When Huey Lewis recently revealed his diagnosis of Ménière’s disease, the 67-year-old musician publicly joined a group of about 615,000 Americans living with the unpleasant, disorienting inner-ear disorder.
Ménière’s affects men and women equally, with symptoms including unpredictable bouts of vertigo (attacks of a spinning sensation)…progressive hearing loss…tinnitus (ringing or buzzing in the ears)…and a sense of pressure or “fullness” in one ear.
An often-overlooked symptom: Falls. A small percentage of people with Ménière’s experience drop attacks, sudden falls that may be triggered by fatigue, poor lighting or visually stimulating situations.
THE FIRST STEP
Ménière’s is thought to be caused by pressure and fluid in the inner ear, which play a key role in hearing and balance. Though it’s not understood why, some people develop an excess concentration of sodium in the fluid bathing the inner ear, causing swelling and the firing of incorrect hearing and balance signals to the brain.
For this reason, the mainstay of Ménière’s treatment typically involves restricting sodium intake to 1,500 mg to 2,000 mg a day and taking a mild oral diuretic. This one-two punch eases fluid buildup in the inner ear, allowing the majority of Ménière’s sufferers to control their symptoms.
Before moving on to more aggressive treatment options, some people also can get relief from their Ménière’s symptoms if they…
• Control allergies. About 40% of Ménière’s patients have allergies, and ongoing research suggests an association. Treating allergies may minimize Ménière’s symptoms.
• Watch for food sensitivities. Some research has linked certain food sensitivities to Ménière’s disease. For example, if you are sensitive to gluten (a protein found in wheat, barley and rye), your Ménière’s symptoms may improve if you avoid gluten.
• Reduce stress. A link between stress and an uptick in Ménière’s attacks was substantiated by a study published in 2018 in Otology & Neurotology. A relaxation technique called autogenic training (AT), in which you recite a set of affirmations designed to reverse the physical manifestations of stress, such as I am calm and My heartbeat feels regular, also has been found to help people with Ménière’s. Search for a local AT therapist at GoodTherapy.org. (But anything to lower stress could be useful.)
Some Ménière’s patients will need even more help. They may benefit from one or more of the following therapies—results vary, so consult your doctor for advice…
• Anti-inflammatory steroids. Taken orally or delivered with a tiny needle directly through the eardrum into the inner ear (called an intratympanic injection or IT), steroids reduce inner-ear swelling. When they work, steroids can provide relief for anywhere from a few weeks to a few months or longer in some cases. Whether taken orally or via injection, these steroids have benefits and drawbacks.
Oral steroids, such as prednisone, can be taken anywhere. So if an episode hits on the weekend, it’s convenient to take a pill. However, oral steroids can have systemic side effects, such as increased blood sugar levels and overall fluid retention. They should be used under a doctor’s supervision and for only a few days at a time.
Intratympanic injections must be administered in the doctor’s office, usually over a series of appointments. But because the medicine is delivered directly to the ear, it’s much less likely to cause systemic side effects.
• Endolymphatic sac shunt. For patients who are still in the first few years of symptoms and have maintained most of their hearing, a shunt is a good option. Performed on an outpatient basis under general anesthesia, an incision is made behind the ear…the endolymphatic sac (a nonsensory organ in the inner ear) is opened up…and a tiny silicone shunt is inserted, allowing microscopic amounts of fluid to drain out of the inner ear. A shunt will alleviate vertigo in about two out of three cases for a variable period of time.
• Intratympanic gentamicin treatment (ITG). The antibiotic gentamicin (Garamycin), used for serious bacterial infections throughout the body, has toxic effects when applied directly to the inner ear. That might sound frightening, but when carefully administered via ITG, it allows a doctor to selectively damage the balance cells in the inner ear, dialing down the intensity of Ménière’s attacks.
Because only one ear is typically involved, patients maintain a functioning balance mechanism in their healthy ear. However: At least one in five patients suffers permanent hearing loss in the affected ear after ITG, so it’s preferred to start with a small dose and check back in a few weeks for any improvement of symptoms.
THE LAST RESORT
A small percentage of Ménière’s patients will need a vestibular nerve section. This surgery essentially “unplugs” the vertigo signal by cutting the nerve that connects the balance and movement sensors in the inner ear to the brain. Performed under general anesthesia, it offers a near guarantee of ending vertigo. In those patients who already have very poor hearing in the affected ear, a bone-anchored hearing aid (BAHA) can be implanted at the time of surgery to help rehabilitate the hearing loss.
BEWARE OF MISDIAGNOSIS
Ménière’s disease is often mistakenly blamed on an ear infection, low blood pressure, dehydration or the aging process.
Also: Vestibular migraine (VM), a relatively newly discovered type of migraine that causes vertigo, ear pressure and aura, also can be mistaken for Ménière’s. VM causes attacks that are far shorter in duration than Ménière’s—minutes, not hours, mainly striking women. If you’ve been told that you have Ménière’s, make sure to ask your doctor about VM, as treatments may differ.