed an increase in endolymph is responsible for the characteristic feeling of fullness in the ear and the diminished hearing and balance. What might cause such a change in fluid level is not known.
While symptoms can often be controlled, there is no cure for Meniere’s disease. Treating the disorder is complicated by the fact symptoms often go into remission or fluctuate in severity. The disease is progressive and eventually leads to deafness in at least one ear plus deterioration of balance.
In an effort to reduce the pressure caused by excess fluids in the inner ear, initial treatment may include a low-salt diet along with a diuretic medication such as dyazide. While this may resolve the dizziness, it usually has little or no effect on the roaring in the ears or the hearing loss.
Some doctors also may advise the patient to quit smoking and reduce intake of caffeine and alcohol. These have been reported by some as possible triggers of symptoms.
Corticosteroids are sometimes prescribed as second line treatment for their effect in reducing inflammation, altering electrolyte balance and improving blood flow to the inner ear. Steroids also may have an effect on the immune system, which is believed by some to be implicated in many cases of Meniere’s disease.
Many other medications, including anti-nausea drugs and vasodilators, are used to control symptoms. And some patients have opted for alternative treatments: acupuncture, hypnotherapy or herbal supplements such as gingko biloba and vinpocetene.
A recently introduced device, the Meniett, has demonstrated some short-term effectiveness. The Meniett puffs air into the ear under low pressure. For the device to work, tympanostomy tubes must be inserted into the ears through a minor surgical procedure. Tympanostomy tubes on their own may also have an effect on symptoms.
All treatments seem to have some effectiveness for all patients. On the other hand, no one treatment works consistently for every patient.
Surgery is reserved for patients with disabling symptoms who have not responded to other treatments. There are risks involved, and, even though much progress has been made over the past three decades, results from most surgical options are not consistently good.
Extended episodes of vertigo such as those experienced by Martha can be a major disability. With the world whirling around her, she found it virtually impossible to work or even walk across the room until the symptoms passed. Lifestyle changes and medications helped her stop the spinning long enough to think about her long-term options.
Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.
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