MenieresInfo.com Blog

A reader asks:

What drugs are contraindicated with Meniere’s Disease?

We haven’t seen any authoritative listing, comprehensive or otherwise, of drugs that are *always* contraindicated with Meniere’s Disease. (Remember that the cause of Meniere’s Disease is unknown.) Of course, we haven’t seen everything.

The better answer is to ask your Meniere’s Disease doctor about any drug that has been prescribed by any other doctor and whether it will adversely affect your Meniere’s Disease or adversely interact with any drug that your Meniere’s Disease doctor has prescribed.

Some substances are known to trigger or exacerbate the symptoms of Meniere’s Disease in *some* patients, such as caffeine, nicotine, and salt. Therefore, initial treatment will usually include avoidance of these triggers. Other patients find that they are not affected by these substances.

Some substances are known to be “ototoxic” to a greater or lesser degree. “Ototoxic” means toxic to the ear, either by impairing balance, damaging hearing, or inducing tinnitus. We’ve not seen anything authoritative that indicates that Meniere’s Disease patients are any more sensitive to these substances than anyone else, but, as we always say, we’ve not seen everything. (Note that exposure to loud sound can also damage one’s hearing.) On the other hand, having already suffered the effects of Meniere’s Disease, one might want to reduce any controllable exposure to anything that might further worsen one’s condition, no matter how remote the chances.

The bottom line: talk to your doctor.

A reader asks:

Does Meniere’s Disease result in any characteristic personality changes?

Our simple answer is “no,” but we’ll let you read the literature and come to your own conclusions.

Search PubMed here.

That said, some patients develop the following conditions, for rather obvious reasons:

Of course, some patients develop none of those conditions.

We, who are not doctors, speculate that factors include the severity of one’s Meniere’s Disease, the success in treating it, the nature of one’s employment, the support that one gets from one’s doctor, the support that one gets at work, and — perhaps most importantly — the support that one gets at home.

A reader asks:

I have Meniere’s Disease. My family doctor does nothing for me. I need help in managing this. I get dizzy when lying flat or turning in bed. My family does not understand how awful this is. Where can I go for help?

When one doctor doesn’t help, go to another doctor. A family doctor is the wrong specialty for Meniere’s Disease. For resources to help you find a doctor, see the MenieresInfo.com Doctors Page. We always recommend multiple medical opinions, both for diagnosis and for treatment options.

We suggest that you read the MenieresInfo.com Start Page.

Note that dizziness arising from certain positions may or may not indicate some disorder other than Meniere’s Disease, such as benign paroxysmal positional vertigo (BPPV). But that’s something to discuss with a specialist.

Lack of understanding among families of Meniere’s Disease patients is all too common — and sad. There are those who don’t understand, those who don’t want to understand, and those who simply cannot understand. The effect on the patient is pretty much the same — devastating.

VEDA (Vestibular Disorders Association, located in the U.S.) has a listing of support groups for patients here.

You might think that you would like to send one’s family to a support group for families of Meniere’s Disease patients, and we would agree with you, but we don’t know of any. Perhaps families should be invited to observe meetings of support groups for patients. We wish we had a better answer for you.

A reader asks:

My doctor suspects that I may have Meniere’s Disease. I am reading up on it now and I am not thrilled at the thought of having it. My worst symptom right now is vertigo accompanied by vomiting, and ringing in one ear. After an attack of vertigo, I have difficulty in focusing my vision. I feel like I have to fight to get my eyes to focus on anything. I haven’t had a severe vertigo attack in three days, but my eyes just want to close and I just want to sleep. That’s when I’m most comfortable. Is this normal?

What you are really asking first is whether you have Meniere’s Disease. We have no idea. One must have the proper diagnostic tests and be diagnosed by a medical professional. See the MenieresInfo.com Diagnosis Page. Note that the symptoms of Meniere’s Disease are also the symptoms of many other disorders and conditions, and that one must have a “differential diagnosis” in order to figure out which of the many disorders one might have. The symptoms of Meniere’s Disease are described at MenieresInfo.com here.

The fact that one’s doctor “suspects” that one “may” have Meniere’s Disease seems rather uninspiring of confidence to us. We always recommend multiple medical opinions, both for diagnosis and for treatment options. See the MenieresInfo.com Doctors Page.

You say that you have “vertigo accompanied by vomiting.” With Meniere’s Disease, nausea and vomiting are not symptoms. Rotational vertigo is a symptom. A consequence of rotational vertigo can be nausea, and a consequence of nausea can be vomiting. But vomiting is not a direct symptom of Meniere’s Disease.

