News and views from the heart of England - Issue 2    © David Smith 2018

An unpleasant affliction

Meniere’s Disease, named after a French physician called Prosper Ménière, is a disorder of the inner ear that affects both hearing and balance, and is characterised by episodes of severe dizziness, hearing loss, and tinnitus. It is not known what causes it. The condition affects about 2 people in every 1000, and tends to affect women more often than men. Typically, it occurs in adults, with prevalence increasing with age. Not all sufferers of Meniere’s Disease experience the same symptoms, or the same severity of symptoms. However, the classic characteristics of the disease are

Periods of remission between attacks are common, and attacks tend to occur in clusters. I have had occasions when attacks have occurred two or three times a week, and yet I have experienced periods of remission between clusters lasting for months, and even for a few years. Unfortunately, the length of remission is no guarantee that fresh attacks cannot occur without warning.

Meniere’s Disease is linked to an excess of fluid in the inner ear. The inner ear has a system of membranes containing a fluid called endolymph. In a Meniere’s Disease attack endolymph bursts from its normal channels and flows into other areas, causing damage to hearing and balance cells.

There is no cure for Meniere’s Disease. There are few treatments beyond rather severe surgical processes, so management of the disease tends to be important for sufferers. It is believed that a high salt diet causes fluid retention within the inner ear, so sufferers are normally recommended to reduce their salt intake. I actually try to avoid foods which contain a higher sodium content than 0.2mg per 100 grams of food. Other substances that sufferers are advised to avoid include caffeine, alcohol, and tobacco.

There are some surgical treatments that can be carried out if Meniere’s Disease  - dizziness, in particular - becomes too difficult to manage, but many such treatments are destructive, and do not guarantee to preserve remaining hearing. Surgery to decompress the endolymphatic sac can be temporarily effective. Non-destructive treatments do not address the root cause of vertigo in Meniere’s Disease, and repeated treatments, if successful at all, are often necessary. Destructive surgery techniques are irreversible, and involve the removal of inner ear function. This is called labyrinthectomy. Another drastic method involves cutting the nerve to the balance part of the inner ear. A technique called Intra-Tympanic Gentamycin (ITG) is often used in what is called a chemical labyrinthectomy. ITG treatment involves the injection of a drug called gentamycin directly into the inner ear, through the ear drum. ITG treatment does not prevent further attacks, of course. All it does is to destroy the response of the balance function to the effects of the attack. Decline in hearing, as a result of an attack, continues. I had right ear ITG in 2001.

Meniere’s Disease usually starts in one ear, and, in about half of all patients, extends to the other ear over time. One consultant half-jokingly suggested to me that this is because most people get Meniere’s Disease in middle age, and are dead before the other ear can be affected. In my case, I contracted Meniere’s Disease when I was 21, so it was probably always likely that my second ear would be affected. Hearing loss usually fluctuates in the early years, and becomes permanent in the later stages, often with severe distortion and fragmentation. Hearing aids and cochlear implants can be of some use, but Meniere’s damaged hearing is notoriously difficult to work with. Meniere’s Disease is reckoned to burn out when vestibular function has been destroyed by the disease to the point where vertigo attacks cease - that is, when the ear can no longer respond to attacks. I’ve had it now for almost fifty years.