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Treatments for Meniere's disease
1. Supplements that may help
Dietary supplementation is exactly what it says it is, 'supplementing' your diet to work in synergy with a healthy whole food diet; it is not meant to replace it.
Those who add specific supplement regimens high in antioxidants to a diet low on salt, sugar, saturated fats, trans fats, hydrogenised fats, GMO's, junk foods, processed foods, alcohol and sugary chemical filled sodas while high in fresh (organic if possible) fruits and vegetables get the best results.
Click here to read details on this regimen and find links to the exact supplements.
Lipoflavonoid
Lipoflavonoid Plus
Lipoflavonoid Plus is an over the counter nutrient based formula that dates back to 1961.
It contains bioflavonoids extracted from citrus fruit peel. Eriodictyol glycoside is the exact extract and has been shown to improve microcirculation in the inner ear canal in at least one medical study, which concluded that Lipoflavonoid provides a beneficial effect for patients suffering from tinnitus due to Meniere's disease.
Some ear, nose and throat specialists recommend Lipo-Flavonoid for their patients who suffer from tinnitus.
Can Lipoflavonoid Help Meniere's Symptoms?
Recommendations from the Clinical Nutrition Desk Reference
Dr Laurant Bannock DrHS MS LN. world renowned Nutritionist and international speaker recommends the following supplementation for Meniere's and tinnitus in his acclaimed book 'The Clinical Nutrition Desk Reference':
Vitamin C - for increased immune function
Bioflavonoids - antioxidant & anti-inflammatory properties
Thymus extract - immune support & helps decrease foods allergies (thought by some to be a causative factor in tinnitus and Menere?s disease
Propolis - natural antibiotic and attacks viruses
Beta-carotene - potent anti-oxidant and immune booster. Beta carotene is what is known as pro-vitamin A. It allows your body to form the amount of vitamin A needed at any given time rather than overloading it.
Ginkgo biloba - increases circulation to the ear
Manganese - deficiency has been linked to ear problems
N-acetyl cysteine - may thin mucus and help ears to drain
You can see the common theme above among all these nutrient roles. This is to combat oxidative stress, reduce inflammation and to improve blood flow.
As stated above, supplementation works in synergy with a healthy diet and is not meant to replace food.
John of Ohio's regimen
If you have searched the web much for answers on Meniere's then you may have come across a regimen of supplements put together by a biologist who goes by the web name of "John of Ohio".
The basic approach of John is similar to that of the supplements written of above with one distinct difference. John seems to aim at specifics within the ear mainly and the possibility that your cause maybe linked to the herpes virus, which has been shown to be a causative factor in at least some people.
The supplements used with such success over the past 16 years (first regimen above) is aimed at making sure your immune system is strong enough to deal with the hydrops and therefore stop all the symptoms, regardless of the underlying cause.
One other major difference is that while John recommends stand alone supplements, the regimen above top uses is a broad spectrum completely balanced set of nutrients that work in synergy.
Like us, John refused to accept, in his words, "the American dogma that Meniere's treatments could be only palliative (merely suppressing some symptoms), that he had have to learn to live with it."
According to John, he researched how physicians in other countries dealt with Meniere's disease; notably Europe and Russia.
Someone who recently mailed Meniere's Help said she thought John's regimen was a "crock", to quote her.
It is certainly true that we have had sufferers come to us who have tried John's regimen and had no success only to later live symptom free using the supplements recommended above.
That said, there is credibility in what John suggests. Visit the forums and social media online and you will no doubt read about people who have tried John's regimen. There are plenty of stories of success and John himself claims there is over an 80% success rate.
More than likely one major aspect as to whether there is any success may depend on the quality of what people use. As stated above, not all supplements are created equal and there is plenty of garbage in the stores that are useless to anyone, let alone someone with Meniere's.
As John quite rightly says, there are many factors to consider and what might work for one might not work for another. The quality of the supplements, the quality of your diet, your lifestyle and the origin of your underlying root cause all have an influence on what works for you.
Our personal view is that is that John's regimen may help ease the symptoms if you use quality supplements, eat a healthy fresh food diet and your underlying cause is linked to the herpes virus.
John's regimen seems to have more success for those whose symptoms are a result of the herpes virus.
There are several possible root causes, herpes is one possibility.
Confused or overwhelmed? Click here to read The Need for Balance - Dealing with the Causes of Meniere's
John's recommendations are:
Lemon bioflavonoids
Lemon rind has a high concentration of a bioflavonoid known as eriocitrin. Eriocitrin has been shown to dilate (widen) both capillaries and small arteries, allowing increased blood flow. It also increases capillary permeability, allowing chemicals to diffuse through the capillary wall.
Vinpocetine
Vinpocetine is a plant-derived chemical from Europe. It is extracted from the Vinca minor plant and in many parts of Europe it is used for Meniere's disease.
It is also used by Russian astronauts to combat vertigo. It is known to increase circulation through small blood vessels. It is also claimed that using vinpocentine over long periods of time can decrease tinnitus.
L-lysine
The amino acid l-lysine is used to combat the possibility that herpes viruses are a major cause of Meniere's symptoms. L-lysine is known to effectively interfere with the replication of herpes viruses
Beta 1,3 Glucan
Also present in the regimen to tackle the herpes virus. Beta glucan products attach to white blood cells (macrophages) and increase the immune system's ability to fight off bacteria and suppress fungi and viruses. Beta glucans are also strong anti-oxidants.
Gingko biloba
Ginkgo biloba extract has been used for thousands of years and is one of the most "prescribed" "medicines" in Germany. It is derived from the ginkgo tree that is prevalent in east Asia. It promotes blood flow, especially through the small peripheral blood vessels of the brain. It is known as the "memory herb" among some people in high pressure jobs.
Prescribed by naturopaths, herbalists and nutritionists for tinnitus and Meniere's. This is used as part of the regimen in the first paragraph at the top of the page.
Vitamin C and vitamin E
Vitamin C works in synergy with bioflavonoids and is a powerful antoxidant.
Vitamin E is an essential ingredient in the fight against inflammation and oxidative stress.
Methylsufonylmethane ( MSM )
MSM is reputed to increase healing in damaged tissue and also reduce allergic reactions. It is usually used for joint support.
Vertigoheel
Vertigoheel is a homeopathic remedy for vertigo and dizziness. He claims it worked for him and that studies show it can help vertigo from Meniere?s disease.
Vertigoheel is a prescription drug in the U.S. but the same product under the different name of Cocculus Compositum can be bought over the counter.
Cocculus Compositum is a remedy for "motion sickness, lightheadedness and nausea.
2. Dietary considerations
Dietary considerations for reducing Meniere's symptoms are eating plenty of fresh (organic if possible) vegetables, in particular dark green leafy vegetable, plenty of fresh fruits and getting omega oils through fish and nuts.
Also consider gluten and dairy allergies as part of your trigger list for your symptoms..
We know that diet plays a big part in keeping triggers at bay. Caffeine and alcohol should also be limited or cut out completely. If you are doubtful as to the importance of diet read this mail we received in September 2013:
"My husband is doing quite well now. He quit taking all medication and instead we made a pretty major lifestyle change.
