Meniere's Disease: Diagnosis and Treatment Options

Diagnosis of Meniere's Disease

Hello Doctor, last week I experienced sudden and frequent episodes of dizziness, tinnitus, and a sensation of fullness in my ears.
After visiting a clinic, the doctor suspected it was a cold and suggested I take cold medication and monitor my symptoms.
During the medication period, my symptoms fluctuated, but I noticed that my left ear has been increasingly perceiving multiple sounds compared to my right ear, which raised concerns about my hearing.
Therefore, I went to Tzu Chi Hospital in Taipei for further evaluation.
Initially, I underwent a hearing test, which did not reveal any significant abnormalities.
The doctor then scheduled a brainstem auditory evoked response (ABR) test for two weeks later and prescribed "Ning Ear Vertigo" to alleviate my symptoms.
However, my symptoms continue to fluctuate.
I recently came across information suggesting it could be Meniere's disease, and I would like to ask the doctor: 1.
How is Meniere's disease diagnosed? (I have dizziness, tinnitus, and a sensation of ear pressure, with the left ear being the most affected, but the symptoms fluctuate.) 2.
Can the brainstem test diagnose Meniere's disease? 3.
If diagnosed with Meniere's disease, would surgery be a more effective option? Thank you, Doctor!

Mr. Lai, 20~29 year old female. Ask Date: 2017/04/02

Dr. Li Jiaxuan reply Otolaryngology

1.
The diagnosis of Meniere's disease typically requires clinical symptoms, audiometric testing, and physical examination.

2.
Brainstem examination is performed to rule out the possibility of dizziness caused by other conditions.

3.
Medication is usually used for management, unless the symptoms are severe, as the risks associated with surgery are relatively high.
Wishing you safety and well-being.

Reply Date: 2017/04/02

More Info

Meniere's disease is a chronic inner ear disorder that can significantly impact a person's quality of life. It is characterized by episodes of vertigo, tinnitus (ringing in the ears), a feeling of fullness or pressure in the ear, and fluctuating hearing loss. Understanding the diagnosis and treatment options for Meniere's disease is essential for managing symptoms and improving daily functioning.

Diagnosis of Meniere's Disease
1. Clinical Symptoms: The diagnosis of Meniere's disease primarily relies on clinical symptoms. Patients typically experience recurrent episodes of vertigo that can last from 20 minutes to several hours, along with tinnitus and aural fullness. The symptoms can vary in intensity and frequency, which can make diagnosis challenging.

2. Audiometric Testing: Hearing tests are crucial in the diagnostic process. Audiometry can help identify hearing loss patterns typical of Meniere's disease, which often shows fluctuating low-frequency hearing loss.

3. Exclusion of Other Conditions: Other potential causes of vertigo and hearing loss must be ruled out. This may involve imaging studies, such as MRI, to exclude tumors or other structural abnormalities in the ear or brain.
4. Additional Tests: While brainstem auditory evoked response (BAER) testing can help assess auditory pathways, it is not specifically used to diagnose Meniere's disease. Instead, it is more useful for ruling out other conditions that may cause similar symptoms.

Treatment Options
1. Medications: Initial treatment often includes medications to manage symptoms. Antihistamines, antiemetics, and diuretics may be prescribed to help alleviate vertigo and reduce fluid retention in the inner ear. "Ning Ear Vertigo" (宁耳眩) is one such medication that may be used to relieve symptoms.

2. Dietary Changes: Patients are often advised to reduce salt intake, as high sodium levels can exacerbate fluid retention in the inner ear. Caffeine and alcohol may also be restricted.

3. Therapies: Vestibular rehabilitation therapy can help patients manage balance issues and improve stability. This is particularly beneficial for those who experience chronic dizziness.

4. Surgical Options: If medical management fails and symptoms are severely debilitating, surgical options may be considered. Procedures such as endolymphatic sac decompression or vestibular nerve section can provide relief. However, surgery carries risks and is typically reserved for severe cases.

5. Cochlear Implants: In cases where hearing loss becomes profound, cochlear implants may be an option to restore some degree of hearing.

Impact on Daily Life
Meniere's disease can significantly affect daily activities, work, and social interactions. The unpredictability of vertigo attacks can lead to anxiety and avoidance of certain situations, impacting overall quality of life. Patients may find it challenging to perform tasks that require balance or concentration, such as driving or operating machinery.

Conclusion
If you suspect you have Meniere's disease, it is crucial to consult an ear, nose, and throat (ENT) specialist for a comprehensive evaluation. Early diagnosis and a tailored treatment plan can help manage symptoms effectively and improve your quality of life. Regular follow-ups and monitoring are essential to adjust treatment as needed and to address any new symptoms that may arise.

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