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Ménière's Disease is a repetitive disorder characterized by vertigo, fluctuant hearing loss, ear noise, ear pressure, and annoying sensitivity to loud noise. The cause of Ménière's Disease appears to be an immune or inflammatory response which ruptures the inner compartment of the inner ear. As Ménière's Disease builds inner ear pressure, hearing declines, noise in the ear increases, and a sense of ear pressure develops. When the vertigo attack starts, nausea, vomiting, and/or inability to walk may also. Symptoms may last minutes to hours. As the Ménière's attack subsides, the associated symptoms may also improve, but hearing loss may persist to varying degrees. Ménière's Disease eventually quits bothering over 70% of people, but can be quite troublesome. Management is with medicine for most cases, surgery in some. Medical management of Ménière's Disease includes salt restriction, diuretics (water pills), sedatives (meclizine, diazepam, lorazepam, alprazolam), and anticholinergics (propantheline, glycopyrrolate), and other.
Surgical management of Ménière's Disease is reserved for individuals whose symptoms have not been controlled with medication. Several options are available: Transtympanic gentamicin places the medication into the middle ear from which it diffuses into the inner ear. The treatment was pioneered in Europe, but has been given in the United States for over ten years. Gentamicin helps Ménière's Disease by doing two things to the inner ear: suppresses balance organ responsiveness and ability of the inner ear to secrete fluid. Several methods of applying gentamicin to the inner ear exist. Use of ear tubes, ear wicks, and ear catheters, and simple direct injection have all been reported to be equally effective. At the Tampa Bay Hearing and Balance Center, Dr. Bartels and Dr. Danner use the simple direct injection since comparative scientific studies show that the more complex and more expensive treatment methods show no statistical advantage. Process of the injections is monitored with hearing tests and assessment of balance function.
As the gentamicin begins to work, it causes imbalance, may cause increased ear noise, and may cause some worsening of the hearing only in the treated ear. Completion of treatment is usually per plan developed before the injections have started. When the hearing is quite good, a single injection is commonly used. Although a single injection may be a little less likely to be successful, it is also less likely to worsen the hearing in the treated ear. When the hearing is poor, more injections may be planned. More injections, in the experience of Dr. Bartels and Dr. Danner, are more likely to stop the Ménière's Disease.
Endolymphatic sac surgery operates on a bag-like organ on the backside of the inner ear. The endolymphatic sac is thought to function as a removal organ for larger molecules leftover from inner ear metabolism. It may also be the major source of the immune/inflammatory response that triggers a Ménière's Disease attack. Other parts of the inner ear may play a smaller role. The surgical approach is through the mastoid bone behind the ear. Surgery is usually completed as an outpatient under general anesthesia. Risk to hearing is low. Some perioperative dizziness is common. Most persons return to work within a couple of weeks.
Labyrinthectomy stops Ménière's Disease by removing the bad balance organ surgically. It is generally reserved for an affected inner ear that has poor hearing. Success rates exceed 95%.
Selective vestibular nerve section is the procedure most likely to stop Ménière's Disease. Partial vestibular nerve section separates the balance nerve from the hearing nerve and cuts the balance nerve portion. The approach is behind the mastoid bone, in front of the base of the brain. Cutting the balance nerve unhooks the Ménière's Disease affected inner ear so that it can no longer cause vertigo. The major early side effect of surgery is dizziness, but early postoperative exercise improves the rate of recovery of balance. After a day in the intensive care unit, patients usually go home in two to three days. Plan on a period of a few weeks of home exercises before returning to usual activities.
Total eighth nerve section removes both the hearing and balance nerves and is a bit more likely to stop the vertigo and lessen the inner ear noise.
Other surgeries have been reported over the years, but are less often applied.
Cochleosacculotomy is a performed through the ear canal. A needle puncture of the inner ear compartments may resolve the vertigo problem, but has a significant chance of causing hearing loss. It may be most applicable to elderly or persons with poor health when transtympanic gentamicin is not effective.