What causes tinnitus in meniere's disease, stiff achy joints and fatigue - For You

Thus it can see that there are numerous factors that are weakly correlated with tinnitus, and that hearing impairment is the most strongly associated. Most tinnitus comes from damage to the inner ear, specifically the cochlea (the snail like thing on the right of figure 1, labeled '9'). Patients with Meniere's disease often describe a low pitched tinnitus resembling a hiss or a roar. Tinnitus can also arise from damage to the nerve between the ear and brain (8th nerve, labeled 6, auditory nerve). Tinnitus arises more rarely from injury to the brainstem (Lanska et al, 1987), and extremely rarely, to the brain itself (e.g. Tinnitus can be associated with Basilar Artery Migraine (BAM), and also tinnitus can be more bothersome when one is having a migraine (Volcy et al, 2005), like sound and light and smells. In our opinion, people are very quick to blame drugs for their tinnitus, but it is rare that this is borne out. Often people bring in very long lists of medications that have been reported, once or twice, to be associated with tinnitus. As tinnitus is essentially subjective, malingering of tinnitus as well as psychological causes of tinnitus is certainly possible.
In malingering, a person claims to have tinnitus (or more tinnitus), in an attempt to gain some benefit (such as more money in a legal case). Schecklmann et al (2014) suggested that tinnitus is associated with alterations in motor cortex excitability, by pooling several studies, and reported that there are differences in intracortical inhibition, intra-cortical facilitation, and cortical silent period. ABR (ABR) testing may show some subtle abnormalities in otherwise normal persons with tinnitus (Kehrle et al, 2008). We occasionally recommend neuropsychological testing using a simple screening questionnaire -- depression, anxiety, and OCD (obsessive compulsive disorder) are common in persons with tinnitus. Microvascular compression of the 8th nerve is not a significant cause of tinnitus (Gultekin et al. Other entities that can sometimes be seen on radiological testing and that can cause pulsatile tinnitus, include AVM's, aneurysms, carotid artery dissection, fibromuscular dysplasia, venous hums from the jugular vein (found in half the normal population), vascular tumors such as glomus, ossifying hemangiomas of the facial nerve, osseous dysplasias such as otosclerosis and Paget's, elevated intracranial pressure. Disrupted sleep is the most significant complaint, and affects between 25-50% of tinnitus patients. The algorithm that we use in our practice to diagnose and treat tinnitus is here (a PDF graphic).
There is a small literature concerning use of intravenous and local anesthesia for tinnitus.
Liu et al (2011) reported use of botox for tinnitus due to tensor tympani myoclonus, by inserting gelfoam with botox through a perforation in the tympanic membrane. Pramipexole was recently reported effective for tinnitus in a study of 40 patients with age related hearing loss in Hungary. Most of the discussion of devices for tinnitus are discussed, as is proper, under the placebo page. Cochlear implants, which are used for severe bilateral unaidable hearing loss, usually improve tinnitus (Amoodi et al, 2011). These are devices based on the idea that tinnitus is usually worst when things are very quiet.
Occasionally persons with Meniere's disease have relief or reduction of tinnitus from transtympanic gentamicin.
Microvascular compression syndrome, in theory, may cause tinnitus, but we have had very little success when the few patients we have seen with this syndrome have undergone surgery. Tinnitus usually improves in profoundly deaf individuals who undergo cochlear implantion (Olze, 2015). Avoid exposure to loud noises and sounds, avoid environments that are very quiet (as this makes tinnitus more noticeable). Tinnitus Retraining Therapy (TRT) is a method of treating tinnitus helpful for some (Wang et al, 2003). Hoare DJ, Kowalkowski VL, Kang S, Hall DA.Systematic review and meta-analyses of randomized controlled trials examining tinnitus management.
Mahboubi H, Ziai K, Brunworth J, Djalilian HR.Accuracy of tinnitus pitch matching using a web-based protocol. Piccirillo JF, Garcia KS, Nicklaus J, Pierce K, Burton H, Vlassenko AG, Mintun M, Duddy D, Kallogjeri D, Spitznagel EL Jr.Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus Arch Otolaryngol Head Neck Surg. Wineland AM, Burton H, Piccirillo J.Functional Connectivity Networks in Nonbothersome Tinnitus. In 1861, the French physician Prosper Meniere described a condition which now bears his name.
An acute attack of Meniere’s disease is generally believed to result from fluctuating pressure of the fluid within the inner ear. Abnormally enlarged fluid pathways into the ear, such as the vestibular aqueduct or cochlear aqueduct, may also be associated with Meniere’s-like symptoms, but recent evidence is against a relationship between the cochlear aqueduct and Meniere’s disease. Franz (2007) suggested a link between Meniere’s disease and joint disease of the jaw (temporomandibular joint), the cervical spine, Eustachian tube dysfunction, and autonomic nervous system dysfunction.