We have tried to cut all processed foods out of our diets and are eating a whole food diet.
Since we made this change, he has returned to his good health.
No symptoms at all, until we fall off the wagon and start eating junk again"
Consider superfoods found in nature such as fresh cranberries (not juice as this is full of sugars) and sea vegetable. These are full of essential vitamins and minerals and a good source of natural idodine.
Click here to read Superfoods for Meniere's disease
Chlorella
Chlorella is a nutrient packed superfood that comes from green algae. It is high in Vit C, Vit E, protein and carotenoids. What makes Chlorella a superfood is it is packed with chlorophyll . This is beneficial to our health because it?s such a powerful blood cleanser and blood cell builder.
It is also a powerful detoxifier, rich in enzymes that promote quick rejuvenation of our cells, high in Amino acids, improves liver function, it's an anti-inflammatory, anti-oxidant - neutralizes free radicals, promotes healthy intestinal flora and alkalizes the body. All of which are beneficial to Meniere's sufferers.
There are many cases of people reducing or ridding themselves of Meniere's symptoms using chlorella supplements.
Meniere's Help's own Mike tried them in Japan and said they helped a great deal for a time and were part of the reason he opened up his mind to the possibility that the supplements we use may help him, which of course they ultimately did.
The chlorophyl found in chlorella can also be found in leafy green vegetables (darker the better), Kale, herbs like parsley and cilantro and wheat grass is one of the highest sources of chlorophyll available.
Ideally eating plenty of fresh organic leafy veggies is best but if you can't keep to that or you live in a region where GMOs and heavily sprayed pesticides are prevalent then Chlorella supplements are a very good idea.
Broken cell wall chlorella is the best option because this form is more bioavailable. Meaning it will absorbed inside the body properly.
Click here to get Chlorella
3. Acupuncture
Western physicians may discount acupuncture full stop, saying there is no scientific evidence that the energy flows and pathways that acupuncture helps even exist.
The fact is, that is an outdated belief. Quantum physicists now tell us that we are of course made up of flowing energy fields.
The very matter we are made of at its core level is simply electro-magnetic energy. The heart has a very powerful electro-magnetic field that is 1000 times stronger than the brain.
We have half a dozen major energy points running up the core of our body and the energy flows all over, through a multitude of smaller energy points.
Acupuncture taps into those energy points and helps it flow in a more balanced, energized way.
The benefits you may or may not get from acupuncture depends on the knowledge and skill of the practitioner.
In our experience, direct and second hand, acupuncture is not a cure but can often give great relief from symptoms.
Assessment of results of Acupuncture for Meniere's disease, extract from the Journal of Chinese Medicine:
The assessment of the results is recorded in three categories: Marked Improvement, Improvement and Failure
Marked improvement: dizziness disappeared and hearing improved after treatment, with no relapse during a follow- up of one year.
Improvement: dizziness disappeared but hearing was not improved after 3 courses of treatment.
Failure: no improvement was noted or a slight improvement with relapse during a follow-up of 6 months
Of the 72 cases, 36 were markedly improved (50.0%) after 2- 3 courses of treatment, 17 improved (23.6%) and 19 failed (26.4%). The treatment was more effective in cases of short duration.
4. Chiropractic Manipulation
Chiropractors believe that Meniere's disease may be a direct result of a misalignment of the cervical bones in the neck. This misalignment is thought to put pressure on the root of the balance and hearing nerves.
Chiropractors believe that manipulation of this area can relieve most of the symptoms and in most cases correct the underlying cause.
In the experience of the main contributor to Meniere's Help, Mike Spencer, this was indeed the case. We also receive many emails from sufferers who corrected problems with their neck and back and found their symptoms disappeared completely.
So it would appear that in at least some cases this may have been major factor in the root cause of their symptoms of Meniere's.
As with acupuncture, and indeed any other profession, success and the correct diagnosis depends very much on the skill, experience and knowledge of the practitioner.
Mike says that he went to a chiropractor in the UK and was laughed at by an "arrogant, ignorant woman" who had no idea what she was talking about and gave him the worst most painful session he ever received. She insisted that Meniere's had no connection to the neck.
He had already seen a highly reputable chiropractor in Japan and was immediately told his atlas bone (C1) was misaligned and his back and hips were twisted probably as a result of a knee injury years before.
Mike, the founder of Meniere's Help had been more or less symptom free for ten years as a result of using the regimen of dietary supplements in paragraph one above but still had a slight tinnitus and deafness following a shunt operation.
After several sessions with Kato Sensei in Japan, he was shocked when his hearing returned and tinnitus disappeared altogether.
He had heard of other sufferers' hearing returning while they were on the supplements but in his case, whereas his hearing fluctuated anywhere from terrible to normal before his shunt implant, afterwards his hearing had been at a constant very low level. Now his hearing is almost back to normal.
So this emphasizes the need to be checked by a reputable cervical certified chiropractor and the wisdom of getting a second or even a third opinion on anything to do with your health.
In public hospitals in Japan you will see notices on the walls advising patients to always get a second opinion; wise words indeed.
Dr Michael Burcon is a world renowned Chiropractor and speaks in many countries on the subject of Meniere's. He reported these findings:
"After upper cervical specific chiropractic care, one hundred and thirty six out of the one hundred and thirty nine patients presented with an absence or dramatic reduction of symptoms, especially vertigo - that's 97%!
Dr Burcon says that prior to the onset of symptoms, all one hundred and thirty nine cases suffered cervical traumas; most from automobile accidents, resulting in previously undiagnosed whiplash injuries.
He maintains that many sufferers have suffered cervical trauma at some point in their life and it may take many years for the effects to show up in the symptoms of vertigo or Meniere's."
Click here to read more on chiropractics for Meniere's
Neurocranial Restructuring
There are success stories reported after having Neurocranial Restructuring (NCR). This is a relatively new treatment that comes from the same hypothesis as chiropractics but the actual practice is different.
NCR is similar to cervical spine chiropractic treatment in that it concentrates on the muscular skeletal aspect of the body as an holistic solution to Meniere's disease or vertigo.
Neurocranial Restructuring is a manipulative craniosacral procedure that works directly on the primary cause of neuro-musculoskeletal dysfunction - a misaligned skull.
Click here to read about Neurocranial restructuring for Meniere's disease and vertigo
5. Chinese Medicine
Traditional Chinese medicine is a huge subject in itself. Chinese medicine concentrates on biological deficiencies, excesses and dysfunctions of the body's internal organs and how this affects other parts of the body. In this case the ear.
Here is an extract from a report on how Chinese medicine can help Meniere's disease and tinnitus:
Traditional Chinese physicians divide vertigo into four major categories, two associated with excess type conditions and two associated with deficiency type conditions, as outlined in the Advanced Textbook on Traditional Chinese Medicine and Pharmacology:
Hyperactivity of kidney yang, secondary to a syndrome of liver qi stagnation, development of liver fire, and damage to the liver yin. The standard treatment for this type of problem is Gastrodia and Uncaria Combination (Tianma Gouteng Tang), which may be modified to treat vertigo by adding chrysanthemum, tribulus, and prunella (or other modifications as appropriate to the specific presentation of symptoms).
