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Author: admin | 31.12.2015 | Category: Ginkgo Biloba Tinnitus

Meniere’s Disease, also known as Endolymphatic Hydrops, is an inner ear disorder that is caused by an overproduction or underproduction of endolymphatic fluid found within the cochlea or inner ear. As a result of the pressure changes of the inner ear, fluctuating low frequency hearing loss occurs, which can become permanent and worsen over time. The exact cause of Meniere’s Disease is unknown, however there several factors that may contribute to it. Gentamycin: A steroid injection applied across the eardrum to the inner ear to help resolve some of the symptoms. Hearing Aids will help to improve audibility and localization of sounds in one’s every day listening situations. Labyrinthectomy, removal of the inner ear, and a Chemical Labyrinthectomy, a drug used to destroy the vestibular (balance) system, may be recommended however only as a last resort.
We have 3 locations in Calgary: North, North West and South and an office in each Okotoks, Cranbrook and Creston, and Invermere, British Columbia. Menieres disease is characterized by a cyclical pattern of sudden hearing loss, tinnitus (ringing in the ears) followed by vertigo.
As mentioned under tinnitus the frequency of the noise with Menieres is in the low pitch area.
In the beginning of the disease treatment in about 80% of cases is by salt restriction to 1500 mg per day and the use of a potassium sparing diuretic such as Dyazide or Maxzide. When there is Menieres disease affecting both sides, a treatment with 60 mg of prednisone per day for several weeks with slow tapering is considered a therapeutic trial. If this improves the condition, this is considered to be proof that this type of Menieres disease is due to autoimmune inner ear disease. This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor.
Besides a stoppage of drainage pathways, abnormally enlarged fluid pathways into the ear such as the vestibular aqueduct or cochlear aqueduct may also be associated with Meniere's like symptoms.
Thus, the bottom line is that in most patients with Meniere's disease in 2015, the underlying cause of Meniere's disease is unknown. Figure 3a: Audiogram (hearing test) typical of early Meniere's disease on the right side (x=left, o=right). A longer discussion of the information to be gained in testing of persons with Meniere's disease is found here. When there is sulfa allergy, one may try amiloride by itself, or ethacrinic acid (edecrin).
Histamine injections (irrational treatment as histamine is broken down rapidly in the body). What the author recommends in his practice in Chicago for medical prevention of Meniere's. These are combined with symptomatic drugs such as meclizine, benzodiazepines, and antiemetics, to be taken during attacks. In persons with severe progressive bilateral disease, the author will generally recommend a trial of high dose steroids. An emerging treatment that may eventually end up as a standard treatment is multiple injections of steroids into the middle ear. The big problem with this section is separating placebo's from slightly effective treatments. There are an immense number of placebo and probable or nearly placebo treatments for Meniere's disease.
The Meniett device's status at this writing (2010) seems most likely to be a slightly effective treatment. There is a separate page on this topic, but briefly, for intractable unilateral Menieres disease cases, we often presently advise a low dose gentamicin protocol. Persons who have intractable bilateral Meniere's disease are offered a trial of steroids with a safer immunosuppressant should this be effective, a modified gentamicin protocol, and very occasionally systemic aminoglycosides to deaden both ears. In our opinion, medical treatments, including a reasonable trial of anti-migraine drugs such as verapamil or venlafaxine, should precede use of any last resort treatment.
Hearing is thought to gradually decline throughout life, with roughly 50 dB loss in 10 years. Note that it is not the overall level of sodium that is important, but whether or not it fluctuates that is important in avoiding attacks of dizziness.
Gu X, Fang ZM, Liu Y, Huang ZW, Zhang R, Chen X.Diagnostic advantages of intratympanically gadolinium contrast-enhanced magnetic resonance imaging in patients with bilateral Meniere's disease.