Meniere’s disease can cause hair cell death, as well as mechanical changes to the ear.
There is presently no evidence that Meniere’s disease kills the cochleovestibular nerve (Kitamura et al, 1997).
At the present time there is no cure for Meniere’s disease, but there are ways to manage the condition and help you control symptoms. Between attacks, medication may be prescribed to help regulate the fluid pressure in your inner ear, thereby reducing the severity and frequency of the Meniere’s episodes.


Although intratympanic steroids injections have also been recently used to treat Meniere’s disease by Shea, the present consensus is that treatment has not yet been clearly proven to be effective or to have a reasonable scientific basis.
For bilateral Meniere’s disease, when the patient is incapacitated and it cannot be determined which ear is causing the dizziness, intramuscular streptomycin (1 gm twice a day) can be given on an outpatient basis until the first sign of ototoxicity develops.
Since the acute symptoms of Meniere’s disease are episodic, it is important to explain to your family and friends what might happen when you have an attack. In September 2012, a visit to the National Library of Medicine’s search engine, Pubmed, revealed more than 6800 research articles concerning Meniere’s disease published since 1883. Distinct causes are microvascular compression syndrome, viral infections of the 8th nerve, and tumors of the 8th nerve. For example, Tandon (1987) reported that 1% of those taking imiprimine complained of tinnitus.
We doubt that this means that motor cortex excitability causes tinnitus, but rather we suspect that these findings reflect features of brain organization that may predispose certain persons to develop tinnitus over someone else.
Because papilloedema is so rare, and tinnitus is so common, it is very unusual to find this dangerous condition. This is not surprising considering how disturbing tinnitus may be to ones life (Holmes and Padgham, 2009).
This is because of the very high correlation between anxiety and depression with tinnitus-related annoyance and severity (Pinto et al, 2014).
At that date there were 4 double-blind placebo controlled trials of antidepressants for tinnitus. A recent trial in older people showed that atorvastatin had no effect on the rate of hearing deterioration but there was a trend toward improvement in tinnitus scores over several years. This is a drug designed for heart disease, that is marketed in Europe for vertigo and tinnitus. If you have tinnitus associated with a hearing loss, a hearing aid is a reasonable thing to try.
For venous tinnitus, possibilities include jugular vein ligation, occlusion of the sigmoid sinus, or closure of a dural fistula. The effects of unilateral cochlear implantation on the tinnitus handicap inventory and the influence on quality of life. Medium-term results of combined treatment with transcranial magnetic stimulation and antidepressant drug for chronic tinnitus.
Comparison of auditory brainstem response results in normal-hearing patients with and without tinnitus. Maintenance repetitive transcranial magnetic stimulation can inhibit the return of tinnitus. Meniere’s disease is a disorder of the inner ear that causes episodes of vertigo, ringing in the ears (tinnitus), a feeling of fullness or pressure in the ear, and fluctuating hearing loss. Meniere’s patients who have associated migraines are reported to have an earlier age of disease onset and a higher rate of family history, suggesting a genetic component (Cha, 2007).
Interestingly, the Framingham study found that 2% of the population of the United States believe they have Meniere’s disease, suggesting that there is considerable chance of misdiagnosis. In a review of literature, Ciuman (2009) stated that the endolymphatic sac in those with enlarged vestibular aqueduct was thin, whereas it was fibrous in those with Meniere’s.
Although a recent study showed significant neural deterioration in a guinea pig model of endolymphatic hydrops, a hallmark of Meniere’s (Megerian, 2005). This is an important part of treatment for virtually all patients with Meniere’s disease.
A permanent tinnitus (ringing in the ears) or a progressive hearing loss may be the consequence of long-term Meniere’s disease. It is thought that this reduces symptoms of Meniere’s disease by eliminating excess endolymphatic fluid within the ear. This fluctuation causes the symptoms of hydrops (pressure or fullness in the ears), tinnitus (ringing in the ears), hearing loss, dizziness and imbalance. In spite of this concentration of effort by the medical community, Meniere’s disease remains a chronic, incurable disorder that causes progressive disability to both hearing and balance.
Long-term vertigo control in patients after intratympanic gentamicin instillation for Meniere’s disease. Long-term disability of class A patients with Meniere’s disease after treatment with interlymphatic gentamycin.
The potential role of joint injury and eustachian tube dysfunction in the genesis of secondary Meniere’s disease. Evaluation of retrosigmoid vestibular neurectomy for intractable vertigo in Meniere’s disease: an interdisciplinary review. HLA-DRB1*1101 allele may be associated with bilateral Meniere’s disease in southern European population.
Dexamethasone perfusion of the labyrinth plus intravenous dexamethasone for Meniere’s disease.
Illness behavior, personality traits, anxiety and depression in patients with Meniere’s disease. Dexamethasone inner ear perfusion for the treatment of Meniere’s disease: A prospective, randomized double-blind crossover trial.