A consequence of an attack of rotational vertigo due to Meniere’s Disease can be fatigue. A really acute attack of rotational vertigo can result in fatigue for hours or even days, with the fatigue being commensurate with the intensity and duration of the attack. Fatigue, in turn, results in sleep. Sleep due to fatigue is different from sleep which makes one comfortable.

An inability to focus one’s eyes is not a direct symptom of Meniere’s Disease, but can be an obvious consequence of experiencing rotational vertigo. Obviously, fatigue can produce a similar sensation. However, you seem to describe an inability to focus your eyes to an extent and for a duration that exceeds what you might expect from the intensity and duration of the attacks of vertigo that you are experiencing.

In any event, all of this needs to be discussed with one’s doctors, keeping in mind that despite the suspicions and maybes of one’s doctor, you have yet to be confidently diagnosed with anything.

A reader asks:

What is a drop attack?

There is a degree of controversy surrounding the term “drop attack.”

Some Meniere’s Disease patients describe a “drop attack” as a sudden, acute, attack of vertiginous rotational vertigo so great that they fall down as the world swirls around them, usually followed by nausea from the rotational vertigo, which in turn is usually followed by vomiting from the nausea, but consciousness is not lost as in a blackout or fainting spell.

There is a phenomenon known as “Tumarkin’s Crisis” or “Otolithic Crisis of Tumarkin,” in which one suddenly drops to the ground for unknown reasons and without other symptoms and yet immediately stands up again and carries on with one’s business. Some people believe that this is the only true meaning of the term “drop attack.”

We believe that when one drops suddenly to the ground, then “drop attack” is an appropriate description, whether or not the drop happens to be an otolithic crisis of Tumarkin, and that it is an appropriate description of a sudden acute attack of vertigo due to Meniere’s Disease that makes one so dizzy that one falls down.

For more information on drop attacks, visit MenieresInfo.com here.

To search PubMed, click here.

A reader comments on her pregnancies with Meniere’s Disease:

I was diagnosed with Meniere’s Disease at age 29. I became pregnant with my first child at age 30. During my first pregnancy, I had episodes of feeling off balance, with tinnitus and hearing loss in both ears. I worked as a Medical Technologist during my whole first pregnancy and was able to perform my job with only minor problems.

I became pregnant with my second child at age 33. By this time I had chosen to be a stay at home mother for reasons having nothing to do with my Meniere’s Disease. In the 30th week of my second pregnancy, I had several severe vertigo attacks, with tinnitus and hearing loss in both ears. After delivering my second child, my attacks were less frequent and less severe.

I became pregnant with my third child at age 35. I never had a vertigo attack with my third pregnancy, although later in the pregnancy I had some episodes of feeling lightheaded and off balance, with tinnitus in both ears.

Now I have tinnitus on and off and I have fluctuating hearing loss. I have good days with one or both ears being clear, but symptoms do come and go. I have found that, for me, eating a diet low in carbohydrates and with lean meats seems to work well. I keep my cats outside and I have reduced most allergens indoors. I replaced most of my wall-to-wall carpeting with hardwood floors and I placed Berber rugs on top of the hardwood floors. Reducing caffeine does not seem to help me, so I drink coffee as I always did.

I will probably try for a fourth child in a year or two at age 38 or 39, with the belief that another pregnancy will be no different from the first three.

We are grateful for these thoughtful and detailed comments and encourage other readers to provide their experiences.

We previously posted on pregnancy here.

Remember that although the reader’s comments above are very encouraging, there are surely other patients who have had greater difficulties. Nothing is certain with Meniere’s Disease. However, as we have said before, we have not heard of a patient regretting a pregnancy due to Meniere’s Disease, but we haven’t heard of everything.

A reader asks:

I have been suffering Meniere’s Disease for three years. I went on a diet a year ago to lose some weight, and eventually lost about 25 pounds. Since then, I haven’t had a significant attack, I’ve been able to tolerate more salt in my diet, and I stopped taking diuretics. Can weight loss reduce the symptoms of Meniere’s Disease?

To search PubMed, click here. We didn’t find any articles on this subject one way or the other.

Can weight loss reduce excess endolymphatic fluid that is the prevailing (but not the only) theory of Meniere’s Disease? Dunno.

Can weight loss improve general health, both physical and mental, thereby reducing stress and improving the symptoms of Meniere’s Disease? Our sheer speculation in the absence of evidence one way or the other is, “sure.”

