Wednesday, December 7, 2022

What Type Of Hearing Loss Is Meniere’s Disease

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Treatments For Meniere’s That Are Slightly Effective

Hearing Loss In Meniere’s Disease

The big problem with this section is separating placebo’s from slightly effective treatments. This intrinsically involves a cost-benefit comparison.

There are an immense number of placebo or nearly placebo treatments for Meniere’s disease. There is nothing wrong with a placebo, if it provides some benefit , and you can afford to do this. However, we don’t think that placebos that are billed to health care insurance providers should be supported. The treatments briefly discussed below are not placebos, but they are high in cost , and low in benefit .

The Meniett device‘s status at this writing seems most likely to be a slightly effective treatment or perhaps just a placebo. This treatment requires a surgical procedure and purchase of a very expensive device . We do not recommend Meniett treatment in our practice. We prefer low-dose gentamicin after medication fails.

Here is what a patient who had a good experience with the Meniett told me.

Hearing Loss Runs In My Family

Hearing loss has affected my family in ways that no one ever wanted to face or admit. Several members of my extended family have lived with varying degrees of untreated hearing loss for many years now.

It didnt matter how much we pushed and prodded them to explore the possibility of hearing aids. They wouldnt even entertain the idea. The stigma is very real.

But after years of denial and arguments, they all finally purchased hearing aids!

In some ways, it feels like a victory. Hearing loss affected their quality of life in ways that were all too obvious to us, but not at all to them.

But it also brings me face to face with one of my deepest fearsa truth I push away at every turn that because of Menieres disease, my hearing is more at risk than all of my family members combined.

I havent really had a reason to think deeply about the possibility of my own hearing loss in a long time. But this reopened the door in my mind and made what happened next all the more terrifying.

Menieres Hearing Loss Progression

At the beginning of this condition, hearing loss may be unnoticeable. Menieres affects the lower tonal ranges of sounds, and even then, its only in one ear. Sadly, for most people, this mild hearing loss only gets worse.

During the middle stage of the disease, a person may not have as many vertigo episodes, or they may not seem as severe. Nonetheless, tinnitus continues. Hearing loss increases. There may be months in between prevalent symptoms now.

After several years, vertigo continues to fade. Sometimes, it disappears totally. Meanwhile, ringing in the ear becomes markedly worse and distracting. Hearing loss also progresses. This element alone leaves people feeling off balance or unsteady even without vertigo.

Between 50 and 74% of Menieres patients end up with some level of hearing loss in both ears rather than just the one ear where symptoms began. If the second ear will show signs of damage, it will usually do so within five years of the diseases inception.

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What Can Be Done To Reduce The Frequency And Severity Of Menieres Disease Attacks

This is the way that we attempt to prevent Meniere’s attacks at Chicago Dizziness and Hearing:

The purpose of treatment between attacks is to prevent or reduce the number of episodes, and to decrease the chances of further hearing loss and damage to the vestibular system. A permanent tinnitus , constant imbalance, or a progressive hearing loss may be the consequence of long-term Meniere’s disease. Hearing aids may be necessary.

Standard medical treatments:

  • The hydrops diet regimen will probably be recommended . This is an important part of treatment for virtually all patients with Meniere’s disease. STRICT adherence to this dietary regimen will result in stabilization in most patients.
  • Between attacks, diuretic medication may be prescribed to help regulate the fluid pressure in the inner ear, thereby reducing the severity and frequency of the Meniere’s episodes. Dyazide is the most common medication for this purpose, and others are listed above. The literature suggests that diuretics are modestly helpful . See notes above concerning other agents.
  • Vestibular suppressants such as Antivert or Clonazepam, and anti-emetics are used on an as-needed basis.

