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29.04.2014

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Answer to the problem: Around 40,000 people suffer from Meniere's, and many end up with permanent hearing loss.
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Meniere’s disease, also called endolymphatic hydrops, is a disorder of the fluid balance in the inner ear. The classical symptoms of Meniere’s disease are episodic rotational vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. If the hearing loss becomes permanent, patients are often debilitated by the attendant tinnitus or head noise, which can be constant and unremitting.
Your doctor will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. When the history has been completed, diagnostic tests will check your hearing and balance functions. A low salt diet and a diuretic (water pill) is usually the first line treatment and will reduce the frequency and severity of attacks of Meniere’s disease in many patients.
If vertigo attacks are not controlled by conservative measures and are disabling, one of the following surgical or interventional procedures might be recommended: Intratympanic treatment, also known as chemical labyrinthotomy, is an office procedure in which a medicine, such as steroid or gentamicin, is injected into the middle ear. Doctors there are injecting steroids straight into the ear to calm the inflammation and reduce the swelling in the labyrinth.
Its cause is unknown, but it is one of the most common reasons for dizziness originating in the inner ear. Tinnitus and fullness of the ear in Meniere’s disease may come and go with changes in hearing, occur during or just before attacks, or be constant.
You may be asked whether there is history of Meniere’s disease or migraines in your family, or personal history of syphilis, mumps, or other serious infections in the past, inflammations of the eye, an autoimmune disorder or allergy, or ear surgery in the past.
They may include hearing tests (audiograms, otoacoustic emission tests (OAE), auditory brainstem response tests (ABR)) as well as special tests of inner ear balance and fluid function (Electronystagmography (ENG), electrocochleography (ECoG), and vestibular evoked myogenic potential (VEMP)).
In order to receive the full benefit of the diuretic, it is important that you restrict your intake of salt and take the medication regularly as directed. Gentamicin is an antibiotic that causes a partial loss of balance function in the treated ear, controlling vertigo in about three fourths of cases and usually preserving hearing.


Often, only one ear is involved, but both ears may be affected in from 15 to 50 percent of patients.
There may also be an intermittent hearing loss early in the disease, especially in the low pitches, but a fixed hearing loss involving tones of all pitches can develop in time. During vertigo attacks, patients are usually incapacitated and unable to perform activities normal to their work or home life. Some people are too frightened to go outside in case they get an attack.' It is not known what exactly causes the build-up of fluid, although bone abnormalities in the middle ear and infections may play a part. Dysequilibrium or imbalance and generalized tiredness may follow for several hours and even days. Most of the time I could manage, but if an attack occurred I had to stop what I was doing and sit down.' Over the weeks the tinnitus (the ringing in the ears) got louder. The symptoms of Meniere’s disease may be only a minor nuisance, or can become disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning. Some doctors believe that reducing the amount of salt in the diet as well as avoiding caffeine and alcohol can help, although the evidence is only anecdotal. The endolymphatic sac shunt procedure is an ear operation that is usually preserves hearing.
Benie's GP referred her to a specialist before scans and a hearing test confirmed the diagnosis: Meniere's disease. Sometimes patients are offered an injection into the middle ear with a drug called gentamicin.
In cases of bilateral Meniere’s disease, you will be advised to undergo detailed evaluation for food and other environmental allergies. But Benie was one of the lucky ones - she's benefited from a new treatment for the disease. Selective vestibular neurectomy is a procedure in which the balance nerve is cut as it leaves the inner ear and goes to the brain. Experts have hailed it as one of the biggest breakthroughs in treating the condition for many years. As a last resort, patients may be offered surgery, removing some of the bone in the inner ear to create more space.


If you have vertigo without warning, you should not drive, because failure to control the vehicle may be hazardous to yourself and others. Vertigo attacks are permanently cured in a high percentage of cases, and hearing is preserved in most cases. Meniere's disease is a condition that affects a part of the inner ear known as the labyrinth. As such, you may have to forego ladders, scaffolds, and use of heavy machinery until your Meniere’s disease is under better control. Eighty to 85% of patients’ symptoms are controlled for long periods of time with dietary modifications and medication. The labyrinth is also key to our sense of balance, sensing when the head moves and transmitting this information, via the vestibular nerve, to the brain. However, the tinnitus got even louder, until last July - six months after the problem started - she suffered a vertigo attack that lasted for five hours. Labryrinthectomy and eighth nerve section are procedures in which the balance and hearing mechanism in the inner ear are destroyed on one side. With Meniere's, the fluid in the labyrinth builds up, causing the tissue to swell, and disrupting both hearing and balance. This is considered when the patient with Meniere’s disease has poor hearing in the affected ear.
This leads to symptoms such as vertigo (attacks may last anything from several minutes to 24 hours), nausea, vomiting, palpitations and sweating.
Labryrinthectomy and eighth nerve section result in the highest rates for control of vertigo attacks. As far as I know, I'm cured.' The procedure is available on the NHS and costs up to ?500 privately.




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