Could the improved symptoms be a coincidental fluctuation that is common with Meniere’s Disease or a temporary remission? That is always possible, given the fluctuating nature of the disease. One never knows.

But nothing succeeds like success and if it works for you, it works for you.

Glad to hear that you are doing better.

As always, we suggest that one talk to one’s doctor and get multiple medical opinions, both for diagnosis and for treatment options.

Update: See this subsequent post.

A reader asks:

Should patients with Meniere’s Disease avoid pregnancy?

This is absolutely, positively, a subject to discuss with one’s doctors and a subject not to be influenced by what one may see on the Internet.

That said, here are a few thoughts that you may want to use as talking points with your doctors.

Search PubMed here.

We do not know of any risk posed by Meniere’s Disease to the fetus — but we don’t know everything. Be sure to talk to your doctors.

Meniere’s Disease is not hereditary. However, it does occur with increased frequency in *some* families (no one knows why). Thus, Meniere’s Disease is said to be “familial.” See our previous post here.

Anecdotally, some patients have reported that their symptoms worsened during pregnancy. Other patients have reported that their symptoms lessened or abated during pregnancy.

Some drugs prescribed to Meniere’s Disease patients to treat the symptom of vertigo are known to pose risks to a fetus. Other drugs have been studied and are not known to pose risks to a fetus (but there are no guarantees). See Dr. Timothy Hain’s information here.

We have never heard a patient say that she regretted having become pregnant because of Meniere’s Disease. But we haven’t heard everything.

Remember, this subject is best discussed with your doctors. A significant factor will be the extent to which Meniere’s Disease affects you and the extent to which you are willing to forego during pregnancy any treatment that might place the fetus at risk. In other words, a long, hard haul may (or may not) be even harder.

We wish you our best.

A reader comments:

I am embarrassed and feel older psychologically because I don’t want to ask people to repeat everything they say. But it’s getting more and more difficult by the day. I have two dogs, so they hear things that I can’t hear anymore. At any rate, this is not something I had planned on in my life, and I find it very frustrating.

Meniere’s Disease patient David Copithorne has written a lot about his hearing loss, the way that hearing loss changed his life, and how hearing aids have helped him. He also writes about the latest developments in hearing technology. We suggest that you start reading his posts here, and continue here (read from bottom to top). Then go on to the rest of his blogsite, www.hearingmojo.com.

A reader asks:

I have been diagnosed with Meniere’s Disease. I have been with the airlines for twenty some odd years and specifically flew on a regular basis on turbo prop planes. I am just wondering if there is a connection.

Meniere’s Disease is “idiopathic.” The cause is unknown. The answer to every question that begins, “Is there a connection between Meniere’s Disease and . . .” is “no,” or, at least, “not that anyone knows.” If you knew what caused your symptoms, you wouldn’t have Meniere’s Disease. See the MenieresInfo.com Cause Page.

But who can help but wonder about flying? That “aural fullness” that comes with Meniere’s Disease — that awful “plugged ear” feeling that you can’t get rid of — it feels just like middle ear pressure as when you are descending in an airplane, doesn’t it? You can’t help but try to equalize the air pressure between the middle ear and the ambient pressure, can you? You hold your nose and blow — not too hard — and hope for a “pop.” But it doesn’t happen.

Even though aural fullness feels just like middle ear pressure, it isn’t middle ear pressure. Or if it is, it’s not due to Meniere’s Disease. If you have a dysfunctional Eustachian tube in addition to Meniere’s Disease, you might have real middle ear pressure. If you have a cold in which congestion blocks the Eustachian tube, in addition to Meniere’s Disease, you might have real middle ear pressure. But Meniere’s Disease does not cause middle ear pressure — it just feels that way. The way that you know this is because the Eustacian tube is a “vent” — a connection between the middle ear and the pharnyx. It equalizes the pressure between the middle ear and the ambient pressure, even if you have Meniere’s Disease.

A reader asks:

I have Meniere’s Disease. I have heard music from time to time for the past several years. Since December, I have heard music almost continuously. At first it was the same song over and over for about three days. Then the music changed. While at the airport I heard a Christmas song that I thought was coming over the intercom. When I realized it was the music in my head I ran from the airport. When I got to my parkedcar, the music was still going and it was very clear and loud enough I could even hear the instrumental parts. My ENT doctor said that I just think it is music. He said my brain realizes my hearing is not working and is making sounds that I interpret as music. I am still hearing music regularly 30 days later and it is not always the same song over and over. Occassionally I hear a song that I am not familiar with. Have you heard of this?

