Incurable Meniere's hard to diagnose
By the faculty of Harvard Medical School for The Harvard Medical School Adviser

Q: I've been having bouts of dizziness, and a friend suggested that I might have Meniere's disease. What is it, and what can I do about it?

A: Meniere's (say "menears") disease stems from a disturbance in the inner ear -- the part of your body that helps control your sense of balance. For unknown reasons, in Meniere's disease excess fluid builds up in part of the inner ear called the labyrinth (see illustration). Pressure from this excess fluid can damage some of the delicate structures in the inner ear. The result is dizziness and vertigo (a sensation that you or things around you are spinning). Not surprisingly, other symptoms include loss of balance, nausea and vomiting. Some people also hear ringing, buzzing or other noises, and some experience hearing loss.

Meniere's disease strikes men and women equally. Although it can occur at any age, it usually begins between the ages of 30 and 50. In most cases, only one ear is affected. The symptoms appear suddenly, without warning, and can last minutes to hours to days. Many people have only mild symptoms. But others have symptoms so severe they're disabling. Hearing loss comes and goes, but over time some degree of hearing loss may become permanent.

Diagnosing Meniere's disease can be tricky. Your doctor cannot examine the inner ear directly, so there is no simple way to tell whether fluid has built up. Usually, your doctor will diagnose Meniere's disease if you experience the typical symptoms and other possible causes of the symptoms have been ruled out. Your doctor will start by taking a medical history, including information about past or current medical problems and medications that you take. He or she will ask you detailed questions about your symptoms, including when they started, how often and for how long they occur, and how disabling they are. Your doctor then will examine you, with a special focus on your ears, nose, throat and balance system.

A simple hearing test may help pinpoint the problem. People with Meniere's disease have a particular type of damage to nerves responsible for normal hearing, which may make it difficult to tell the difference between similar-sounding words such as "boat" and "moat."

Doctors sometimes also recommend special scans that allow them to see the brain, middle ear and other structures inside the head. These scans can check for tumors and other problems that can cause symptoms that are similar to Meniere's. Another test, known as a rotational test, checks certain nerves to assess your body's balance system. In a darkened room, small electrodes are positioned near your eyes. Then, your ear canal is stimulated with water, air or changes in the position of your head. The electrodes measure how your inner ear responds. If you have Meniere's disease, doctors can spot typical changes caused by the buildup of fluid in the inner ear. If the diagnosis remains uncertain, you may be referred to an ear, nose and throat specialist or a neurologist.

There is no cure for Meniere's disease. However, the symptoms typically come and go, and only a minority of people with this condition will go on to develop permanent difficulties. Many doctors recommend avoiding caffeine, alcohol, salt and nicotine, which may reduce the frequency or severity of attacks.

To help ease symptoms, doctors can prescribe different types of medications. These include:

-- Anti-vertigo medications, such as meclizine (Antivert or Bonine) or betahistine, to relieve or prevent vertigo and dizziness

-- Antinausea medications, such as prochlorperazine (Compazine), to relieve nausea and vomiting

-- Diuretics, such as hydrochlorothiazide (HydroDIURIL), to reduce the amount of fluid that builds in the inner ear

People who are disabled by severe or frequent attacks may need specialized procedures or surgery. One treatment involves injecting an antibiotic, such as gentamicin, into the middle ear. This partially destroys the balance function of the ear, leaving the other ear to control balance. About 75 percent of people who get this treatment experience less vertigo once they've adjusted to their new sense of balance. Another procedure involves cutting a tiny hole in the inner ear to help clear out some of the accumulated fluid. It controls vertigo attacks in about 50 percent to 65 percent of patients. A different operation cuts the balance nerve that runs from the inner ear to the brain.

Most cases of vertigo are much less serious and many correct themselves in time. Still, if you continue to experience unexplained spinning or dizzy sensations, buzzing in your ears, or hearing loss, see your health care professional. If you need a specialist, you may be referred to a "spin doctor" -- not a political consultant, but a neurologist or ear doctor.

Copyright 2007 the President and Fellows of Harvard College. Developed by Harvard Health Publications (www.health.harvard.edu). Distributed by UFS. Submit questions to harvard_ adviser@hms.harvard. edu.