Retention of turbid phlegm in the middle burner, which results from eating too much greasy and/or sweet foods, working too much, and, as a result, impairing the ability of spleen and stomach to transport and transform. The standard treatment for this type of problem is Pinellia and Gastrodia Combination (Banxia Baizhu Tianma Tang), though sometimes Hoelen Five Herb Formula (Wuling San) is given in mild cases to drain the excess dampness; when the dampness-phlegm syndrome is severe, hoelen and alisma (ingredients of Wuling San) are added to the Pinellia and Gastrodia Combination. If the phlegm combines with a fire syndrome, then Bamboo and Hoelen Combination (Wendan Tang) may be used instead or along with Pinellia and Gastrodia Combination.
Deficiency of kidney essence (yin),which may be the result of congenital deficiency, aging, or excessive stress on the kidney system. The standard remedy for this problem is either Rehmannia Six Formula (Liuwei Dihuang Wan) or Zuogui Wan (Left Returning Pill, referring to restoration of yin to the left kidney); this formula may be modified, if necessary, to address deafness.
A survey of the Chinese literature indicates that Meniere's disease is usually more easily treated than persistent tinnitus and symptoms such as deficiency heat, or to address accompanying kidney yang deficiency.
Deficiency of qi and blood, which may result from prolonged illness, massive blood loss, or chronic deficiencies of spleen and stomach function. The standard remedy for this type of problem is Ginseng and Longan Combination (Guipi Tang); in cases of weakened stomach function, shen-chu, hoelen, and dioscorea can be added.
In general, the treatment of Meniere's disease parallels that of tinnitus and deafness. However, the symptom of dizziness connotes, to most physicians, an accumulation of dampness in the head, so that there is greater emphasis on treating the type 2 vertigo described above, while simple tinnitus or loss of hearing (not accompanied by significant dizziness) is more frequently treated by tonifying the deficiency of qi, blood, and yin (the strategies involved in type 3 and type 4 vertigo).
Combination syndromes are likely. For example, a person with chronic poor diet may accumulate phlegm and dampness, but not adequately nourish qi and blood; with aging, the lack of nourishment can lead to kidney yin deficiency, which results in liver yin deficiency; the combination of liver yin and blood deficiency contributes to liver fire and liver yang rising, carrying with it the pathological fluids that have accumulated.
Thus, an elderly person may suffer from Meniere's disease simply as a consequence of long-term dietary indiscretion along with aging. These combination syndromes can also arise via other pathways; for example, emotional distress may cause liver qi stagnation which will lead, over the long run, to the problem of liver fire and liver yang rising; in the meantime, this problem yields disturbance of the spleen and stomach (liver qi adversely affecting these organs) and weakening of kidney yin under the influence of liver fire.
In the case of such combination syndromes, it is important to evaluate the extent of excess and deficiency that exists and treat accordingly. In some cases, one can first clear some of the excess (relatively quickly) and then treat the deficiency (over an extended period of time); in other cases, the deficiency may be so severe that it needs to be treated in order to help alleviate the excess.
You can see that the very focus of Chinese medicine is on the root cause. In this case mostly the internal organs and how that affects the Meniere's condition. This may be a medial cause as other causes may be resulting in dysfunction of the internal organs that lead to endolymphatic problems.
Still, this is the polar opposite of western medicine, which for the most part, focuses on the symptoms, or the end result.
It is like a fireman tackling a fire from a gas main. Does he spray foam or water on the resulting flames all day or does he turn the gas main off?
Read more on Chinese medicine here: Chinese Medicine for Meniere's disease
6. Vestibular Rehabilitation Therapy (VRT)
Vestibular rehabilitation therapy (VRT) is an exercise-based program designed to promote central nervous system compensation for inner ear deficits.
VRT is sometimes used with a variety of vestibular problems, including benign paroxysmal positional vertigo (BPPV), Meniere's disease, labyrinthitis, and vestibular neuritis.
The purpose of VRT is to retrain the brain to recognize and process signals from the vestibular system in coordination with vision and the ability to sense the position and location and orientation and movement of the body and its parts. This often involves desensitizing the balance system to movements that provoke symptoms.
A qualified physical therapist (PT) or occupational therapist (OT) will first perform a thorough evaluation that begins with a medical history and includes observing and measuring posture, balance and gait an assessment possibly including eye-head coordination tests that measure how well a person?s eyes track a moving object with or without head movement.
The therapist will develop an individualized treatment plan that includes specific head, body, and eye exercises to be performed both in the therapy setting and at home.
Depending on the diagnosis and collaboration with the physician, the in-office treatment with the therapist may also involve a specialized form of VRT called a canalith repositioning procedure, which is often referred to as the Epley maneuver.
7. Orthokine therapy
Dr. Peter Wehling Founder of The Center for Molecular Orthopedics in Dusseldorf, Germany, has developed a procedure where the patient's own blood is taken, incubated and manipulated then reintroduced into the body and acts as a natural anti-inflammatory.
Originally this was used for treating sports people to combat chronic pain, usually in joints. The treatment is called Orthokine therapy
The ear is affected by inflammation in Meniere's disease and the procedure is said to have been developed further where it may be possible for the hearing and balance nerves damaged by Meniere's to be healed.
At the time of writing, this has not been made available as a standard Meniere's treatment.
Orthokine therapy is now available in the USA and the UK at private clinics but not offered as a treatment for Meniere's. There are ways to get it done, but reports claim that it will cost you in the region of $10,000 and to our knowledge will not be covered by health insurance.
That said, it is an exciting prospect for the future. If this treatment can be used to combat inflammation in the joints, it can be used on other parts of the body, In fact it already has been used for Meniere's.
Dana White, the UFC President was treatment for Meniere's in Germany is said to feel "cured".
Click here to read The Need for Balance - Dealing with the Causes of Meniere's
8.Diuretics:
By increasing urine production, treatment with diuretics contributes to a "negative sodium balance", which means that more sodium is lost from the body than is consumed.
This contributes to the effects of a low sodium diet and results in hormone level changes associated with sodium conservation by the body.
Hydrochlorothiazide is used as a potassium sparing diuretic.** It comes in the brand names as Dyazide and Maxzide.
**Note: Some diuretics deplete potassium levels in the body and that depletion alone it is said can cause Meniere's like symptoms.
If you are taking potassium depleting diuretics, it would be a good idea to eat potassium rich foods such as bananas, potatoes and apples to keep your levels normal**
Furosemide which comes in the brand name Lasix, is what is known as a loop diuretic, a specific class of diuretics that inhibits re-absorption of sodium and chloride ions, thereby increasing the volume of urine excreted.
It is also known that stria vascularis in the cochlea (the tissue that secretes endolymph) is highly sensitive to furosemide, although it is not known whether this helps in the action of this diuretic.
Acetazolamide which comes in the brand name of Diamox is a carbonic anhydrase inhibitor, anticonvulsant, and antiglaucoma agent.
Acetazolamide is sometimes prescribed because of its effectiveness in treating glaucoma of the eye (with which endolymphatic hydrops is sometimes compared). However, regulation of endolymph in the inner ear occurs by completely different mechanisms to those in the eye, so that acetazolamide is unlikely to have any direct effect on hydrops in the ear.