You could be describing musical hallucinations, and, if so, you’ll be glad to know that we have heard of this, and that you are not alone. Click here to read more from our recent post in response to a similar inquiry.

We are not doctors, so we cannot say whether you do or do not hear musical hallucinations. You sound skeptical of your doctor’s comments. We are firm believers in skepticism, and we always recommend multiple medical opinions, both for diagnosis and for treatment options.

Revised and Updated January 18, 2006.
Originally posted January 11, 2006.

Based on the press release:

Announcing “Inner Ear Balance and Dizziness Disorders,” a new 234-page book describing vestibular disorders and their effect, diagnosis, and treatment in easy to understand language by P.J. Haybach, R.N., M.S., author of both “Meniere’s Disease: What You Need to Know” and “BPPV: What You Need to Know.”

“Inner Ear Balance and Dizziness Disorders” is available in two formats, print and non-printable ebook. The print format is available from Amazon here and at BookSurge here at $20.99. The non-printable ebook format is a good choice for readers in a hurry or on a strict budget because it’s available for immediate download at BookSurge here at the lesser price of $7.99.

More information, including the table of contents, index, and a sampling from the book, can be found on this page at the author’s web site: www.balance-and-dizziness.com.

Haybach is the author of the must-read book for Meniere’s Disease patients and those who know them, “Meniere’s Disease: What You Need to Know,” and numerous other books and short publications. Click here.

The new book should be of interest to, among others, those who are trying to get a diagnosis for their balance and dizziness symptoms and Meniere’s Disease patients who are wondering whether they have been correctly diagnosed (which would include many of us). (See the MeniereInfo.com section on “mimics” here.) The individual disease chapters are short but there are lengthy lists of references to give one a good start if one intends to do further research on one’s own.

Here is the table of contents, courtesy of the author, P.J. Haybach, via email:

Chapter 1: Introduction
Chapter 2: Whom Should I Go To?
Chapter 3: The Symptoms
Chapter 4: The Workings of the Ear
Chapter 5: Where Do Vestibular Disorders Come From?
Chapter 6: What Do I Have?
Chapter 7: The History
Chapter 8: The Examination
Chapter 9: Testing
Chapter 10: Treatment
Chapter 11: Diet
Chapter 12: Medications
Chapter 13: Physical Therapy
Chapter 14: Surgery
Chapter 15: Acoustic Neuroma
Chapter 16: Arnold Chiari Malformation Type I
Chapter 17: Benign Paroxysmal Positional Vertigo (BPPV)/Benign Positional Vertigo (BPV)
Chapter 18: Benign Positional Vertigo of Childhood
Chapter 19: Cervical Vertigo (Cervicogenic Vertigo)
Chapter 20: Cholesteatoma
Chapter 21: Delayed Endolymphatic Hydrops
Chapter 22: Endolymphatic Hydrops
Chapter 23: Enlarged Vestibular Aqueduct Syndrome
Chapter 24: Immune System Diseases (Autoimmune Diseases)
Chapter 25: Labyrinthitis
Chapter 26: Lyme Disease
Chapter 27: Mal de Debarquement
Chapter 28: Meniere’s Disease
Chapter 29: Migraine
Chapter 30: Multiple sclerosis
Chapter 31: Otosclerosis
Chapter 32: Ototoxicity
Chapter 33: Perilymphatic Fistula
Chapter 34: Shingles
Chapter 35: Superior Semicircular Canal Dehiscence
Chapter 36: Syphilis
Chapter 37: Temporal Bone Fracture
Chapter 38: Vascular Loop Compression
Chapter 39: Vestibular Neuronitis/Neuritis
Chapter 40: Vertebrobasilar Insufficiency
Chapter 41: Vestibulopathy
Chapter 42: von Hippel Landau Disease
Chapter 43: More
Chapter 44: Vestibular Loss
Chapter 45: Vertigo
Chapter 46: Imbalance
Chapter 47: Tinnitus and Hearing Loss
Chapter 48: Anxiety, Panic and Fear
Chapter 49: Depression
Chapter 50: Fatigue
Chapter 51: Stress
Chapter 52: Thought and Memory
Conclusion

Note: We get no compensation for this post, and we get no commissions on sales.

A reader asks:

For a couple of years, I have had all of the symptoms of Meniere’s Disease, plus fever on the left side of the head but focused on the ear. When I recently moved to a city at a higher elevation, my symptoms were more pronounced during the drive. Has there been any research on the effect of atmospheric pressure on the symptoms of Meniere’s Disease?

