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Author: admin, 09.06.2015. Category: How To Stop Ringing In Ears Home Remedies

Meniere's Disease is thought to be triggered by immune reactions, metabolic disturbances within the inner ear, inner ear infections or trauma, possible allergic conditions, and other injures to the inner ear.
Hearing loss is generally most pronounced in the lower frequencies and is accompanied by a distinct sensation of pressure, fullness or a stopped-up feeling in the ear. Sea shell-like roaring, ringing or bell-like noises in the ear (tinnitus) can be extremely distracting and bothersome.
The clinical symptoms of Meniere's disease are thought to be caused by an increase in the fluid pressure within the delicate membranes of the inner ear.
The classic theory is that during a Meniere's spell, the delicate membranes within the inner ear (cochlea) rupture.
Unfortunately, the sudden disruption of the normal inner ear tissues leads to injury of the tiny hair cells that are responsible for hearing and balance.
In some patients, Meniere's disease is only intermittently bothersome and takes an overall mild course.
Periods of increased symptoms, which are unpredictable and occur without warning, may be followed by long periods of improvement or even complete remission. Some blood tests are available to help rule out autoimmune inner ear disease that may simulate Meniere's Disease.
The history and quality of symptoms are very important in making the diagnosis of Meniere's disease. On physical examination, the eardrums and neurological exam are usually normal, especially between the acute episodes of dizziness. A new test, vestibular evoked myopotentials, VEMP, are now being used to test patients who are suspected of having Meniere's Disease.
High resolution CT scans may be performed to rule out superior semi-circular dehiscence syndrome (SSCDS). Measurements of hemoglobin, blood sugar (glucose), cholesterol, immune system status, liver, kidney, thyroid function testing, and testing for infectious diseases such as syphilis, lyme disease, and infectious mononucleosis may be among the studies needed to rule out other conditions that may cause symptoms similar to those found in Meniere's disease. Medical treatment is directed towards decreasing the frequency of attacks, stabilizing the hearing, and managing the episodes of vertigo when they occur.
Medication(s) may be prescribed to reduce the severity of symptoms and possibly to decrease the frequency of Meniere's spells. A recent treatment for patients with Meniere's Disease that is effecting both ears (Bilateral Meniere's Disease) is the administration of oral methotrexate in low, weekly doses. Vestibular (balance) rehabilitation programs may be useful in helping to adjust to the loss of balance function that is often seen in more advanced cases of Meniere's disease. Endolymphatic sac decompression is a surgical procedure performed to treat intractable Meniere's disease.
Other surgical procedures are available to treat Meniere's disease but must be tailored to the patient's individual needs and circumstances. For most patients with Meniere's Disease, a combination of lifestyle changes and medication leads to significant improvement. In the last few years, a minimally invasive procedure has been developed that can lead to a significant relief of vertigo with less surgical risk. Gentamicin is a common antibiotic that has been used for many years to treat serious bacterial infections intravenously. Both of these medications can be toxic when the large doses are given orally or intravenously.
Middle ear perfusion treatment of the inner ear with these medications has been performed at both academic and clinical medical centers in the United States.
The success of Middle Ear Perfusion has been aided by advances in carbon dioxide lasers, fiberoptic endoscopic technology, and high definition video imaging.
Dexamethasone seems to be most effective in patients with early Meniere's disease who have tinnitus, fluctuating hearing loss, and dizzy spells.


