and Managing Recurring Dizziness: Insights on Meniere's Disease

Recurrent dizziness

Approximately 3-4 months ago, the patient experienced sudden severe dizziness and vomiting, leading to a visit to a teaching hospital where a brain CT scan was performed and deemed normal by the physician.
Due to recurrent episodes, the patient continued to seek care in both the otolaryngology and neurology outpatient clinics, undergoing hearing tests, balance assessments, and even an EEG in the cardiology department.
Aside from the hearing test indicating hearing impairment, all other test results were normal.
The patient has been on ongoing oral medication treatment, but symptoms have persisted over the last two weeks, with episodes occurring for 4-5 days a week, compared to 2-3 days a week previously.
The patient is under continuous outpatient follow-up and has been diagnosed with Meniere's disease.
However, despite several months of treatment, the symptoms have worsened.
Could this be related to weather factors? Are there other treatment options that could lead to improvement?

Miss Liang, 20~29 year old female. Ask Date: 2010/12/09

Dr. Xu Jiazhen reply Otolaryngology

Patients with vertigo have various underlying causes, and a neurological examination is generally required for a definitive diagnosis.
If we consider Meniere's disease, symptoms often improve with medication.
However, as you mentioned in your letter, if you are experiencing persistent dizziness, with symptoms escalating from two to three times a week to almost daily, it is advisable to investigate the underlying cause further.
You may need to be hospitalized for examination and treatment.
In outpatient settings, many patients present with similar conditions, and physicians can often identify the underlying issues with careful assessment, leading to symptom relief.
I recommend that you seek further evaluation at a hospital with comprehensive facilities.

Reply Date: 2010/12/09

More Info

Meniere's disease is a chronic inner ear disorder characterized by episodes of vertigo, tinnitus (ringing in the ears), hearing loss, and a sensation of fullness in the ear. It typically affects one ear, but in some cases, it can affect both. The exact cause of Meniere's disease is not fully understood, but it is believed to be related to an abnormal accumulation of fluid in the inner ear, which can disrupt the normal functioning of the auditory and vestibular systems.

Your experience of recurrent dizziness and vomiting, along with the diagnosis of Meniere's disease, is consistent with the symptoms associated with this condition. The fact that you have undergone various tests, including CT scans, hearing tests, and balance assessments, is essential in ruling out other potential causes of your symptoms. The normal results from these tests, except for the hearing impairment, suggest that Meniere's disease is indeed the likely diagnosis.

The worsening of your symptoms, particularly the increase in the frequency and duration of your episodes, can be frustrating and concerning. Several factors may contribute to the exacerbation of Meniere's disease symptoms:
1. Fluid Balance: Meniere's disease is often linked to fluid balance issues in the inner ear. Factors such as dietary salt intake, hydration levels, and stress can influence fluid retention and exacerbate symptoms. Reducing salt intake and maintaining proper hydration may help manage symptoms.

2. Weather Changes: Some patients report that changes in weather, particularly fluctuations in atmospheric pressure, can trigger or worsen their symptoms. While this is anecdotal, it is worth considering if you notice a pattern correlating your symptoms with weather changes.

3. Stress and Anxiety: Emotional stress can also play a significant role in the frequency and severity of Meniere's disease episodes. Stress management techniques, such as mindfulness, meditation, or counseling, may help alleviate some of the symptoms.

4. Medication Management: If you have been on medication for several months without significant improvement, it may be worth discussing with your healthcare provider the possibility of adjusting your treatment plan. Some medications, such as diuretics, can help reduce fluid retention, while others may help manage vertigo symptoms.

5. Vestibular Rehabilitation Therapy (VRT): This is a specialized form of physical therapy aimed at helping individuals with balance disorders. VRT can help improve balance and reduce dizziness through specific exercises tailored to your needs.

6. Surgical Options: In severe cases where conservative management fails, surgical interventions may be considered. Procedures such as endolymphatic sac decompression or vestibular nerve section can provide relief for some patients.

It's crucial to maintain open communication with your healthcare providers, including your ENT specialist and neurologist, about your worsening symptoms. They may recommend further evaluation or adjustments to your treatment plan based on your current condition. Keeping a symptom diary can also be beneficial, as it may help identify triggers and patterns that can inform your management strategy.

In summary, while Meniere's disease can be challenging to manage, understanding the potential contributing factors and exploring various treatment options can help improve your quality of life. If you continue to experience worsening symptoms, do not hesitate to seek further evaluation and support from your healthcare team.

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