Virtually all published research can be found at PubMed. You can search PubMed for connections between Meniere’s Disease and atmospheric pressure by clicking here. Virtually all current clinical trials can be found here. Forms of research not falling into these two categories can be difficult to find.

What you describe is a decrease in atmospheric pressure. Anecdotally, some patients have reported that increases in barometric pressure, as from an approaching storm, can trigger or exacerbate their symptoms. Avoiding one’s triggers, or at least, observing one’s triggers, can be an important part of treatment. See the MeniereInfo.com Treatment Page. Also anecdotally, most patients seem able to fly without problems due to pressure changes, and we don’t recall any anecdotal reports that patients have worsened or bettered their symptoms in the long term by simply moving to different elevations. One of the treatments for Meniere’s Disease is the Meniett Device, which introduces pulses of pressure into the middle ear.

All that said, it seems to us that atmospheric pressure, like almost everything else, affects us all differently, and that there have been no certain conclusions reached.

We don’t know what you mean by “fever on the left side of the head but focused on the ear,” but whatever it means, it is not one of the four classic symptoms of Meniere’s Disease. See the MenieresInfo.com Symptoms Page.

We recommend that you proceed with all possible haste to medical professionals for the purpose of finding out what is causing your symptoms and getting treatment. There are resources to help you to find a doctor at the MenieresInfo.com Doctors Page. The symptoms of Meniere’s Disease are also the symptoms of many other disorders. It takes medical professionals and a differential diagnosis to determine what might be the cause of the symptoms that are shared by Meniere’s Disease and other disorders. See the MenieresInfo.com Diagnosis Page.

A reader asks:

I have been taking anti-depressant drugs for over a decade, including zoloft, welbutrin, seroquil, and effexor. More recently, I received inoculations for hepatitis a and b prior to international travel. Just a few weeks ago, I developed symptoms consistent with Meniere’s Disease. Could the anti-depressants, or the hepatitis inoculations, have caused Meniere’s Disease?

Meniere’s Disease is “idiopathic,” meaning that the cause is unknown. Therefore, the question “can this cause Meniere’s Disease,” is always answered “no,” or, at least “as far as is known, no.” See the MenieresInfo.com Cause Page.

Many, perhaps most, people who have Meniere’s Disease have not taken anti-depressant drugs or received hepatitis inoculations prior to developing symptoms. (It is not unusual to develop depression in conjunction with Meniere’s Disease and thereafter begin taking anti-depressant drugs.) Surely many people have taken anti-depressant drugs long term and or have received hepatitis inoculations without developing Meniere’s Disease.

But this means nothing one way or the other as to whether you have Meniere’s Disease. Remember that the symptoms of Meniere’s Disease are also the symptoms of many other disorders. Only a differential diagnosis by medical professionals can determine which of the many possibilities is responsible for your symptoms. See the MenieresInfo.com Diagnosis Page.

A reader asks:

How can I find a doctor in Canada who is knowledgeable about Meniere’s Disease?

There are resources to help you find a doctor at the MenieresInfo.com Doctors Page.

Try this search at PubMed.

Updated January 17, 2006
Originally posted January 16, 2006

A reader asks:

What is the relationship of microvascular compression syndrome (MCS) to Meniere’s Disease?

Microvascular compression syndrome (MCS) (also called vascular compression and neurovascular compression) occurs when a blood vessel is situated so close to a nerve that it contacts and presses upon a nerve.

Under various theories, MCS is either:

In any event, MCS can cause the same symptoms as Meniere’s Disease. It is treated by surgery, called “microvascular decompression” (MVD), in which the offending blood vessel is moved off of the nerve. A pad may be placed between the blood vessel and the nerve. Update: Some drugs may give symptomatic relief.

Read more about microvascular compression at these links:

MenieresInfo.com Cause Page
MenieresInfo.com Start Page
MenieresInfo.com Diagnosis Page
MenieresInfo.com Treatment Page
Dr. Timothy Hain
PubMed

A reader asks:

I had unilateral Meniere’s Disease for five years, and have recently become bilateral. I have learned to manage the vertigo over time. My primary concern now is the preservation of my hearing. A recent loss of hearing in my previously uninvolved ear has forced me to get a hearing aid for the first time. What can be done to specifically preserve hearing, apart from the usual treatments for vertigo?