Acetazolamide also acts as a diuretic and may, by increasing sodium excretion, be beneficial.
The action of acetazolamide is different in that it inhibits the enzyme carbonic anhydrase, which influences carbon dioxide, and bicarbonate homeostasis, and may affect pH regulation in some tissues. One study (Brookes and Booth, 1984) reported poor results and a high incidence of side effects with this diuretic
Hydrochlorothiazide (HCTZ) comes in the brand names HCTZ, Esidrix, Oretic, HydroDiuril and Microzide.
Antihypertensive HCTZ is one of the diuretic components of Dyazide.
9. Anti-emetic, Anti-nausea and Anti-vertigo drugs
Most of these drugs are generally aimed at treating vertigo in Meniere's disease, but it is also thought that they may also help in controlling the condition itself by reducing stress and anxiety.
Anti-nausea:
Meclizine Hydrochloride comes in the brand names Antivert, Bonine, D-Vert, Dramamine II, Meclicot, Medivert.
You can buy Meclizine over the counter in travel sickness pills.
It is believed to work by decreasing the sensitivity of the body's central nervous system balance centers. It helps manage motion sickness and affects the chemoreceptor trigger zone to control vomiting.
Betahistine comes in the brand name Serc. It is the most widely used anti vertigo drug for Meniere's ouside the USA. and is a an H1 binding histamine.
Betahistine is also reported to increase cochlear blood flow, which may in some way also contribute to the improvement seen in patients. Serc is not available in the USA but generic forms of betahistine may be available by prescription through compounding pharmacies.
Click here to read: Betahistine For Meniere's Disease Efficacy and Safety Study
Promethazine Hydrochloride is a tranquilizer, antiemetic, H1 receptor blocker, Phenothiazine. and comes in the brand name of Phenergan.
Promethazine controls nausea, vomiting and motion- sickness. An H1-blocking antihistamine with sedative and anti-emetic properties.
Dimenhydrinate comes in the brand names of Dramamine and Vomex.
It is an antiemetic and an H1 receptor blocker. Dimenhydrinate is an antihistamine used to treat motion sickness, nausea and vomiting. It works by blocking histamine from binding to its receptor, preventing histamine from exerting its effects.
Prochlorperazine Maleate (Phenothiazine) comes in the brand names of Compazine and Stemetil. It is a tranquilizer; antiemetic and an antipsychotic.
Prochlorperazine is used for the management of psychotic disorders, anxiety and to control emesis (nausea and vomiting). It works by blocking the dopamine receptors in different parts of the brain.
Stemetil is widely used outside the USA.
Scopolamine [Transdermal] comes in the brand name of Transderm-Scop and is an anticholinergic agent and antiemetic.
Transdermal scopolamine is a naturally occurring belladonna alkaloid with anticholinergic properties. It is used to prevent nausea and vomiting associated with motion sickness in adults. It does this by altering stimulation to the central nervous system.
Hydroxyzine Pamoate comes in the name of Vistaril. It is an antihistamine, tranquilizer, antiemetic and H1receptor blocker.
Hydroxyzine pamoate is an antihistamine used to treat a variety of allergic conditions. It is even used
preoperatively to help induce sleep.
It works by blocking the action of histamine, an important inflammatory mediator in the body, from binding to its receptor and exerting its effects.
Thiethylperazine Maleate comes under the brand name of Torecan. It is a type of antiemetic called Phenothiazine.
Thiethylperazine works by triggering brain chemoreceptors to alter the message to the vomit center in the brain and is used to treat severe nausea and vomiting.
10. Anti-Anxiety drugs
As we know, stress is an important factor in triggering Meniere's attacks. It is well documented that stress changes some hormone levels (especially of the corticosteroids).
It is thought that treating the stress may itself lead to an improvement in the patient's Meniere's condition. So-called "life-stress situations" can commonly precede attacks not to mention fear of future attacks themselves.
The greater the fear of attacks, the more frequent and severe they become and vice versa. It becomes a vicious cycle.
The use of anti-anxiety drugs is aimed at breaking this cycle.
Click here to read Stress and Meniere's disease
Click here to read Meniere's disease and Anxiety
Diazepam (Benzodiazepine) comes in brand name of Valium, Di Tran and Diazepam Intensol.
Diazepam is a type of central nervous system (CNS) depressant (medicine that slows down the nervous system).
It is used to treat several disorders including panic disorder, muscle spasms, anxiety, and alcohol withdrawal. It is also used in combination with other anti-seizure medications to treat seizure disorders.
Lorazepam comes in the brand names Ativan and Lorazepam Intensol.
Lorazepam is a benzodiazepine, a type of central nervous system (CNS) depressant (medicine that slows down the nervous system). It is used to treat anxiety, anxiety associated with depression, or insomnia.
Alprazolam comes in the brand names Xanax and Alprazolam Intensol.
Alprazolam is a benzodiazepine, a type of central nervous system (CNS) depressant (medicine that slows down the nervous system). It is used to treat anxiety, anxiety associated with depression and panic disorders.
Chlorpromazine Hydrochloride (Phenothiazine) comes in the brand name Thorazine.
Antiemetic Chlorpromazine is a tranquilizer that belongs to a class of antipsychotic drugs called phenothiazines.
It is used to treat schizophrenia as well as for the control of anxiety or agitation in certain patients, severe nausea and vomiting and severe hiccups. Chlorpromazine works in the brain and at all levels of the central nervous system to exert sedative and anti-nausea activity.
11. Steroids
Sometimes steroids are prescribed for Meniere's patients.
These steroids are synthetic glucocorticoids (the natural form are synthesized by the adrenal glands).
Because some patients see positive benefits as a result of the suppression of an autoimmune response, this has been used to support the concept that Meniere's disease may arise from some form of autoimmunity.
Glucocorticoids have many effects on the body; affecting carbohydrate and protein metabolism, lipid metabolism, electrolyte balance, inflammatory responses and immune responses.
However, it is also thought possible that these steroids may have a direct effect on fluid homeostasis in the ear.
It is therefore impossible at the present time to know exactly which of the effects of these steroids is important in relieving the symptoms of Meniere's disease.
Prednisone comes in the brand names of Deltasone, Meticorten and Orasone.
Glucocorticoid Prednisone is a glucocorticoid steroid used to treat a variety of inflammatory conditions, including asthma, allergic reactions and autoimmune diseases (such as lupus). It works by altering how the immune system responds to certain stimuli.
It may also act directly on fluid homeostasis in the inner ear by interacting with glucocorticoid receptors in the ear.
One of the reasons that autoimmune disorders are believed to be one of many causes of Meniere's symptoms is that some sufferers respond to Prednisone.
Cortisone Acetate comes in the brand name of Cortisone.
Cortisone acetate is a glucocorticoid used to treat a variety of inflammatory conditions, including the management of adrenocortical insufficiency (when the body lacks glucocorticoids). Cortisone may act to supplement the body's natural glucocorticoid stores or alter how the immune system responds to certain stimuli.