Sato G1, Sekine K, Matsuda K, Ueeda H, Horii A, Nishiike S, Kitahara T, Uno A, Imai T, Inohara H, Takeda N. Episodic vertigo is the most common reason for patients to seek and pursue treatment for Meniere’s disease.
If episodes of vertigo persist despite changes in diet, medication called diuretics can be helpful. Other options are available and include transtympanic decadron or gentamicin, decadron perfusion of the inner ear, endolymphatic sac surgery, vestibular neurectomy and labyrinthectomy surgery.
Steroid treatment of the inner ear may offer beneficial effects for the symptoms of Meniere’s disease. A powerful way of delivering steroid to the inner ear is by injection into the middle ear through the tympanic membrane. There is a 1% chance of a persistent 1 mm perforation of the eardrum at the injection site. This form of treatment involves injection of medication through the eardrum into the middle ear. A shunt is placed in the endolymphatic sac, a reservoir for endolymph, to shuttle fluid out of the sac and into a cavity created in the mastoid.
Step 3: A mastoidectomy is done exposing the semicircular canals, venous sinus, and dura covering the brain. Step 4: Spinal fluid is drained and the brain relaxes, exposing the trigeminal nerve (responsible for the conduction of facial sensation), the vestibulocohlear nerve (hearing and balance), and the facial nerve.
This is an operation to divide the balance nerves and interrupt the connection between the inner ear and the brain.
The middle fossa approach is the least commonly used and involves an incision above the ear followed by removal of bone over the brain.
Another approach is the retrolabyrinthine approach, which involves incisions behind the ear similar to the endolymphatic shunt procedure.


A third approach is the suboccipital approach, which involves an incision further behind the ear and removal of bone over the covering of the brain. Learn how Metropolitan NeuroEar Group gives back to the community through numerous philanthropic efforts. Sudden sensorineural hearing loss is hearing loss that results from damage to either the cochlea or the cochlear nerve. The viral infection manifested by a cold may propagate into the inner ear or cause an inflammatory reaction in the inner ear that is harmful to hearing. This shows a cross-section of the cochlea with the vestibular membrane, the membrane that separates endolymph and perilymph, in its proper position.
The inner ear has an intricate structure of membranes that separate two different kinds of fluids, the endolymph and the perilymph.
The blood supply to the inner ear comes from the labyrinthine artery which is a tiny branch off the anterior inferior cerebellar artery.
There is no known correlation between development of strokes in general and sudden hearing loss. Because the hearing loss occurs more in the low frequencies, it becomes difficult for people to hear low pitched sounds. However, further testing by an Ear-Nose and Throat (ENT) Specialist is necessary to confirm this diagnosis. At this point the management of care would be given over to a rheumatologist who likely will consider the use of methotrexate. In our clinical practice, where we care for large numbers of Meniere's patients, the most common age of presentation is in the 6th decade.
While in the past, it was felt that plumbing problems (hydrops) in the ear were responsible for the disease, the most current opinion is that hydrops is a marker for the Meniere's disease, rather than necessarily being responsible for the symptoms.
Recent evidence is against a relationship between the cochlear aqueduct and MD (Yilmazer et al, 2001). We ourselves hold this opinion, based in part on a study in which patients with Meniere's disease had a very high prevalence (about 25%) of autoimmune thyroid disease (Brenner et al, 2004). However, the evidence is against this being the main mechanism in human beings (see Kitamura et al, 1997; Nadol et al, 1995).
Those who present to the doctor with more severe hearing impairments at onset, usually do worse than those who have milder hearing impairments (Sato et al, 2014). Although Ondansetron isn't as strong as phenergan or compazine, and doesn't always work, it also doesn't have much side effects either. All of the above diuretics have sulfa in them, which persons with sulfa allergies may be unable to tolerate.
Loop diuretics such as Edecrin should be used in low doses and with caution because they are ototoxic.
