I have Meniere's disease, and I get two vertigo attacks a week. Please help.

Question

Hello doctor,

I have been told by my ENT and another specialist that I have Meniere's. I have two vertigo attacks a week, ataxia gait, where I stagger when I walk, tinnitus, ear fullness, and hearing impairment during an attack. This has led me to suffer from mild hearing loss. This is for a report I am putting together for my VA rating. I am looking for an ENT specialist who will look over some results and write a second opinion. I need it to explain that the staggering I have been suffering is an ataxic gait and is familiar with people who suffer from vertigo, Meniere's disease, and other vestibular conditions. I also need them to explain that the fullness in the ear and stuffed feeling can cause severe hearing impairment during an attack. I am on an incredibly short time table and require help and a doctor's opinion as soon as possible. I can scan and send over documents tomorrow morning and have a teleconference as quickly as possible.

Answer 1

Hi,

Welcome to icliniq.com.

All your symptoms do go in favor of Meniere's disease. Let me first brief you on what happens in Meniere's disease. Our ear is divided into three components. The outer, the middle, and the inner ear, The inner ear, to be specific, is responsible for two actions. 1. Processing and relaying sound impulses. 2. Maintenance of equilibrium in synchrony with the cerebellum. The inner ear is divided into various sub-components, like the semicircular canals, vestibule, and cochlea.The cochlea is further divided into three components, i.e., the scala media, scala vestibuli, and scala tympani. Scala media contains the endolymph while the vestibuli and tympani contain the perilymph. The endolymph and perilymph are unique in their way. This maintenance of their difference in the composition should be maintained at all costs for the inner ear's optimum functioning. The endolymph in the scala media is produced and drained at a special rate. The quantity in the scala media should be maintained as any decrease or increase can create trouble. There is an excessive accumulation of endolymph in Meniere's due to excessive production or due to defective drainage leading to a bulge in the scala media's membrane. Excessive accumulation is the reason why this condition is also called endolymphatic hydrops. The membrane separating the scala media and vestibuli is extremely thin, and any bulge going beyond a particular extent can cause its rupture causing the mixing of the endolymph and perilymph. Symptoms occur due to two reasons, 1. Hearing loss happens when there is a mixture of the two components, as the action potential required to transmit nerve impulses does not occur. 2. The bulge in the scala media membrane causes vertiginous symptoms due to the false hyper firing of the vestibular nerves secondary to the nerve fibers' irritation. This is also responsible for the fullness in the ear. 3. Due to this mismatch of hyper firing, the cerebellum also gets involved causing ataxia in a few people. 4. Few people develop drop attacks called the Tumarkin's Otolithic Crisis, where there is sudden dislodgment of the otolithic structures located in the crista ampularis of the semicircular canals. 5. The symptoms can also occur in reverse order and such a condition is called Lermoyez syndrome. For any case of Meniere's, there should be VNG (videonystagmography), VEMP (vestibular evoked myogenic potential), and a hearing test to be done to ascertain possible, probable, particular diagnosis of this disease. Medications given depend on the intensity of the problem, and they do provide adequate amounts of relief in most people. In refractory cases, a surgery called endolymphatic sac decompression is done under general anesthesia, which is meant to prevent excessive accumulation and facilitate a drainage pathway. I hope this answers your query. Please do let me know if there is anything more that you need to know, and we will get back to you as soon as possible. Warm regards.