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What Doctors Don't Tell You

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October 2020 (Vol. 5 Issue 7)

Minieres disease

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Q) My partner has been suffering from dizziness, vertigo, nausea, occasional vomiting, headaches, lethargy, lack of concentration, tinnitus, and a feeling of pressure and fluctuating deafness in one ear for over a year now

Q) My partner has been suffering from dizziness, vertigo, nausea, occasional vomiting, headaches, lethargy, lack of concentration, tinnitus, and a feeling of pressure and fluctuating deafness in one ear for over a year now. An MRI, so far as we know, has not shown anything. All his GP has given him are painkillers and betahistine for the dizziness (which is not really working that well).

From what we have read, all the symptoms are pointing to its being Meniere's disease, or something similar. Is there anything that he can do for himself to relieve the symptoms and get back to some kind of normal life? He has been unable to work since all this began.-J.B., via e-mail

A) Meniere's disease (MD) is a disorder of the inner ear, first described in 1861 by Prosper M'eni`ere, a French ear-nose-and-throat physician. Also known as 'recurrent aural vertigo', the disease comes with specific symptoms: dizziness (vertigo), loss of hearing, a feeling of pressure in the ear and tinnitus (ringing in the ear). It tends notto be a constant problem, but often appears out of blue in sudden attacks. These can be severe, involving such serious vertigo that sufferers can lose their balance and fall to the floor. These so-called 'drop attacks' can last for hours or even days. They are often accompanied by vomiting and sweating. Other symptoms include so-called 'brain fog', exhaustion, headaches, vision problems and (hardly suprisingly) depression.

There's no objective clinical test for MD, so the diagnosis has to be made exclusively on the symptoms. This means that there's always room for doubt that it's the correct diagnosis. Given these circumstances, it's good news that your husband has undergone magnetic resonance imaging (MRI), as MD symptoms can mimic those of an acoustic neuroma (a benign, non-cancerous tumour of the acoustic nerve, in the inner ear).

It's very likely that your GP also thinks the problem is Meniere's as he has prescribed betahistine, the standard treatment for MD. However, although the drug has been around for more than 35 years, it has never been adequately tested in a proper clinical trial, according to a recent survey of the data. What few clinical trials there have been indicate that it's not very effective, particularly in the case of tinnitus (Cochrane Database Syst Rev, 2001; 1: CD001873). Ironically, the side-effects of the drug can some-times worsen symptoms such as nausea and vomiting (Cochrane Database Syst Rev, 2001; 1: CD001873).

Indeed, as the drug doesn't seem to be doing your husband much good, the GP will probably advise that he undergo surgery to insert a shunt into the ear to drain the fluid, or to sever the vestibular nerve to stop the dizziness. Although success is claimed for these operations, the results are described as "variable", and some procedures can actually damage hearing.

As usual, none of the conventional treatments attempt to tackle the root cause of the disease which, in medico-speak, is termed 'idiopathic'-which means it's a mystery. But there's now growing interest in the idea that MD may be an autoimmune disease, possibly brought about by some kind of allergic or immunological reaction.

One theory is that the inner ear-particularly the endolymphatic sac, which is where the fluid buildup occurs in Meniere's-can trap antigens and generate an immune response. A number of possible mechanisms have been suggested: the sac could be a target organ for food or chemical sensitivity; it might become inflamed in response to the antigens; or there might be an inherent weakness in the ear due to a viral infection in childhood. Whatever the reason, the endolymphatic sac is thought to be the focus of immune reactivity in the inner ear. Repeated inflammation may result in the release of fluid into the sac, causing the MD symptoms.

Probably the most research on the link between allergy and MD has been carried out by doctors at the House Ear Institute in Los Angeles. Struck by the similarities between MD symptoms and allergic reactions in general, they sent out questionnaires to all of their MD patients from 1994 to 1998. From the more than 700 who responded, they discovered that these patients had significantly more allergies than most people-59.2 per cent had inhalant allergies (for example, to pollen and house-dust mites), and 40.3 per cent were allergic/ sensitive to certain foods (Otolaryngol Head Neck Surg, 2000;

123 [1 Pt 1]: 69-75).

The doctors then decided to treat the allergies, putting these MD patients on an allergen-free diet and through a programme of desensitization. The results, although not spectacular, were promising, with almost half the patients achieving solid control of their vertigo, and over half maintaining or improving their hearing (Otolaryngol Head Neck Surg, 2000; 122: 174-82).

Another theory is that the symptoms of MD may be caused by muscular tension or structural problems in the jaw and neck, according to osteopaths in two clinics, in Germany and Sweden, respectively, who have successfully treated patients by physical manipulation. The Swedes have had particular success, reporting "highly significant decreases in the intensities of vertigo, non-whirling dizziness, tinnitus, feeling of fullness in the ear and headache" (Cranio J Craniomandib Pract, 2003; 21: 50-60).

Finally, your husband could try taking Ginkgo biloba,or the homeopathic product called Vertigoheel (see, both of which have been proven to reduce vertigo (J Altern Complement Med, 2005; 11: 155-60).

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