If there is a significant improvement in hearing, then there is an attempt to switch to Enbrel (an immunosuppressant with less side effects than steroids), with the thought that in this situation an autoimmune disorder is more probable. There is nothing wrong with a placebo, if it provides some benefit (presumably psychological), and you can afford to do this. This treatment requires a surgical procedure (insertion of a ventilation tube) and purchase of a very expensive device (the pressure machine). Gentamicin is administered through the ear drum every month for a total of one or two administrations. The difficulty in pregnancy is that there should be an effort to avoid medications that might cause birth defects or otherwise injure the unborn child. Vertigo spells are generally thought to persist for decades, although with a gradual decline after roughly the first decade (Huppert et al, 2010). It is not necessary or wise to lower your salt intake to amounts barely able to sustain life.
Psychological characteristics of patients with Meniere's disease compared with patients with vertigo, tinnitus or hearing loss. Reducing or eliminating smoking is not only good for Meniere’s disease but also good for your health in general. Administration of steroids to the inner ear is an attempt to reduce the inflammation within the inner ear. From here, the steroid diffuses through the round window (one of the two openings into the cochlea of the inner ear)membrane and enters the inner ear.
The medication, which is then taken up by the inner ear, destroys the hair cells of the inner ear. Of the surgical options, this is the most conservative operation with minimal risk to hearing. The mastoid bone is entered and the endolymphatic sac is decompressed, meaning that the bony covering is removed. The ear may protrude slightly shortly after surgery, but it should return to its original position in two to three weeks.
90-95 percent of patients who undergo this operation for Meniere’s disease will not have another spell of vertigo. The roof of the canal through which the balance nerves run is removed and the nerves are then divided. Nearly all patients with Meniere's disease will be vertigo-free after a labyrinthectomy. Using a high-powered drill, the mastoid bone is entered and the semicircular canals are removed.
Sanjay Prasad MD FACS is a board certified physician and surgeon with over twenty years of sub-specialty experience in Otology, Neurotology, advanced head and neck oncologic surgery, and cranial base surgery. These fluids vary in their electrolyte composition and produce an electrochemical gradient across membranes. This theory assumes that a clot or spasm of this tiny branch causes decreased blood supply to the inner ear. In another words, patients who develop sudden hearing loss do not have an increased chance for developing other kinds of strokes. The increased pressure can break through the membranes to the inner ear and cause an abnormality in the chemical make-up of the fluid. After several hours, at the most 24 hours, this episode is over, only to return in a few weeks again.
In about 20% of patients with Menieres disease that is confined to one ear, surgery would be advisable.


We think Meniere's disease should more properly be called Meniere's syndrome, but we will use the two terms as if they were the same. This probably reflects the age distribution of Meniere's in Chicago Illinois, which of course is also a function of the age of the population in Chicago. Enlarged vestibular aqueducts are one of the most commonly identified inner ear bony malformations in children with sensorineural hearing loss of unknown cause (Oh et al, 2001). On the other hand, Ruckenstein and others recently obtained a large number of autoimmune blood tests in a group of 40 patients with unilateral Meniere's disease including CBC, ANA, Anti-Sjoegren, RF, Complement, antiphospholipid antibody, western blot for heat shock protein, MHA (syphilis test), and Lyme. Rather, it seems that Meniere's disease damages both hair cells and nerve fibers in humans. Should MRI scanners become even more powerful in the future, this could be an important test.
Oddly, there is sometimes a discrepency between OAE tests and audiometry in the low-frequency SNHL of Meniere's.
Van Deelen and Huizing studied the use of diuretics in Meniere's disease in a double-blind, placebo controlled trial, and reported that it reduces vestibular complaints, but has no significant effect on hearing (1986). Because Menieres and Migraine are very often combined, this medication's main role may be to treat the migraine associated vertigo that can be confused with or accompany Menieres disease. Of course this strategy should rationally be adjusted to the variability in hearing, as in any undertaking, one's confidence that a particular result has been obtained depends both on the size of the effect as well as the underlying variability in the effect. However, we don't think that placebos that are billed to health care insurance providers should be supported.