Dexamethasone Sodium Phosphate or dexamethasone acetate comes in the brand name of Adrenocot, Dalalone, Decadron,Decaject, Dekasol, Dexacorten, Dexasone, Dexim, Dexone, Hexadrol, Medidex, Primethasone and Solurex.
Dexamethasone belongs to a class of anti-inflammatory agents called corticosteroids. It is used to treat various inflammatory conditions. It works by altering the way the immune system responds to certain stimuli.
Dexamethasone is sometimes given locally to the cochlea (by injection through the eardrum into the middle ear space) in conjunction with intravenous administration. This allows higher drug levels to be achieved in the cochlea.
12. Anti-histamines
Calcium channel blocker - Stugeron / Cinnarzine comes in the brand names Claritin and Allegra.
There are no studies in which the efficacy of this drug has been assessed in Meniere's patients.
It is not known exactly how it influences Meniere's symptoms and/or function of the ear is not known.
Studies in animals with endolymphatic hydrops have shown the endolymph calcium level to be elevated. Limited measurements of endolymph sampled from Meniere's patients also shows a high calcium level.
This raises the possibility that a calcium disturbance may contribute to the symptoms of Meniere's disease.
Some physicians, especially in those in Europe, have been using calcium channel blockers to treat Meniere's disease, including, Flunarizine, Nimodipine and Cinnarzine.
13. Osmotic agents
Glycerol
Glycerol is given to patients with Meniere's disease as part of some diagnostic tests. The effect is very short-term (hours) and glycerol is not used as a long-term therapy.
In addition, glycerol sometimes produces the side effects of nausea and headache.
Urea
Urea is given to patients with Meniere's disease as part of some diagnostic tests. Its effects are very short-term (hours) and urea not used as a long-term therapy.
However, urea is not well accepted by patients due to the taste and the side effects, which can include nausea and headache.
Isorbide
Isorbide is used as an osmotic agent, which produces diuresis (production of urine). Clinically, isorbide is better accepted than urea and glycerol as it tastes better and does not have the side effects.
It has been reported that over an 8 week period, isorbide treatment improved hearing in 38% of the patients in one study (Kakigi et al, 1995) but no reduction in vertigo was reported.
Isorbide is widely used to treat Meniere?s patients in Japan.
14. Ototoxic Antibiotics
In Meniere's disease, antibiotics are not used for their conventional, anti-bacterial purpose. Instead, it is used to selectively damage the sensory hair cells of the vestibular system.
This can also be described as a chemical labyrinthectomy, which represents a non-surgical, method to reduce the sensitivity of the vestibular system.
By impairing or destroying these cells, the brain is no longer sent "incorrect" information. The hope is that, given at the right doses, vestibular function is reduced without damaging hearing. It is usually injected into the middle ear space through the eardrum, and enters the inner ear through the round and oval windows.
This method can be effective, but in practice it is difficult to achieve vestibular ablation without causing some damage to hearing.
Research has been done to find the best regimen of antibiotic applications. Olsen et al. (1995) reported that best results were obtained with 2-4 applications to the middle ear, with a greater likelihood of hearing loss if more treatments were given.
One common approach is to "titrate" the number of treatments to the patients symptoms, using just enough to alleviate vertigo without necessarily destroying all vestibular function.
Gentamicin
Gentamicin is injected through the eardrum into the middle ear space. From there it diffuses into the fluids of the inner ear.
Usually, repeated injections are performed over a period of weeks, which allows hearing function to be monitored to minimize the chances of further hearing loss.
Gentamicin is usually used only when one ear is affected.
Streptomycin
This is used in cases of bilateral Meniere's disease some doctors administer streptomycin intramuscularly at a dose which is titrated to suppress labyrinthine function.
One of the problems associated with bilateral ablation of the labyrinths is a condition called oscillopsia, where visual problems can be as disturbing to the patient as vertigo.
The goal with streptomycin administration is to reduce the sensitivity of the labyrinths without totally ablating them.
15. Sodium bicarbonate infusion
In Japan physicians often administer intravenous sodium bicarbonate as a treatment for an acute vestibular/Meniere's attack i.e. vertigo.
This therapy is not presently used in the USA or Britain.
In Japan, a sufferer can visit an ENT clinic without an appointment and if having a vertigo attack, will be rushed straight in, put on this drip and left to rest. It is used with great success in reducing chronic symptoms at that time.
16. Surgical Procedures
It has been suggested that the improvement seen in patients following ear surgery may in part be due to the general anesthesia used. Furthermore, some patients benefit from anesthesia without surgery.
Gates (1999) reported that in the 30% of Meniere's patients who did not respond to low-salt diet, diuretics and stress reduction, 60% of these patients gained relief from vertigo by one injection of the anesthetic, Innovar.
This has been attributed to a long-lasting depression of the vestibular system by some anesthetics.
Endolymphatic Shunt
Endolymphatic sac surgery is still relatively controversial.
Based on a published study, many physicians regard endolymphatic sac surgery as a "placebo" surgery (i.e. the patient gets the same outcome whether or not the sac is acutally shunted) and will no longer perform it.
One physician has described the procedure as "at best non- specific and at worst of no value". Others regard surgery of the sac to as a valuable "intermediate step" between non-surgical therapies and the more invasive procedure of vestibular nerve section.
Endolymph-subarachnoid shunt.
A drainage tube is inserted between the endolymphatic sac and the cranium.
Endolymph-mastoid shunt
This involves placing a tube between the endolymphatic sac and the mastoid cavity of the middle ear.
This procedure is generally used as an alternative to potential problems of opening the cranium in the endolymph-subarachnoid shunt.
It is possibly still one of the most common procedures used of the surgical options available and it is claimed that this operation has a possible 60%success rate.
60% is open to debate judging by the sheer amount of sufferers who contact Meniere's Help and report that they have had the operation and it was ultimately unsuccessful.
(click here to read Managing Meniere's Disease for more on this argument)
Endolymphatic sac decompression
This surgery involves drilling away the bone overlying the endolymphatic sac to make a larger "cavity" for the sac to occupy.
So instead of stopping the cause of the swelling sac or stopping the sac from swelling this procedure creates a larger area for the inflamed sac to spead into, presumably to prevent the sac from pressing on the balance and hearing nerves.
Tympanostomy tube inserted through the eardrum
This is a relatively minor procedure which is often used in children and adults for the relief of middle-ear infections.
The purpose of the tube is to maintain a tiny hole through the eardrum.
Although the medical community has been skeptical that this treatment would have any bearing on Meniere's disease, many physicians claim success rates as good as endolymphatic shunt surgery.
Studies suggest a high proportion of Meniere's patients do get relief from vertigo after using this procedure.
A study in animals has provided scientific support that the procedure is effective, finding that hydrops developed to a lesser degree when the eardrum was perforated.
However, other physicians remain unconvinced and there is as much controversy on this issue, as there is with endolymphtic shunts.
Endolymphatic sac partial ablation (destruction)
There are claims that outcomes equal or better that of other sac procedures using this procedure of partially ablating (destroying) the distal region of the endolymphatic sac.