According to Park and Moon (2004), hearing impairment roughly doubles the odds of having tinnitus, and triples the odds of having annoying tinnitus.
Somatic tinnitus means that the tinnitus is coming from something other than the inner ear.
In a double-blind trial of paroxetine for tinnitus, 3% discontinued due to a perceived worsening of tinnitus (Robinson, 2007).

Specialists who care for patients with ear disease, usually know very well which drugs are problems (such as those noted above), and which ones are nearly always safe.
Of course, tumors are a very rare cause of tinnitus, as tinnitus is at least 100 times more common than tumors of the inner ear area. On the other hand, Hoekstrat et al (2011) suggested that in general these drugs do not work for tinnitus. This study suggested that Botox might improve tinnitus to a small extent (7 improved with active, 2 improved with placebo). Be sure that you try the hearing aid before buying one, as tinnitus is not always helped by an aid. Given that smartphone apps do the same thing as tinnitus maskers, and that most newer hearing aids are blu-tooth capable, we see little reason to pay for a masker-hearing aid when one already owns a cell phone. Surgery seems worth considering only in extreme situations - -the tinnitus is extremely loud, very distressing, and there is a methodology to decide whether or not the tinnitus can be improved with surgery.
On the other hand, very few individuals with tinnitus are deaf enough to qualify for cochlear implants. A Meniere’s episode generally involves severe vertigo (spinning), imbalance, nausea and vomiting. These are attributed to sudden mechanical deformation of the otolith organs (utricle and saccule), causing a sudden activation of vestibular reflexes. Between the acute attacks, most people are free of symptoms or note mild imbalance and tinnitus.
Recently, the the HLA-Cw allele was found to much higher in Meniere’s patients than controls (Khorsandi et al., 2011).
While some people have hearing that fluctuates like this without any further symptoms of dizziness or tinnitus, in most cases, this does not progress to Meniere’s disease (Schaaf et al, 2001). This treatment however damages the inner ear and causes bilateral vestibular paresis, which has its own set of symptoms and disability. Auditory and vestibular hair cell stereocilia: relationship between functionality and inner ear disease.
Long-term effects of the Meniett device in Japanese patients with Meniere’s disease and delayed endolymphatic hydrops reported by the Middle Ear Pressure Treatment Research Group of Japan. Intratympani gentamicin treatment of patients with Meniere’s disease with normal hearing. Practically, as there is only a tiny proportion of the population with objective tinnitus, this method of categorizing tinnitus is rarely of any help.
In other words, the changes in the brain associated with tinnitus seem to be associated with emotional reaction (e.g. In a large study of tinnitus, avoidance of occupational noise was one of two factors most important in preventing tinnitus (Sindhusake et al. Tinnitus from a clear cut inner ear disorder frequently changes loudness or pitch when one simply touches the area around the ear. There are case reports concerning tinnitus as a withdrawal symptom from Venlafaxine and sertraline (Robinson, 2007). Nevertheless, this quality of tinnitus probably justifies a trial of oxcarbamazine (a less toxic version of carbamazepine). TMS seems to be somewhat helpful for depression and migraine, and one would think that a modality that worked for these, would also work to some extent for tinnitus. If tinnitus is reduced by intratympanic lidocaine injection, it seems reasonable to us that surgical treatment may also be effective (for unilateral tinnitus).
Other possibilities, however, are selection bias and different patterns of the disease in different countries. Vestibular (motion sensing) hair cells seem more resilient but there is also a slow decline in the caloric response in the diseased ear over roughly 15 years (Stahle et al, 1991). We presently do not recommend vestibular nerve section for Meniere’s disease, except in situations where gentamicin injection has failed.
Large amounts of caffeine may trigger migraine (migraine can be difficult diagnostically to separate from Meniere’s disease). It seems to us that it should be possible to separate out tinnitus into inner ear vs everything else using some of the large array of audiologic testing available today. The exact prevalence of TMJ associated tinnitus is not established, but presumably it is rather high too. In our clinical practice, we have occasionally encountered patients reporting worsening of tinnitus with an antidepressant, generally in the SSRI family.
When this doesn't happen, the treatments that work the best for tinnitus are those that alter ones emotional state -- antidepressants and antianxiety drugs, and ones that allow you to get a full night's sleep.
Robinson reported that tinnitus in depressed patients appears more responsive to antidepressants than in non-depressed patients.
We have encountered patients who have excellent responses to cervical epidural steroids, and in persons who have both severe tinnitus and significant cervical nerve root compression, we think this is worth trying as treatment.
Having TMJ increases the odds that you have tinnitus too, by about a factor of 1.6 (Park and Moon, 2014).
Mechanisms for impovement were suggested to be direct effects of increased serotonin on auditory pathways, or indirect effects of tinnitus on depression or anxiety. The majority of people with Meniere’s disease are over 40 years of age, with equal distribution between males and females.

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