Middle Ear Perfusion is a promising treatment for Meniere's disease that does not respond to medical therapy. Atlas JT, Parnes LS: Intratympanic gentamicin titration therapy for intractable Meniere's Disease. Silverstein H, Arruda J, Rosenberg SI: Direct round window membrane application of gentamicin in the treatment of Meniere's disease. Kilpatrick JK, Sismanis A, Spencer RF, Wise CM: Low-dose oral methotrexate management of patients with bilateral Meniere's disease. Marzo SJ, Leonetti JP: Intratympanic gentamicin therapy for persistent vertigo after endolymphatic sac surgery.
Nakashima T, Naganawa S, Sugiura M, Teranishi M, Sone M, Hayashi H, Nakata S, Katayama N, Ishida IM. The mixing of inner ear fluids results in a sudden electrical discharge within the cochlea due to fluids with different electrolyte concentrations mixing together.
It is possible that some, if not many, cases are due to a decrease in blood flow to the inner ear when the inner ear hydrostatic pressure prevents normal blood flow from reaching inner ear tissues. This study enables visualization of the structures of the inner ear and brain in order to rule out tumors, strokes, multiple sclerosis, hydrocephalus, congenital anomalies, and other abnormalities which can cause dizziness and imbalance. In SSCDS, there is an erosion of the normal bone that covers the top of the superior semi-circular canal.
Ultimately, the patient and a skilled ear specialist must evaluate the history, physical examinations, entire clinical picture, and test results together in order to arrive at a diagnosis. Regular exercise, adequate rest, and control of other medical problems may be helpful as well. In this transmastoid surgical procedure, an incision is made behind the ear, and the mastoid bone is entered.
One procedure involves cutting the balance nerves (Vestibular Nerve Section) which is a neurosurgical procedure.
However, some individuals will continue to have disabling symptoms in spite of comprehensive medical therapy. This procedure involves the use of a carbon dioxide laser, small fiberoptic telescopes, and placement of steroids or ototoxic medication through a very small opening made in the eardrum. In an outpatient surgical center setting using intravenous sedation, a local anesthetic is used to numb the ear canal and the eardrum. Left Eardrum: Paparella Type I tube to aid in delivering additional doses of medication to the middle ear. Right Middle Ear: Mucosa removed from round window niche, exposing the round window membrane.
Right Eardrum: Paparella Type I tube to aid in delivering additional doses of medication to the middle ear. It is performed on an outpatient basis and appears to be safe, is much less invasive than older surgical techniques, and will hopefully benefit many patients who have either failed conservative medical management or who require a more active approach to their condition. Dexamethasone perfusion of the labyrinth plus intravenous dexamethasone for Meniere's disease. Intratympanic injection of dexamethasone: time course of inner ear distribution and conversion to its active form.
Intratympanic gentamicin treatment in Meniere's Disease: patients' experiences and outcomes. Intratympanic dexamethasone for sudden sensorineural hearing loss after failure of system treatment. Dependence of hearing changes on the dose of intratympanically applied gentamicin: a meta-analysis using mathematical simulations of clinical drug delivery protocols. Combined intratympanic and systemic use of steroids for idiopathic sudden sensorineural hearing loss.


Intratympanic versus intravenous delivery of dexamethasone and dexamethasone sodium phosphate to cochlear perilymph. Intratympanic steroid injections as a salvage treatment for sudden sensorineural hearing loss: a randomized, double-blind, placebo-controlled study.
Altered frequency dynamics of cervical and ocular vestibular evoked myogenic potentials in patients with Meniere's Disease. Intratympanic treatment of intractable unilateral Meniere's Disease: Gentamicin or Dexamethasone? The effect of intratympanic methyl prednisolone and gentamicin injection on Meniere's Disease. Endolymphatic sac surgery versus intratympanic gentamicin for the treatment of intractable Meniere's Disease: a retrospective review with survey.
Meniere's Disease may be due to vessel inflammation (vasculitis), aging and narrowing of blood vessels, and additional unrecognized factors such as problems with calcium channel metabolism, etc. Classically, two muscles are used: (1) the sternocleidomastoid muscle (cervical VEMP or cVEMP) and (2) the inferior rectus muscle of the eye (ocular VEMP or oVEMP). The procedure is call "Laser Assisted Tympanotomy with Middle Ear Perfusion" or "LAT" for short.
Treating the inner ear with very small, strategically-placed doses of gentamicin takes advantage of this effect by inactivating the sensory cells that cause episodes of vertigo. Once the eardrum is numb, a carbon dioxide laser beam focused through a microscope is used to perform a Laser Assisted Tympanostomy (LAT) - an extremely small, bloodless opening in the eardrum approximately 2-3 mm. A randomized, double-blind, placebo-controlled clinical study to assess safety and clinical activity of OTO-104 given as a single intratympanic injection in patients with unilateral Meniere's disease. Foster has proposed that increase fluid pressure within the cochlea (endolymphatic hydrops) causes a decrease in blood flow to cochlear and vestibular tissues.
Genetic studies are being performed at The University of Iowa, Iowa City, IA as well as several other leading research centers.
Distension of the saccule of the inner ear in Meniere's Disease is what is being indirectly measured and porvides diagnostic potential. However, it has been found to have limitations such as not completely resolving the vertigo and sometimes leading to additional hearing loss.
Three study groups were evaluated, each receiving a different number of doses of gentamicin. However, there is considerable emotional pain when the disease is difficult to control, and the spells are unpredictable.
Steroids, such as prednisone, can help reduce the severity of acute attacks but have significant side effects if taken for prolonged lengths of time. The procedure usually requires an overnight stay in an outpatient surgery center and is of relatively low risk.
Overall study results showed control of vertigo in 75%, improvement in tinnitus in 48%, improvement in ear fullness in 62%, and hearing preservation in 90% of patients.
However, we do not know what causes the increase in fluid pressure within the cochlea (increased production of inner ear fluid, decreased reabsorption of the fluid, or a combination of both). A fiberoptic examination of the middle ear and round window area is then performed using delicate 1.7 mm Middle Ear Endoscopes (lighted fiberoptic tubes) attached to a miniature television camera. Again, the hearing loss may be due to patchy areas of ischemic tissue within the inner ear secondary to a lack of adequate blood flow. The round window is located and any scar tissue, adhesions, or obstructions that may be present are carefully removed.



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