Bilaterality of the condition gradually increases with time, but in most the symptoms in the opposite ear are minor.
Close monitoring of blood pressure and potassium levels by your primary care physician is recommended. During the procedure, the eardrum is elevated and the round window (one of the two openings into the cochlea of the inner ear) membrane is perfused with high-dose steroid. The medication, Gentamicin, is an antibiotic that is toxic to the hair cells of the hearing and balance organ.
Unfortunately, control of vertigo occurs in only 60 percent of patients undergoing this operation. After the operation, disequilibrium lasts until the brain learns to compensate and adapt to the lack of input from one inner ear.
He is chief surgeon and founder of the private practice, Metropolitan NeuroEar Group, located in the metropolitan Washington D.C.
Patients who develop other kinds of strokes do not have an increased chance of developing sudden hearing loss, either. Other symptoms of Meniere’s Disease include roaring tinnitus, sudden and spontaneous vertigo (dizziness), and pressure changes in the ears. It is a little older than the typical age of presentation of vestibular migraine which is in the 5th decade, much older than the reported highest prevalence age for non-vestibular migraine (about 35), and similar to the age of presentation of BPPV.
The vestibular aqueduct extends from the medial wall of the vestibule to the posterior surface of the petrous temporal bone. Only elevations in the antiphospholipid antibody test were found 27% of patients, above the expected 6-9%. Studies of humans are handicapped by the possibility that Meniere's is the final common pathway of a variety of illnesses of the ear. Potential reasons are an exitatory nystagmus, Bechterew's phenomenon (recovery nystagmus), Meniere's involving the opposite ear, and stronger vestibular responses on the side with hydrops due to hydrodynamic factors associated with hydrops.
Another new MRI approach involves injecting gadolinium through the ear drum, and then a MRI scan (Gu et al, 2014).
The same cannot always be said for meclizine, lorazepam and klonazepam, phenergan or compazine.
Much room for improvement in these algorithms is needed -perhaps involving daily hearing monitoring using an internet protocol. The treatments briefly discussed below are (probably) not placebos, but they are high in cost (because they are surgical), and low in benefit (because the literature suggests low or no efficacy). This is a relatively painless procedure that involves anesthetizing the tympanic membrane and then injecting the steroid thereafter. The fluid that would normally enter the sac is shunted away from the inner ear and into the cavity created by the surgery, where it is then reabsorbed.
This is an operation that is recommended to patients who have no useful hearing in the dysfunctional ear.
The membrane-break theory assumes that for some reason there is a break that occurs in the membranes that causes mixing of the two fluids. Most persons with enlarged vestibular aqueducts with ear disorders have hearing loss, but occasionally there is an association with vestibular problems (Shessel and Nedzelski, 1992).
This technique is plausible, but we are doubtful that the diagnostic gain justifies injecting gadolinium dye into the middle ear. Kundu (2006) were unable to come to a conclusion as to efficacy as no papers published up to 2006 were adequate for meta-analysis.
Avoiding adding salt to meals and curtailing intake of snacks high in sodium, including canned foods and fried foods, can be helpful. Just as in vestibular neurectomy, after the operation, disequilibrium lasts until the brain learns to compensate and adapt to the lack of input from one inner ear. There may be a genetic link between enlarged vestibular aqueduct and Pendred syndrome, which is a congenital thyroid disorder. They concluded that it is unlikely that autoimmune etiologies play a significant role in their population of unilateral Meniere's (Ruckenstein, 2002). These electrodes detect contractions of the facial muscles, and the signals are transmitted to a speaker so the surgeon may hear the responses. Another interpretation of their data is that they may simply not have had an appropriate marker for autoimmune involvement, as well as unilateral Meniere's may have less autoimmune cause than bilateral.
The initial cells that migrate there are destructive in nature; this is the basis for steroid treatment.



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