Treatment of Meniere’s Disease

Balance disorders have wide reaching effects on brain function. Specifically in the case of Meniere’s sufferers, the abnormal input from the balance and hearing receptors in the ears causes changes in the functioning in the brain. This occurs not just in the areas associated with balance, but can affect cognitive function and mood. Anxiety in more common in people with balance disorders.

Vestibule and Cochlea in the Inner Ear Jacopin/Science Photo Library

Why is early diagnosis of Meniere’s disease so important? Are there any difficulties likely to be encountered with early diagnosis of Meniere’s?

Meniere’s can be a difficult diagnosis to make. Often the symptoms can be mild initally (though not always!), and many people present with only some of the classic symptoms. Classically Meniere’s sufferers will have periods of vertigo (sensations of spinning) for between 30 minutes and 24 hours, accompanied by low pitched tinnitus (ringing in the ear), made better by lying with the affected ear down. There is also a feeling of fullness, like a blocked ear, in the affected ear. Some people may have only some of these symptoms. The bouts usually recur. Each recurrance can damage the ear further leading to permanent hearing loss and balance problems. Apart from the obvious problems of hearing loss, balance problems increase the likelihood of falls which are associated with increased mortality, especially in the elderly.

Therefore early diagnosis can speed up access to preventative care which may decrease the degree of progression (and hence the severity of long term damage), and help the person develop coping strategies.

What methods are used for diagnosing Meniere’s disease?

Significant clues can be gained from the patient’s history. As mentioned, as the disease prgresses hearing can be permanently affected, so changes may be see on hearing tests. Tests of inner function for balance like caloric testing (observing eye movements in response to hot or cold water placed in the ear) may reveal deficits in responses. Various tests and scans like MRI and CT scans may be done to exclude other causes of the symptoms like tumours and strokes. Often Meniere’s disease becomes the default diagnosis when all other possible causes for the symptoms have been excluded. This is why it can take quite a while for people to get a diagnosis.

What treatments are available for Meniere’s sufferers?

Conventional medical treatments mainly centre around medications. At the Diamond Valley Brain Centre we focus on natural treatments for Meniere’s disease.

It has been thought that diet modifications like decreasing salt and caffiene may help, however the evidence about this is inconclusive. It is likely to be one of those things that some people respond to and others don’t. Likewise Gingko Biloba herbal preparations can be effective for some people, presumably through its action of increasing bloodflow to the brain and ear.

With our Meniere’s patients we use vestibular rehabilitation exercises. The vestibular (inner ear) systems send messages to the brain stem. Normally this information is pieced together in the brain stem, with the help of another region called the cerebellum, and is sent to the top of the brain, the cerebral cortex. From there it affects multiple areas within the brain.

Current accepted thinking is that Meniere’s patients recover fully between each attack, because it is believed the brain adapts to the different information during an attack, and then re-adapts back when the attack ends. My experience is that many people do not re-adapt and they end up with lasting brain dysfunction. With vestibular rehabilitation, you help the brain adapt to the signals coming from the ear, and thereby help any brain dysfunction.

Functional Neurology identifies and treats what are known as “functional” or physiological lesions within the brain. These lesions are not structural lesions like strokes or tumours and cannot be seen on conventional MRI and CT scans. They can however been seen on functional brain scans like PET, functional MRIs and quantitative EEGs. These lesions can have profound effects on brain functioning. Treatment aims to increase the activity in these dysfunctioning areas using a phenomenon called neuroplasticity. Neuroplasticity has become much more well known following the publication of Norman Doige’s excellent book, “The Brain that Changes Itself”.

Seeking treatment is important.  Questions?  Or to arrange an assessment with us please call 03 9435 2887 or send us a message using the form below.

References.

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BahadIr, C., D. Diraçoglu, et al. (2009). “Efficacy of canalith repositioning maneuvers for benign paroxysmal positional vertigo.” Clinical Chiropractic 12(3): 95-100.

Herdman, S., Ed. (2007). Vestibular Rehabilitation. Philadelphia F A Davis Company.

Hillier, S. L. and V. Hollohan (2007). “Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.” Cochrane Database Syst Rev(4): CD005397.

Hilton, M. and D. Pinder (2004). “The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.” Cochrane Database Syst Rev(2): CD003162.

Jung, J. Y., J. S. Kim, et al. (2009). “Effect of vestibular rehabilitation on dizziness in the elderly.” Am J Otolaryngol 30(5): 295-9.

Medeiros, I. R., R. S. Bittar, et al. (2005). “Vestibular rehabilitation therapy in children.” Otol Neurotol 26(4): 699-703.

Smith, P. F., Y. Zheng, et al. (2005). “Does vestibular damage cause cognitive dysfunction in humans?” J Vestib Res 15(1): 1-9.

Zeigelboim, B. S., K. F. Klagenberg, et al. (2009). “Vestibular rehabilitation: clinical benefits to patients with Parkinson’s disease.” Arq Neuropsiquiatr 67(2A): 219-23.