There are many possible treatments for Meniere’s Disease. See the MenieresInfo.com Treatment Page. As this reader implies, treatments for Meniere’s Disease are usually aimed at relieving vertigo. The vast majority of patients find that vertigo is their most severe problem, but some, like this reader, have vertigo under control and for them their greater concern is preserving hearing. Of course, none of the symptoms of Meniere’s Disease (fluctuating rotational vertigo, hearing loss, aural fullness, and tinnitus) is pleasant. We would all like to be able to reduce all of the symptoms. That said, we all tend to prioritize our symptoms and identify the worst of them at any particular point in time.

However, many treatments, if successful, may (or may not) relieve other or even all other symptoms in addition to vertigo.

Lifestyle treatments, such as stress reduction, low-salt diets, elimination of potential triggers such as tobacco, caffeine, and alcohol, can have an effect on Meniere’s Disease overall, including all symptoms.

Diuretic drugs, such as Maxide, Diazide, and Diamox may improve Meniere’s Disease symptoms overall.

For patients whose Meniere’s Disease is responsivle to immuno-suppressant drug therapy, all symptoms may be improved.

Surgical implantation of pressure equalization tubes (PE tubes, or “grommets”) may or may not have an effect on all symptoms.

Intratympanic (transtympanic) instillation and perfusion of gentamicin, or gentamicin delivered by the Silverstein microwick or the Arenberg round window micro catheter, when specifically intended to ablate (destroy) the so-called “dark cells” that produce endolymph, if successful, might affect all symptoms. However, hearing loss is a risk of this treatment.

Endolymphatic sac surgery to reduce the volume of endolymphatic fluid, if successful, might or might not affect all symptoms. Hearing loss is a risk of this treatment.

Chemical and surgical labyrithectomy, of course, destroy hearing.

Vestibular nerve section (vestibular neurectomy) is intended to eliminate vertigo attacks, without damaging remaining hearing, but hearing loss is a possible consequence of the surgery.

To evaluate the impact of any particular treatment on symptoms, vertigo or otherwise, one should read the published studies. There are links to PubMed research on the MenieresInfo.com Treatment Page and Research Page.

The key to any treatment is to research the possibilities and discuss one’s concerns and questions with one’s doctor. We always recommend multiple medical opinions, both for diagnosis and for treatment options.

The first review has been posted on Kelly Haydon’s play about Meniere’s Disease, “Vestibular,” now playing through January 28, 2006, at Theatre 5 in Manhattan.

The bottom line: “Kelly R. Haydon’s Vestibular wrings poetry out of a rather sensational bunch of circumstances.”

Read the whole review here.

The details of the when and where of the performances are here.

A reader asks:

I have had rotational vertigo going on two months now and still getting worse. The second doctor that I have gone to thinks that I might have Meniere’s Disease. I have gone through the inner ear tests with no abnormalities and have a CAT scan and MRI scheduled. This doctor has recommended meclizine hydrochloride (Bonine and some other over-the-counter brands) and this greatly helps my nausea, but does nothing for my vertigo. My hearing is perfect, I have no tinnitus, and I have no aural fullness. I see that Menieres is progressive, but can it start with only one of the four “classic” symptoms?

This reader has one symptom: persistent, progressive, rotational vertigo. Although there are many definitions of Meniere’s Disease, the most commonly-used definition of “classic” Meniere’s Disease may be found here, which, generally, contemplates four fluctuating symptoms: rotational vertigo, hearing loss, aural fullness, and tinnitus. One of the reader’s doctors has remarked that the reader “might” have Meniere’s Disease.

We speculate that the reader (1) is desperately looking for a diagnosis, even Meniere’s Disease, and (2) is worried that it might be Meniere’s Disease.

As always, we recommend that our reader take one’s concerns to one’s doctor and discuss them. Often a patient’s concerns arise upon reflection and research after one has left the doctor’s office, and one needs to return to the doctor to discuss one’s concerns. We always recommend multiple medical opinions, both for diagnosis and for treatment options. This reader has seen two doctors so far. Seeing more doctors would not, in our opinion, be unreasonable.

The doctor’s remark that the reader “might” have Meniere’s Disease needs to be evaluated in its full context, to which we are not privy. Sometimes a doctor, faced with an uncertain diagnosis involving rotational vertigo, might say “might” with respect to Meniere’s Disease, since Meniere’s Disease for some doctors is the default diagnostic possibility when a more obvious or conclusive diagnosis is not handy. Sometimes a doctor will just make an offhand remark without intending the serious ramifications that a patient might well attach to the remark. In any event, a definitive diagnosis of Meniere’s Disease can only be accomplished by ruling out all other possible disorders having the same or similar symptoms — of which there are many. See the MenieresInfo.com Diagnosis Page, and the section on mimics.

