Living With Meniere's Disease

We do not know exactly what causes Meniere’s disease. Like glaucoma, it is a condition that cannot be cured, but medications, exercises, and lifestyle changes may help minimize the attacks or cut down on the intensity of the symptoms. Nevertheless, the disease may progress or go into short or long-term remissions on its own. Whether one likes it or not, one must learn to live with the disease, so the approach of trying different treatments and avoiding potential triggers is probably the best practical method of living with this disorder. Regular medical attention is important to monitor the disorder, supervise the therapy, and determine if there is permanent damage setting in (particularly with regard to hearing, which may slowly worsen without notice, and which may not be treated with many of the symptomatic therapies used to control the vertigo of Meniere’s).

There are many articles available on the internet from patients who have described their experiences and shared their knowledge. Local Meniere’s disease support groups may be available in your community. These support groups can be very important resources. Patients will often swap information or provide local assistance on common or even unusual treatments that may help (or be found to be ineffective). There are national groups such as VEDA (Vestibular Disorders Association) and the American Tinnitus Association that may have advice or information for Meniere’s sufferers. The American Academy of Otolaryngology Head and Neck Surgery may be able to recommend an ENT doctor who has extensive experience in treating Meniere’s.

Since each person is different and no two cases of Meniere’s disease are exactly alike, almost all treatment of the disorder can be thought of as "experimental". A therapy must be tried for a reasonable period of time and the patients must be active participants. It is the patients’ very important job to record enough information for both themselves and the doctor to know if the therapy is helping. A Meniere’s diary is one very important way to keep tract of Meniere’s symptoms. One should write down every attack, every change in tinnitus, hearing or fullness, or associated symptoms such as nausea, headache, weight change, as well as outside events. For example, if you eat at a restaurant and then 2 hours later develop an attack, it would be great to have a listing of the foods that you have eaten. In this manner, it may be possible to pin down foods or other activities that trigger attacks of Meniere’s (see table 1 for list of common triggers) or foods that you may be allergic to. The import feature in a diary is to record everything that may be important BEFORE an attack of vertigo hits; since one cannot usually predict these attacks, it is important to write down almost any change in one’s routine- food, stress, weather, or unusual situations. If you think that something is triggering your attacks, do not be surprised if the trigger does not always work. For example, if coffee seems to be a trigger, on some days you may be able to drink many cups of coffee without triggering an attack, but on another day even one cup may be enough to start the vertigo. Only by checking over the Meniere’s diary and trying to correlate possible triggers with known attacks, may you be able to determine what your unique triggers are.

Fast-acting oral medications such as glycopyrrolate (Robinul®) or diazepam may be taken as soon as the start of a Meniere’s vertigo spell is noticed. Those people who get a "warning" of tinnitus, decreased hearing, ear fullness, or some other symptom telling them that a "dizzy spell" may be approaching should take their anticholinergic immediately to try to prevent or abort the attack, or lessen its severity.

Most people who have Meniere's disease will employ a strategy of minimizing exposure to triggers, a low-salt diet, and the chronic use of a diuretic to prevent endolymph hydrops. If they experience an attack coming on, they will immediately use a medication to suppress the attack, or a combination of medications such as diazepam and glycopyrrolate. Should the attack persist, an antiemetic such as promethazine may be added to minimize the nausea, and the sufferers may have to lie down and remain still for the duration of the attack. If the attacks seem to be coming on more frequently, perhaps a short course of intensive vertigo suppression, with regular use of an anticholinergic (glycopyrrolate) and a vasodilator (papaverine, betahistine, or niacin) or a few days of using the transdermal scopolamine patch, may help. Some doctors may prescribe a short course of high dose steroids (prednisone, dexamethasone) to suppress a cluster of attacks. Others may consider a trial of unusual medications when the usual therapies do not seem to work. If you are having problems finding a therapy that works, perhaps you should bring printed Web pages to your doctor to discuss use of other therapies. Each case of Meniere’s is unique, and, in addition, doctors may find that certain therapies work better for some oftheir patients than others.

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