Definition and Practice Patterns
A few weeks ago, my curiosity got the best of me, and I decided to look under the covers. No, not those covers. Behave yourself. I started thinking about all the different theories and treatments regarding Meniere’s disease. A wise man would not take a bite from this apple, but much like weird Uncle George mowing the lawn in his pajamas, we have to talk about it sometime. I started with a post a few weeks ago on this blog discussing whether reduction in caffeine really helps Meniere’s patients. Let’s dig a little deeper.
First, let’s be clear on the definition of Meniere’s disease. Many (possibly most) people who think they have Meniere’s disease, in fact, do not have it. In my practice, I would say about half the people that come to us with a previous diagnosis of Meniere’s have been misdiagnosed. Here is a good description of the symptoms of Meniere’s from the website of the American Academy of Otolaryngology-Head and Neck:
“Ménière’s disease describes a set of episodic symptoms including vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Episodes typically last from 20 minutes up to 4 hours. Hearing loss is often intermittent, occurring mainly at the time of the attacks of vertigo. Loud sounds may seem distorted and cause discomfort. Usually, the hearing loss involves mainly the lower pitches, but over time this often affects tones of all pitches. After months or years of the disease, hearing loss often becomes permanent. Tinnitus and fullness of the ear may come and go with changes in hearing, occur during or just before attacks, or be constant.”
Meniere’s disease remains a mystery to most practitioners. Over the years, there have been numerous theories (none proven, some more likely than others) and numerous treatments proposed (most logical, some silly, none proven effective for all patients). Before we begin to discuss evidence (or lack thereof), let’s take a look at how Meniere’s disease is currently managed.
A survey published in the Journal or Laryngology and Otology in 2005 reveals that the most common treatment used in the United Kingdom is a prescription for Betahistine. Betahistine is not currently approved for use in the United States because several studies have shown it to be harmless, but probably ineffective Other common treatments were the prescription of diuretics and recommendations for a low salt diet. Some (about 50%) of physicians in the U.K. also perform sac decompression surgery or perform myringotomies with insertion of a ventilating tube in the suspected ear. Gaining in popularity is the use of intra-tympanic gentamicin.
I don’t have similar data for these practices in the United States, but other than the use of Betahistine, I would guess practice patterns are pretty similar. Next week, we begin a review of some of the common treatments.