Not so standard treatments

What the recommends in his practice in Chicago for medical prevention of Meniere’s. These drugs are administered to most of his patients, generally in the following sequence:

Otosclerosis And Hearing Loss

Ménière

Inside the ear, sound waves are converted first to mechanical energy, then to electrical energy, explains Dr. Ana H. Kim, MD, an associate professor of otolaryngology-head and neck surgery at Columbia University Medical Center in New York. As part of that effort, three small bones within your middle earthe malleus, incus and stapesvibrate. For people with otosclerosis, the smallest bone in the body, the stapes, gets affixed to the surrounding structure, making it unable to move, explains Dr. Kim.

Its almost like a stop sign. The energy flow just stops right there, says Dr. Kim. That is, sound enters the ear, but then the bone growth in the middle ear prevents it from making its way to the inner ear. Otosclerosis is a form of conductive hearing loss.

In some cases, as the ear loses its ability to transmit sound, people may first notice low-frequency hearing loss, meaning that low-pitched sounds are harder to hear.

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Stages Of Meniere’s Disease And Diagnosis

Meniere’s disease commonly affects people in various stages, with symptoms developing over time.

  • Early stage: During this time, a person will experience sudden and often out-of-the-blue episodes of vertigo that last anywhere from 20 minutes to an entire day. An person’s ear may feel blocked or full, and they may have some hearing loss, which typically goes away after the episode fades. It is also common to feel the effects of tinnitus.
  • Middle stage: Symptoms of vertigo tend to become less severe during this stage, while hearing loss and tinnitus will increase in severity. Many people will also experience long-term remission that can last several months.
  • Late stage: During the late stages of Meniere’s disease, patients will not suffer from vertigo as often, and some people will be relieved from it forever. However, tinnitus and hearing loss will likely get progressively worse, and people will likely experience unsteady balance regularly. Most people at this stage feel unstable in dark lighting conditions, for example.

Hearing Aids For Hearing Loss Caused By Menieres Disease

Another treatment for hearing loss caused by Menieres disease are hearing aids. Fortunately, todays hearing aids are much different than the hearing aids of yore. Todays digital hearing aids are smaller and offer the ability to do more than ever. At North Shore Hearing P.C., we offer a full range of hearing aids and will work closely with you to help you find the most suitable devices for your lifestyle. In addition to improving your hearing, hearing aids may also help reduce the ringing sensation in your ear.

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Are There Medications For Meniere’s Disease

Medications focus on treating the various symptoms. These medications may be taken mouth or by injection. For example, motion sickness and anti-nausea medications may reduce spinning sensation and help control nausea. Injections treatments into the middle ear may improve vertigo symptoms. For example:

  • Gentamicin While this drug can increase your risk of hearing loss, it reduces the balance function of your affected ear, and your remaining ear assumes all balance functions.
  • Steroids This drug has a similar function to gentamicin, but is less likely to cause hearing loss.

Living With Meniere’s Disease

Dr Silverstein on 3 types of menieres

Its important for someone exhibiting the symptoms of Menieres to see a qualified physician to rule out other potential underlying causes of the symptoms and to get evidence-based treatment.

Otolaryngologistsor ear, nose, and throat specialists are a good starting point. But neuro-otologistsENTs who subspecialize in ear disordersare most likely to be familiar with the current diagnostic and therapeutic best practices.

Diagnosing Menieres

Diagnosing Menieres is difficult because the symptoms overlap with many other diseases and conditions. For example, dizziness and imbalance can be a symptom of anything from dehydration to hormonal imbalances, to tumorsin rare cases. So, its important to see a medical professional who specializes in ear disorderswith Menieres experience, whenever possible. This may help to minimize the time it takes to determine if the symptoms are attributable to Menieres or to something entirely different.

Treating and managing the symptoms

Because Menieres affects each person differently, physicians will suggest strategies and treatments based on the individuals medical history, lifestyle needs, and the symptoms theyre experiencing.

Some methods for managing Menieres include:

Additional approaches are sometimes used for more difficult cases:

Managing life with Menieres

Specific types of cognitive and behavioral therapies may be helpful in managing the anxiety and/or depression that sometimes accompanies Menieres.