There is no “typical” way that Meniere’s Disease begins. Each patient has one’s own story to tell. See our previous answer to a similar question here. For some of us with Meniere’s Disease, an initial acute attack is marked by all the symptoms. Others of us experience one or two symptoms first, and the other symptoms later. There is just no “typical” pattern, or at least no typical pattern that we have discerned or read about.

Vertigo alone, and vertigo in conjunction with the other symptoms of Meniere’s Disease and a whole lot of other disorders, can be difficult to diagnose. One must be patient while doctors go through the process of differential diagnosis to confirm or eliminate possibilities. With the one symptom of vertigo, there are many, many, many possible disorders about which to worry — Meniere’s Disease being just one of them. We suggest not worrying about any one possibility and instead focusing on getting the diagnostic tests that may help to further the differential diagnosis. (Once again, see the MenieresInfo.com Diagnosis Page.)

It is interesting that our reader is scheduled for both a CT scan and an MRI scan. Perhaps it would be too presumptuous of us to think that both scans are targeted toward the reader’s head. The usual (but not exclusive) choice would be an MRI scan, for the purpose of looking for, among other possible abnormalities, acoustic neuroma (benign tumor on the 8th cranial nerve), or plaque on the brain (which might suggest Multiple Sclerosis).

It is also interesting that our reader reports that meclizine hydrochloride helps one’s nausea but not one’s vertigo. It has yet to be determined that this reader actually has Meniere’s Disease. However, we should note that nausea is not a symptom of Meniere’s Disease. Nausea can often be a consequence of the Meniere’s Disease symptom of vertigo. Without vertigo, Meniere’s Disease patients are not expected to experience nausea. Meclizine hydrochloride is intended to treat vertigo by sedating the vestibular system rather than treat the secondary symptom of nausea, which in Meniere’s Disease patients is often treated with phenergan or compazine. However, meclizine hydrochloride does have antiemetic properties. See Dr. Hain’s information here and here.

A reader asks:

I experienced extreme pressure and tinnitus in both ears during a recent cold. I had a fluid buildup in my ears and my Eustachian tubes were blocked. I was a bit dizzy but did not experience rotational vertigo. After several weeks, the Eustachian tubes unblocked and the fluid in my ears was gone. I continue to have slight dizziness that comes and goes, and fullness and tinnitus in both ears. The tinnitus is intense enough to make it hard to sleep. I saw an otolaryngologist today. A hearing test showed no hearing loss. The doctor said I may have Meniere’s Disease, and prescribed a steroid, a diuretic, and a low sodium diet. If it is Meniere’s Disease, then I know that it was caused by the cold. I read up on Meniere’s Disease and it looks pretty scary. I’m hoping that the steroid, diuretic, and low sodium diet will clear this up and that it is not Meniere’s Disease. I have no hearing loss and no vertigo (just the slight dizziness), so could this really be Meniere’s Disease? Could this be early stages of Meniere’s Disease that will get much worse?

Our response to the question “Do I or could I have Meniere’s Disease?” is always the same: we don’t know. Only a medical professional who has conducted the necessary tests and taken the necessary history can diagnose Meniere’s Disease. See the MenieresInfo.com Diagnosis Page.

Our reader seems pretty sure that one is not experiencing rotational vertigo, but, rather, some other form of dizziness such as faintness, loss of balance, weakness, or light-headedness. Still, sorting out the term “dizziness” can be challenging, and it may take diagnostic tests by medical professionals to be definitive.

“Classic” Meniere’s Disease has four fluctuating symptoms: rotational vertigo, aural fullness, hearing loss, and tinnitus. “Atypical” Meniere’s Disease has fluctuating symptoms of both aural fullness and tinnitus, plus the fluctuating symptom of either hearing loss OR rotational vertigo. See the MenieresInfo.com Symptoms Page.

Meniere’s Disease is “idiopathic,” which means “cause unknown.” If you have Meniere’s Disease, you do not know the cause. So far, nothing, including colds and annoying in-laws, is known to be a cause of Meniere’s Disease. See the MenieresInfo.com Cause Page.

Diagnosis of the symptoms of Meniere’s Disease is difficult, because there are many disorders (”mimics”) that have the same symptoms. See the MenieresInfo.com section on mimics.

