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Author: admin, 12.01.2014
Eustachian tube dysfunction, fluid collection in the middle ear, and sensorineural hearing loss are THE most common causes of ear fullness or clogged sensation in the ear.
This simple technique recently discovered by scientists at leading medical universities is the best way to permanently silence the noise blaring inside your ears. 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. But when sinus congestion from a cold or allergies blocks these tubes, you could develop a variety of problems, including ear infections.
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. Water often then gets trapped behind it, leading to a sudden sensation of blocked ear after a bath or shower. Individuals with a eustachian tube problems may experience difficulty equalizing middle ear pressure when flying. Excess fluid in the middle ear can result from a blocked eustachian tube, which can interfere with normal hearing, since fluid makes it difficult for the eardrum and bones in the inner ear to vibrate properly in response to sound. 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. The middle ear can fill with fluid due to Eustachian tube dysfunction – usually during a cold. When infection does not develop the fluid remains until the eustachian tube again begins to function normally, at which time the fluid is absorbed or drains down the tube into the throat.
Most people who have traveled by air are familiar with the sensation of increased pressure and popping in the ears, especially when the airplane is landing. 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). When you pinch your nose in an effort to pop the ears open, air is forced up the Eustachian tube to equalize pressure in the middle ear space.

During this healing period there are varying degrees of ear pressure, popping, clicking and fluctuation of hearing, occasionally with shooting pains in the ear.
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. The blocked nose, or thick mucus that develops during a cold or other infections, may block the Eustachian tube. If the test indicates that you have a conductive hearing loss, the audiologist will do another test called tympanometry. 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). Chronic blockage of the Eustachian tube can occur when the lining of the nose becomes irritated and inflamed.
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.
Long-term blockage of the Eustachian tube leads to the accumulation of fluid in the middle ear space that further increases the pressure and hearing loss. This can occur with allergies, sinus infections or upper respiratory infections, according to the Weil Lifestyle website. On an airplane, barotrauma to the ear a€“ also called aero-otitis or barotitis a€“ can happen as the plane descends for landing. When there is a hole in a balloon, no pressure can build up as it would automatically escape out the hole. In severe cases, it is possible for the pressure to create a leak between the deepest structures of the ear (the fluid-filled bony canals called the cochlea and semicircular canals) and the inner ear space. The tubes that connect the middle ear to the throat, called the Eustachian tubes, can become blocked and trap fluid that would normally drain from the middle ear. Some common symptoms that can indicate a build-up of inner ear fluid are pressure in the ear or hearing popping or ringing sounds, explains Dr.
Tube placement into the eardrum is indicated for persistent or frequently recurrent ear infections.
If this is necessary, it results in a total loss of hearing in the operated ear and temporary severe dizziness.
I have suffered for a long time, as well as my wife, with hearing loss mainly in my left ear. My left eustachian tube has been blocked of and on and when it does pop slightly I feel pain. I’ve been suffering with a blocked Eustachian tube in my left ear for a month now, still not gone despite several trips to the Doctors and countless tablets and de congestants.
It doesn’t necessarily mean you have an infection either although you will probably have discussed that with your GP.
Can cause long term hearing loss though so you really need to think hard before embarking on this. Then, my ears popped but i was left with this blocked feeling in my left ear, i decided to go back flying and didn’t experience pain but enough crackling and popping to warrant a trip to the docs who advised me to take ibuprofen and not to fly. The pop in the ears is a sign that the air has gone through the eustachian tube to the middle ear. If all of these steps have been tried and your Eustachian tubes are still blocked a doctor can make a small incision in the ear drum to pop your ears for you.
The warm steam can help open your sinuses, which in turn helps lower swelling that keeps eustachian tubes blocked -Try throughout the day to gently pop your ears using the Valsalva maneuver.
In fact, the tests do not indicate any hearing loss (only a little when there is a lot of background noise).
It is the blockage of the Eustachian tube that causes pain in the ears when flying as the changes in air pressure make it difficult for the pressure. My symptom are a little hard to describe, but for the past couple months I have been getting what I can only describe as a popping noise in my ears. Fever, drainage, dizziness, and ear pain indicate that you need to see a doctor about your ear pain, fullness, or discomfort.

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