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A Very Basic Explanation Of How The Ear Works

Normal Hearing:

The Ear

The normal ear has three basic parts:

  • The outer ear
  • The middle ear
  • The inner ear

The dividing point between the outer and middle ear is the tympanic membrane, a sheet-like structure. The middle ear houses three tiny bones ossicles that are linked together.

The inner ear is made up of two systems: auditory and vestibular. The cochlea is a snail shaped structure and it is filled with fluid and has hair-like sensory receptors.

  • It is connected to the brain via the auditory nerve.
  • It is responsible for hearing.

The inner ear also houses the vestibular system, which is a network of tubes and sacs. It also has hair-like sensory receptors.

  • It is connected to the brain via the vestibular nerve.
  • It is responsible for balance.

Balance:

The dictionary defines balance as a state of equilibrium, harmonious arrangement, equal distribution.

This is what the body is trying to accomplish. It coordinates all these systems so we stay right side up. Each system contributes its specific expertise. If one isnt working correctly, or is impaired, we will experience dizziness or lightheadedness, which are also both symptoms of Menieres disease.

How balance works:

There are three individual systems involved. Each must work with the other two in order to create balance/harmony.

Visual System It makes us aware of our surroundings: whether we are standing up or sitting or lying down: in relation to what else is happening. It orientates us to our actual position.

The Struggles Of Finding The Right Hearing Aid

Audiologists know hearing aids help manage hearing loss, and for some people tinnitus as well. Unfortunately, the person with Menieres Disease is a little different. They require sophisticated tuning for their hearing aids, and the tuning must receive regular adjustments as hearing ranges change. For someone with Menieres Disease, the level of sound alters with changes in their inner ear so on any day the hearing aid works, the next day, it may not.

Multi-memory Hearing Aids

Thanks to technology, there are now multi-memory hearing aids that may offset these daily hearing changes. These instruments have different settings that alter the hearing aids frequency, gain, and directional microphone for improved listening based on the situation. An audiologist can preprogram these settings that range from normal to auditorium, for example.

You may find that the normal setting is perfectly fine because this hearing aid adapts and adjusts to different situations from varying environmental sounds to speech. That means people with Menieres hearing loss can go from a busy café, take a walk in the woods, and return to the office without having to change any of their hearing aids settings.

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Location Of Endolymphatic Sac

NIH/NIDCD

  • Surgery. Surgery may be recommended when all other treatments have failed to relieve dizziness. Some surgical procedures are performed on the endolymphatic sac to decompress it. Another possible surgery is to cut the vestibular nerve, although this occurs less frequently.
  • Alternative medicine. Although scientists have studied the use of some alternative medical therapies in Ménières disease treatment, there is still no evidence to show the effectiveness of such therapies as acupuncture or acupressure, tai chi, or herbal supplements such as gingko biloba, niacin, or ginger root. Be sure to tell your doctor if you are using alternative therapies, since they sometimes can impact the effectiveness or safety of conventional medicines.
  • How To Live With Hearing Loss

    Meniere

    In most cases, two things happen.

  • The hearing loss is corrected and the problem disappears.
  • Eventually they learn to look to themselves for happiness and fulfillment. They accept themselves and find they are actually grateful for the challenge.
  • Most will have already had a chance to participate in counseling.

    Other aids could be

    • Hearing aids: there are so many different styles and mechanisms around now.
    • People also need to learn to stand in such a way so that the person with hearing loss is able to see and read their lips or watch their facial expressions.
    • A quiet, relaxed environment is crucial.
    • Background noise must be reduced to an acceptable level.
    • Stress also must be understood and dealt with.
    • The family attitude is very important. If the person experiencing hearing loss is accepted and welcome, the situation will be relaxed and life is much easier for everyone.
    • Its always wise to remember that this person didnt want to have hearing loss or hearing impairment.