The only diagnostic test that you describe is a hearing test. It takes quite a bit more testing to establish whether one has Meniere’s Disease. Once again, see the MenieresInfo.com Diagnosis Page.

Meniere’s Disease is progressive. See the MenieresInfo.com Prognosis Page.

If you become deprived of sleep due to tinnitus, you should contact your doctor and discuss prescription options that may help you to get some sleep. This is very important.

We, who are not doctors, cannot tell you one way or the other whether you have, or might have, Meniere’s Disease. Only a medical professional can do that. There are many disorders that can produce the symptoms of Meniere’s Disease. It takes a differential diagnosis and diagnostic testing to sort out such symptoms. We always recommend multiple medical opinions, both for diagnosis and for treatment options.

Revised and Updated

The first review: “poetry.” Read about it here.

“Vestibular” (A Play About Meniere’s Disease)

As vertigo routinely attacks a former dancer stricken with Meniere’s Disease, an informal conversation with his nurse turns into a revelation that challenges the idea of dependency as a passive force.

There will be a seminar after the performance on Monday, January 23, 2006, starting at 9:00 p.m. and lasting about one hour. Details are still incomplete, but at this point in time a panel discussion is envisioned, led by a moderator. The panel may — perhaps — include cast members, a Meniere’s doctor, and a Meniere’s patient, and there will be audience participation.

To volunteer to serve on the seminar panel, to attend in the seminar audience, or to support the project, contact playwright Kelly Haydon at asm_kelly@yahoo.com.

A reader asks:

I have Meniere’s Disease, and for the most part, it has been manageable. However, I was in a car accident last night. I know I have mild whiplash, but I’m wondering if it is possible for the accident to have had some kind of impact on my Meniere’s. When I woke up this morning, my equilibrium was completely shot. All day I have been having issues with my balance being off, and mild dizzy spells. There was no trauma to my head or ears that I am aware of in the accident. I’m seeking medical treatment this evening; but I was wondering if it has ever been heard of for a car accident to trigger severe changes and Meniere’s attacks?

By all means, seek professional medical attention.

We don’t know of any studies that establish that auto accidents do or don’t or can or can’t aggravate Meniere’s Disease symptoms. It would be difficult to set up a controlled study where patients would volunteer for actual or simulated auto accidents. Auto accidents come in many different varieties. For example, you say that you don’t know of having experienced any head trauma — yet you say you experienced whiplash. To us, who are not doctors, whiplash constitutes head-and-neck trauma. As you seem to imply, it is theoretically conceivable to have sustained head trauma without knowing or recollected it — as in concussion from one’s head being thrashed about.

But it seems as if you are asking whether a mere auto accident not involving head trauma (in this case, as far as you know) can aggravate Meniere’s Disease symptoms. If one’s only trauma from the accident were a broken foot, it would be hard to see a connection. If one sustained head trauma, one could envision a potential problem.

Remember that Meniere’s Disease, as commonly (although not exclusively) envisioned, is an idiopathic (cause unknown) form of endolymphatic hydrops (excess endolymphatic fluid in the inner ear), also called IEH (idiopathic endolymphatic hydrops). There are other forms of endolymphatic hydrops, including traumatic endolymphatic hydrops (TEH). Click here. TEH is not Meniere’s Disease because the cause is known. But if trauma can *cause* TEH, is it reasonable to suspect that it can *worsen* existing endolymphatics hydrops from any cause — in your case IEH or Meniere’s Disease or somehow “add” TEH to existing Meniere’s Disease? It is to us, but that’s something to discuss with your doctor.

Stress is a factor with Meniere’s Disease symptoms. Could stress from an auto accident induce or exacerbate symptoms of Meniere’s Disease? One would think so. And one never knows whether one’s symptoms, or the aggravation of one’s symptoms, are just due to a normal fluctuation of symptoms or are attributable to some other connection.

Could an auto accident cause some other condition that results in balance problems in addition to Meniere’s Disease? Sure. The obvious thing that first comes to mind is concussion, mentioned above. Symptoms of concussion include dizziness and vomiting. Although both of these manifestations of concussion differ from manifestations due to Meniere’s Disease, it might be hard to distinguish them at first. (Dizziness from concussion is not the same as rotational vertigo from Meniere’s Disease. Vomiting from concussion is not the same as the nausea and vomiting that occurs as a consequence of rotational vertigo from Meniere’s Disease.)

Surely you are not the first to experience worsened Meniere’s Disease or Meniere’s Disease-like symptoms following an auto accident. Whether can be connected to the auto accident is something to discuss with your doctor.