(Gibson 1999)
Sacculotomy, Cochleosacculotomy
These are relatively minor surgical procedures which involve perforation of the saccule through the stapes footplate (sacculotomy) or through the round window, via the basilar membrane.
These procedures are not widely used, as while the procedures shows some benefit in reducing vertigo, there is a considerably greater risk to hearing than in other surgical procedures.
The last resorts in surgical options
Vestibular nerve section
This is a highly invasive surgery which can dramatically cure severe cases of disabling vertigo.
The goal of the surgery is to cut the nerve from the vestibular apparatus, while leaving the auditory nerve intact, thereby preserving hearing.
During the recovery period, the brain adapts to manage without vestibular input from the operated side, so that normal activity can be resumed.
There are worries that after this procedure, patients may not be totally asymptomatic (Mattox 1999)
This means that, although severe vertigo attacks may be cured, it is fairly common for chronic disequilibrium or imbalance to persist after the procedure or even get worse.
Labyrinthectomy
Surgical ablation or destruction of either a portion of or the entire labyrinth can be performed by a trans-canal or post-auricular approach.
These procedures are not normally performed unless there is total or significant hearing loss in the affected ear, since collateral damage to the cochlea may produce significant hearing loss in itself.
ENT doctors and audiologists generally insist that once the hearing in the affected ear is lost, there is no chance of it returning due to permanent damage done to the hearing nerves.
This however is proven to be untrue, as both the authors of Meniere's Help and many sufferers who have contacted us have exeperienced a partial or total improvement in hearing from 'alternative' treatments or avenues explored.
Labyrinthectomy and vestibular nerve sections are usually seen as options when all else has failed.
References:
Main source: University of Washington
American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS): "Meniere's Disease Treatment."
American Speech-Language-Hearing Association (ASHA): "Meniere's Disease: Treatment Options."
Vestibular Disorders Association (VEDA): "Treatment for Meniere's Disease
Click here to read Managing Meniere's disease
By increasing urine production, treatment with diuretics contributes to a "negative sodium balance", which means that more sodium is lost from the body than is consumed.
This contributes to the effects of a low sodium diet and results in hormone level changes associated with sodium conservation by the body.
Hydrochlorothiazide is used as a potassium sparing diuretic.** It comes in the brand names as Dyazide and Maxzide.
**Note: Some diuretics deplete potassium levels in the body and that depletion alone it is said can cause Meniere's like symptoms.
If you are taking potassium depleting diuretics, it would be a good idea to eat potassium rich foods such as bananas, potatoes and apples to keep your levels normal**
Furosemide which comes in the brand name Lasix, is what is known as a loop diuretic, a specific class of diuretics that inhibits re-absorption of sodium and chloride ions, thereby increasing the volume of urine excreted.
It is also known that stria vascularis in the cochlea (the tissue that secretes endolymph) is highly sensitive to furosemide, although it is not known whether this helps in the action of this diuretic.
Acetazolamide which comes in the brand name of Diamox is a carbonic anhydrase inhibitor, anticonvulsant, and antiglaucoma agent.
Acetazolamide is sometimes prescribed because of its effectiveness in treating glaucoma of the eye (with which endolymphatic hydrops is sometimes compared). However, regulation of endolymph in the inner ear occurs by completely different mechanisms to those in the eye, so that acetazolamide is unlikely to have any direct effect on hydrops in the ear.
Acetazolamide also acts as a diuretic and may, by increasing sodium excretion, be beneficial.
The action of acetazolamide is different in that it inhibits the enzyme carbonic anhydrase, which influences carbon dioxide, and bicarbonate homeostasis, and may affect pH regulation in some tissues. One study (Brookes and Booth, 1984) reported poor results and a high incidence of side effects with this diuretic
Hydrochlorothiazide (HCTZ) comes in the brand names HCTZ, Esidrix, Oretic, HydroDiuril and Microzide.
Antihypertensive HCTZ is one of the diuretic components of Dyazide.
9. Anti-emetic, Anti-nausea and Anti-vertigo drugs
Most of these drugs are generally aimed at treating vertigo in Meniere's disease, but it is also thought that they may also help in controlling the condition itself by reducing stress and anxiety.
Anti-nausea:
Meclizine Hydrochloride comes in the brand names Antivert, Bonine, D-Vert, Dramamine II, Meclicot, Medivert.
You can buy Meclizine over the counter in travel sickness pills.
It is believed to work by decreasing the sensitivity of the body's central nervous system balance centers. It helps manage motion sickness and affects the chemoreceptor trigger zone to control vomiting.
Betahistine comes in the brand name Serc. It is the most widely used anti vertigo drug for Meniere's ouside the USA. and is a an H1 binding histamine.
Betahistine is also reported to increase cochlear blood flow, which may in some way also contribute to the improvement seen in patients. Serc is not available in the USA but generic forms of betahistine may be available by prescription through compounding pharmacies.
Click here to read: Betahistine For Meniere's Disease Efficacy and Safety Study
Promethazine Hydrochloride is a tranquilizer, antiemetic, H1 receptor blocker, Phenothiazine. and comes in the brand name of Phenergan.
Promethazine controls nausea, vomiting and motion- sickness. An H1-blocking antihistamine with sedative and anti-emetic properties.
Dimenhydrinate comes in the brand names of Dramamine and Vomex.
It is an antiemetic and an H1 receptor blocker. Dimenhydrinate is an antihistamine used to treat motion sickness, nausea and vomiting. It works by blocking histamine from binding to its receptor, preventing histamine from exerting its effects.
Prochlorperazine Maleate (Phenothiazine) comes in the brand names of Compazine and Stemetil. It is a tranquilizer; antiemetic and an antipsychotic.
Prochlorperazine is used for the management of psychotic disorders, anxiety and to control emesis (nausea and vomiting). It works by blocking the dopamine receptors in different parts of the brain.
Stemetil is widely used outside the USA.
Scopolamine [Transdermal] comes in the brand name of Transderm-Scop and is an anticholinergic agent and antiemetic.
Transdermal scopolamine is a naturally occurring belladonna alkaloid with anticholinergic properties. It is used to prevent nausea and vomiting associated with motion sickness in adults. It does this by altering stimulation to the central nervous system.
Hydroxyzine Pamoate comes in the name of Vistaril. It is an antihistamine, tranquilizer, antiemetic and H1receptor blocker.
Hydroxyzine pamoate is an antihistamine used to treat a variety of allergic conditions. It is even used
preoperatively to help induce sleep.
It works by blocking the action of histamine, an important inflammatory mediator in the body, from binding to its receptor and exerting its effects.
Thiethylperazine Maleate comes under the brand name of Torecan. It is a type of antiemetic called Phenothiazine.
Thiethylperazine works by triggering brain chemoreceptors to alter the message to the vomit center in the brain and is used to treat severe nausea and vomiting.
10. Anti-Anxiety drugs
As we know, stress is an important factor in triggering Meniere's attacks. It is well documented that stress changes some hormone levels (especially of the corticosteroids).
It is thought that treating the stress may itself lead to an improvement in the patient's Meniere's condition. So-called "life-stress situations" can commonly precede attacks not to mention fear of future attacks themselves.
