ear, nose, and throat disorders
Meniere Disease
Treatment of Meniere Disease
Preventing attacks by limiting salt, alcohol, andcaffeineand taking a diuretic (water pill) Medications such asmeclizineorlorazepamto relieve sudden attacks of vertigo Medications such asprochlorperazineto relieve vomiting Sometimes medications or surgery to reduce fluid pressure or destroy inner ear structures Following a low-salt diet, avoiding alcohol andcaffeine, and taking a diuretic (such ashydrochlorothiazideoracetazolamide), that increases the excretion of urine) reduce the frequency of vertigo attacks in most people with Meniere disease. However, treatment may not stop the gradual hearing loss. When attacks do occur, vertigo may be relieved temporarily with medications given by mouth, such asmeclizineorlorazepam. Nausea and vomiting may be relieved by pills or suppositories containingprochlorperazine. These medications do not help prevent attacks and thus should not be taken on a regular basis but only during acute spells of vertigo and nausea. To relieve symptoms, some doctors also give corticosteroids such asprednisoneby mouth or sometimes an injection of the corticosteroiddexamethasonebehind the eardrum. Certain medications used to prevent migraines (such as some antidepressants) help some people with Meniere disease. Several procedures are available for people who are disabled by frequent attacks of vertigo despite noninvasive treatments. The procedures aim to reduce fluid pressure in the inner ear or destroy inner ear structures responsible for balance function. The least destructive of these procedures is called endolymphatic sac decompression. (The endolymphatic sac holds the fluid that surrounds the hair cells in the inner ear.) In this procedure, a surgeon makes an incision behind the ear and removes the bone over the endolymphatic sac so that it can be seen. A blade or laser is used to make a hole in the sac, thus allowing the fluid to drain. The surgeon may place a thin flexible plastic drain in the hole to help keep it open. This procedure does not affect people's balance and rarely harms hearing. If endolymphatic sac decompression is ineffective, doctors may need to destroy the inner ear structures that are causing the symptoms by injecting a solution ofgentamicinthrough the eardrum into the middle ear.Gentamicinselectively destroys balance function before affecting hearing, but hearing loss is still a risk. The risk of hearing loss is lower if doctors inject thegentamicinonly once and wait 4 weeks before repeating if necessary. People who still have frequent, severe episodes despite these treatments may need a more invasive surgical procedure. Cutting the vestibular nerve (vestibular neurectomy) permanently destroys the inner ear's ability to affect balance, usually preserves hearing, and successfully relieves vertigo in about 95% of people. This procedure is usually done to treat people whose symptoms do not lessen after endolymphatic sac decompression or people who never want to experience another spell of vertigo. When vertigo is disabling and hearing has deteriorated in the involved ear, the Vestibular system can be removed in a procedure called a labyrinthectomy. Hearing restoration in these cases is sometimes possible with a None of the surgical procedures that treat vertigo are useful in treating the hearing loss that often accompanies Meniere disease. 