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    Common Symptoms Of Menieres Ear Disease

    Menieres symptoms appear most often in people between the ages of 40 and 60, with a slightly higher occurrence in women. Menieres is an under-diagnosed condition because many of its symptoms are common to other physical ailments. A physician must rule out the other possibilities and look for a constellation of symptoms that manifest with Menieres.

    Hearing Loss: Menieres patients may experience short-term hearing loss during an episode. They may also develop greater hearing loss over time that becomes permanent. Viral infections like shingles, long-term exposure to loud noise, head injury, and aging can also cause hearing loss.

    Tinnitus: Some people with Menieres hear ringing in one ear . This may sound like a musical note, buzzing, whirring, chirping or any other number of sounds that are typically constant. Other causes of tinnitus include aging, infections, ear injury, and long-term exposure to loud sounds.

    Vertigo: This is the main sign of Menieres. A person experiences dizziness and a loss of balance for at least 20 minutes in an episode. An inner ear infection, stroke, change in blood pressure, anxiety, brain disorders, diet, and dehydration are vertigo triggers.

    There are other Menieres symptoms too, but for now lets focus on hearing loss, how it affects the patient and the potential of using a hearing aid for your Menieres hearing loss.

    Why Is There A Feeling Of Fullness / Pressure In The Ear

    Another characteristic of Ménières is the sensation of fullness or aural pressure which can be incredibly uncomfortable. Some patients tell us they can gauge their condition is starting again if they notice a change in the sensation of the fullness. The fullness can also fluctuate with the acuteness of the condition. For some people this sensation may disappear completely, however for others it can become chronic with the constant feeling of pressure and this can cause considerable distress.

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    Medications For An Acute Attack Of Meniere’s

    This is the way that we manage acute attacks at Chicago Dizziness and Hearing

    Medications commonly used for an acute attack include the following:

    • Meclizine , chewable . Dose ranges from 12.5 twice/day to 50 mg three times/day. This medication is over the counter. No prescription is necessary.
    • Lorazepam 0.5 mg. Usual dose is twice/day or both at the same time at onset. This medication is effective even if it is not swallowed . Tiredness is expected.
    • Promethazine , orally or rectal suppository . Usual dose is once every 12 hours as needed for vomiting.
    • Prochlorperazine . Usual dose is 5-10 mg every 12 hours as needed for vomiting.
    • Ondansetron . Usual dose is 8mg q 12 hrs for vomiting. . Although Ondansetron isn’t as strong as phenergan or compazine, and doesn’t always work, it also doesn’t have much side effects either. One can certainly work and drive after taking nearly any dose of ondansetron. The same cannot always be said for meclizine, lorazepam and klonazepam, phenergan or compazine.
    • dexamethasone 4 mg orally for 4-7 days. Or a “medrol dose pack” This convenient, rapid, but not very effective treatment is gradually being replaced by . It is usually an “add-on” at the time of a physicians visit for persistent symptoms . Being “hyper” is the most common side effect. Often people feel that they don’t need sleep and do a lot of cleaning (:.
  • Antihistamines
  • meclizine 12.5 mg to 25 mg as needed up to 3-4 times/day
  • diphenhydramine
    • Dexamethasone

    Is There A Cure For Menieres Disease

    Meniere’s Disease can lead to hearing loss

    Menieres Disease results from an abnormal amount of fluid in the inner ear. This is critical for maintaining balance. The cause of this imbalance is unknown. The main reason for Menieres Disease is still not known, so there is no known cure. There are some treatments that can make the chronic symptoms manageable. These include diet, exercise, and medications.

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    How Is Menieres Disease Diagnosed

    To diagnose Menieres disease, a patient must have had at least two episodes of symptoms. These include vertigo, tinnitus or pressure in the ear. They must also have hearing loss confirmed by a hearing test. Menieres Disease symptoms vary from patient to patient. It is possible to have two of these symptoms at the same time as part of conditions other than this disease. It is important to consult a doctor for a correct diagnosis if you have any of these issues.

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