The greater the fear of attacks, the more frequent and severe they become and vice versa. It becomes a vicious cycle.
The use of anti-anxiety drugs is aimed at breaking this cycle.
Click here to read Stress and Meniere's disease
Click here to read Meniere's disease and Anxiety
Diazepam (Benzodiazepine) comes in brand name of Valium, Di Tran and Diazepam Intensol.
Diazepam is a type of central nervous system (CNS) depressant (medicine that slows down the nervous system).
It is used to treat several disorders including panic disorder, muscle spasms, anxiety, and alcohol withdrawal. It is also used in combination with other anti-seizure medications to treat seizure disorders.
Lorazepam comes in the brand names Ativan and Lorazepam Intensol.
Lorazepam is a benzodiazepine, a type of central nervous system (CNS) depressant (medicine that slows down the nervous system). It is used to treat anxiety, anxiety associated with depression, or insomnia.
Alprazolam comes in the brand names Xanax and Alprazolam Intensol.
Alprazolam is a benzodiazepine, a type of central nervous system (CNS) depressant (medicine that slows down the nervous system). It is used to treat anxiety, anxiety associated with depression and panic disorders.
Chlorpromazine Hydrochloride (Phenothiazine) comes in the brand name Thorazine.
Antiemetic Chlorpromazine is a tranquilizer that belongs to a class of antipsychotic drugs called phenothiazines.
It is used to treat schizophrenia as well as for the control of anxiety or agitation in certain patients, severe nausea and vomiting and severe hiccups. Chlorpromazine works in the brain and at all levels of the central nervous system to exert sedative and anti-nausea activity.
11. Steroids
Sometimes steroids are prescribed for Meniere's patients.
These steroids are synthetic glucocorticoids (the natural form are synthesized by the adrenal glands).
Because some patients see positive benefits as a result of the suppression of an autoimmune response, this has been used to support the concept that Meniere's disease may arise from some form of autoimmunity.
Glucocorticoids have many effects on the body; affecting carbohydrate and protein metabolism, lipid metabolism, electrolyte balance, inflammatory responses and immune responses.
However, it is also thought possible that these steroids may have a direct effect on fluid homeostasis in the ear.
It is therefore impossible at the present time to know exactly which of the effects of these steroids is important in relieving the symptoms of Meniere's disease.
Prednisone comes in the brand names of Deltasone, Meticorten and Orasone.
Glucocorticoid Prednisone is a glucocorticoid steroid used to treat a variety of inflammatory conditions, including asthma, allergic reactions and autoimmune diseases (such as lupus). It works by altering how the immune system responds to certain stimuli.
It may also act directly on fluid homeostasis in the inner ear by interacting with glucocorticoid receptors in the ear.
One of the reasons that autoimmune disorders are believed to be one of many causes of Meniere's symptoms is that some sufferers respond to Prednisone.
Cortisone Acetate comes in the brand name of Cortisone.
Cortisone acetate is a glucocorticoid used to treat a variety of inflammatory conditions, including the management of adrenocortical insufficiency (when the body lacks glucocorticoids). Cortisone may act to supplement the body's natural glucocorticoid stores or alter how the immune system responds to certain stimuli.
Dexamethasone Sodium Phosphate or dexamethasone acetate comes in the brand name of Adrenocot, Dalalone, Decadron,Decaject, Dekasol, Dexacorten, Dexasone, Dexim, Dexone, Hexadrol, Medidex, Primethasone and Solurex.
Dexamethasone belongs to a class of anti-inflammatory agents called corticosteroids. It is used to treat various inflammatory conditions. It works by altering the way the immune system responds to certain stimuli.
Dexamethasone is sometimes given locally to the cochlea (by injection through the eardrum into the middle ear space) in conjunction with intravenous administration. This allows higher drug levels to be achieved in the cochlea.
12. Anti-histamines
Calcium channel blocker - Stugeron / Cinnarzine comes in the brand names Claritin and Allegra.
There are no studies in which the efficacy of this drug has been assessed in Meniere's patients.
It is not known exactly how it influences Meniere's symptoms and/or function of the ear is not known.
Studies in animals with endolymphatic hydrops have shown the endolymph calcium level to be elevated. Limited measurements of endolymph sampled from Meniere's patients also shows a high calcium level.
This raises the possibility that a calcium disturbance may contribute to the symptoms of Meniere's disease.
Some physicians, especially in those in Europe, have been using calcium channel blockers to treat Meniere's disease, including, Flunarizine, Nimodipine and Cinnarzine.
13. Osmotic agents
Glycerol
Glycerol is given to patients with Meniere's disease as part of some diagnostic tests. The effect is very short-term (hours) and glycerol is not used as a long-term therapy.
In addition, glycerol sometimes produces the side effects of nausea and headache.
Urea
Urea is given to patients with Meniere's disease as part of some diagnostic tests. Its effects are very short-term (hours) and urea not used as a long-term therapy.
However, urea is not well accepted by patients due to the taste and the side effects, which can include nausea and headache.
Isorbide
Isorbide is used as an osmotic agent, which produces diuresis (production of urine). Clinically, isorbide is better accepted than urea and glycerol as it tastes better and does not have the side effects.
It has been reported that over an 8 week period, isorbide treatment improved hearing in 38% of the patients in one study (Kakigi et al, 1995) but no reduction in vertigo was reported.
Isorbide is widely used to treat Meniere?s patients in Japan.
14. Ototoxic Antibiotics
In Meniere's disease, antibiotics are not used for their conventional, anti-bacterial purpose. Instead, it is used to selectively damage the sensory hair cells of the vestibular system.
This can also be described as a chemical labyrinthectomy, which represents a non-surgical, method to reduce the sensitivity of the vestibular system.
By impairing or destroying these cells, the brain is no longer sent "incorrect" information. The hope is that, given at the right doses, vestibular function is reduced without damaging hearing. It is usually injected into the middle ear space through the eardrum, and enters the inner ear through the round and oval windows.
This method can be effective, but in practice it is difficult to achieve vestibular ablation without causing some damage to hearing.
Research has been done to find the best regimen of antibiotic applications. Olsen et al. (1995) reported that best results were obtained with 2-4 applications to the middle ear, with a greater likelihood of hearing loss if more treatments were given.
One common approach is to "titrate" the number of treatments to the patients symptoms, using just enough to alleviate vertigo without necessarily destroying all vestibular function.
Gentamicin
Gentamicin is injected through the eardrum into the middle ear space. From there it diffuses into the fluids of the inner ear.
Usually, repeated injections are performed over a period of weeks, which allows hearing function to be monitored to minimize the chances of further hearing loss.
Gentamicin is usually used only when one ear is affected.
Streptomycin
This is used in cases of bilateral Meniere's disease some doctors administer streptomycin intramuscularly at a dose which is titrated to suppress labyrinthine function.
One of the problems associated with bilateral ablation of the labyrinths is a condition called oscillopsia, where visual problems can be as disturbing to the patient as vertigo.
The goal with streptomycin administration is to reduce the sensitivity of the labyrinths without totally ablating them.
15. Sodium bicarbonate infusion
In Japan physicians often administer intravenous sodium bicarbonate as a treatment for an acute vestibular/Meniere's attack i.e. vertigo.
This therapy is not presently used in the USA or Britain.
In Japan, a sufferer can visit an ENT clinic without an appointment and if having a vertigo attack, will be rushed straight in, put on this drip and left to rest. It is used with great success in reducing chronic symptoms at that time.
16. Surgical Procedures
It has been suggested that the improvement seen in patients following ear surgery may in part be due to the general anesthesia used. Furthermore, some patients benefit from anesthesia without surgery.
Gates (1999) reported that in the 30% of Meniere's patients who did not respond to low-salt diet, diuretics and stress reduction, 60% of these patients gained relief from vertigo by one injection of the anesthetic, Innovar.
This has been attributed to a long-lasting depression of the vestibular system by some anesthetics.
Endolymphatic Shunt
Endolymphatic sac surgery is still relatively controversial.
Based on a published study, many physicians regard endolymphatic sac surgery as a "placebo" surgery (i.e. the patient gets the same outcome whether or not the sac is acutally shunted) and will no longer perform it.
One physician has described the procedure as "at best non- specific and at worst of no value". Others regard surgery of the sac to as a valuable "intermediate step" between non-surgical therapies and the more invasive procedure of vestibular nerve section.
Endolymph-subarachnoid shunt.
A drainage tube is inserted between the endolymphatic sac and the cranium.
Endolymph-mastoid shunt
This involves placing a tube between the endolymphatic sac and the mastoid cavity of the middle ear.
This procedure is generally used as an alternative to potential problems of opening the cranium in the endolymph-subarachnoid shunt.
It is possibly still one of the most common procedures used of the surgical options available and it is claimed that this operation has a possible 60%success rate.
60% is open to debate judging by the sheer amount of sufferers who contact Meniere's Help and report that they have had the operation and it was ultimately unsuccessful.
(click here to read Managing Meniere's Disease for more on this argument)
Endolymphatic sac decompression
This surgery involves drilling away the bone overlying the endolymphatic sac to make a larger "cavity" for the sac to occupy.
So instead of stopping the cause of the swelling sac or stopping the sac from swelling this procedure creates a larger area for the inflamed sac to spead into, presumably to prevent the sac from pressing on the balance and hearing nerves.
Tympanostomy tube inserted through the eardrum
This is a relatively minor procedure which is often used in children and adults for the relief of middle-ear infections.
The purpose of the tube is to maintain a tiny hole through the eardrum.
Although the medical community has been skeptical that this treatment would have any bearing on Meniere's disease, many physicians claim success rates as good as endolymphatic shunt surgery.
Studies suggest a high proportion of Meniere's patients do get relief from vertigo after using this procedure.
A study in animals has provided scientific support that the procedure is effective, finding that hydrops developed to a lesser degree when the eardrum was perforated.
However, other physicians remain unconvinced and there is as much controversy on this issue, as there is with endolymphtic shunts.
Endolymphatic sac partial ablation (destruction)
There are claims that outcomes equal or better that of other sac procedures using this procedure of partially ablating (destroying) the distal region of the endolymphatic sac.
(Gibson 1999)
Sacculotomy, Cochleosacculotomy
These are relatively minor surgical procedures which involve perforation of the saccule through the stapes footplate (sacculotomy) or through the round window, via the basilar membrane.
These procedures are not widely used, as while the procedures shows some benefit in reducing vertigo, there is a considerably greater risk to hearing than in other surgical procedures.
The last resorts in surgical options
Vestibular nerve section
This is a highly invasive surgery which can dramatically cure severe cases of disabling vertigo.
The goal of the surgery is to cut the nerve from the vestibular apparatus, while leaving the auditory nerve intact, thereby preserving hearing.
During the recovery period, the brain adapts to manage without vestibular input from the operated side, so that normal activity can be resumed.
There are worries that after this procedure, patients may not be totally asymptomatic (Mattox 1999)
This means that, although severe vertigo attacks may be cured, it is fairly common for chronic disequilibrium or imbalance to persist after the procedure or even get worse.
Labyrinthectomy
Surgical ablation or destruction of either a portion of or the entire labyrinth can be performed by a trans-canal or post-auricular approach.
These procedures are not normally performed unless there is total or significant hearing loss in the affected ear, since collateral damage to the cochlea may produce significant hearing loss in itself.
ENT doctors and audiologists generally insist that once the hearing in the affected ear is lost, there is no chance of it returning due to permanent damage done to the hearing nerves.
This however is proven to be untrue, as both the authors of Meniere's Help and many sufferers who have contacted us have exeperienced a partial or total improvement in hearing from 'alternative' treatments or avenues explored.
Labyrinthectomy and vestibular nerve sections are usually seen as options when all else has failed.
References:
Main source: University of Washington
American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS): "Meniere's Disease Treatment."
American Speech-Language-Hearing Association (ASHA): "Meniere's Disease: Treatment Options."
Vestibular Disorders Association (VEDA): "Treatment for Meniere's Disease
Click here to read Managing Meniere's disease
Supporting Meniere's Sufferers Since 2004 - email: meniereshelp@gmail.com
Introduction
Meniere's disease is a chronic inner ear condition that can severely impact the quality of life for those affected. Symptoms such as dizziness, vertigo, tinnitus, and hearing loss can be distressing and difficult to manage.
There are a range of treatments available for Meniere's disease, from medical therapies to surgical options and alternative treatments. , Understanding the best treatment options for you is crucial. Below you will find comprehensive guide to the different treatments for Meniere's disease, including medical and surgical options, as well as alternative therapies that may help to relieve symptoms.
1. Supplements that help
2. Dietary considerations
3. Acupuncture
4. Chiropractic manipulation
5. Chinese medicine
6. Vestibular rehabilitation therapy (VRT)
7. Orthokine therapy
8. Diuretics
9. Anti-emetic, Anti-nausea & Anti-vertigo drugs
10. Anti-Anxiety drugs
11. Steroids
12. Anti-histamines
13. Osmotic agents
14. Ototoxic Antibiotics
15. Sodium bicarbonate infusion
16. Surgical Procedures
Meniere's disease is a chronic inner ear condition that can severely impact the quality of life for those affected. Symptoms such as dizziness, vertigo, tinnitus, and hearing loss can be distressing and difficult to manage.
There are a range of treatments available for Meniere's disease, from medical therapies to surgical options and alternative treatments. , Understanding the best treatment options for you is crucial. Below you will find comprehensive guide to the different treatments for Meniere's disease, including medical and surgical options, as well as alternative therapies that may help to relieve symptoms.
Summary of Medical treatments and possible solutions for Meniere's disease
1. Supplements that help
2. Dietary considerations
3. Acupuncture
4. Chiropractic manipulation
5. Chinese medicine
6. Vestibular rehabilitation therapy (VRT)
7. Orthokine therapy
8. Diuretics
9. Anti-emetic, Anti-nausea & Anti-vertigo drugs
10. Anti-Anxiety drugs
11. Steroids
12. Anti-histamines
13. Osmotic agents
14. Ototoxic Antibiotics
15. Sodium bicarbonate infusion
16. Surgical Procedures