Meniere’s Disease on the Moon

While cochlear implants and other surgical procedures are life-changing miracles within themselves, another story of miraculous success that was the result of an astronaut’s grounding in 1964.  The astronaut’s 1968 triumph over the disease was due to the personal attitude of the individual and the medical genius of the surgical inventor and innovator, Dr. William House.  While the endolymphatic sac procedure had been conceptualized over two centuries ago by Prosper Meniere, through surgical skill and personal courage it was the dawn of a viable treatment for Meniere’s disease, that went to the moon………RMT

————————————————————————

The story begins with the choosing of the Mercury 7 Astronauts.. On October 4, 1957, the Soviet Union launched Sputnik 1, the first artificial satellite. This shattered American confidence in its technological superiority, creating a wave of anxiety known as the Sputnik crisis. Among his responses to this situation, President Dwight D. Eisenhower launched the Space Race. To compete against the soviets, the National Aeronautics and Space Administration (NASA) was established on October 1, 1958, as a civilian agency to develop space technology. One of its first initiatives, Project Mercury, was publicly announced on December 17, 1958.  Project Mercury aimed to launch a man into Earth orbit, return him safely to the Earth, and evaluate his capabilities in space.  Although NASA planned an open competition for its first astronauts, President Eisenhower insisted that all candidates be test pilots. Due to the small space inside the Mercury spacecraft, astronaut candidates could be no taller than 5 feet 11 inches (180 cm) and weigh no more than 180 pounds (82 kg).  Other requirements included being under age 40, hold a bachelor’s degree or the professional equivalent, have at least 1,500 hours of accumulated flying time, and be qualified to fly jet aircraft.  The original pool drew 500 applicants, which was finally whittled down to 7 by a rigorous, demanding process.  Those that withstood the intense selection process, Scott CarpenterGordon CooperJohn GlennGus GrissomWally SchirraAlan Shepard, and Deke Slayton  were announced to the US public as the Mercury 7 Astronauts in January of 1960. While all of these “original astronauts”, and those to follow were truly America’s finest and heroes of the space program, many conquered personal challenges and some died in the line of duty.  Audiologists will appreciate the specific challenge of one of the original Mercury 7, Alan Shepherd.  

Alan Bartlett Shepard Jr. was born on November 18, 1923, in Derry, New Hampshire, to Alan B. Shepard Sr. and Pauline Renza Shepard. He was one of many famous descendants of Mayflower passenger Richard Warren.  As a Annapolis graduate in 1944, Shepherd had a distinguished career in the navy, ships during WWII, later training as a test pilot and finally working through all of the challenges of becoming an astronaut. On January 19, 1961, Robert R. Gilruth, the director of NASA’s Space Task Group, informed the seven astronauts that Shepard had been chosen for the first American manned mission into space.  

After a dramatic Atlantic Ocean recovery, Commander Shepard observed that he  “… didn’t really feel the flight was a success until the recovery had been successfully completed. It’s not the fall that hurts; it’s the sudden stop.” Splashdown occurred with an impact comparable to landing a jet aircraft on an aircraft carrier. A recovery helicopter arrived after a few minutes, and the capsule was lifted partly out of the water to allow Shepard to leave by the main hatch. He squeezed out of the door and into a sling hoist, and was pulled into the helicopter, which flew both the astronaut and spacecraft to the aircraft carrier USS Lake Champlain. The whole recovery process took just eleven minutes. Shepard was celebrated as a national hero, honored with ticker-tape parades in Washington, New York and Los Angeles, and received the NASA Distinguished Service Medal from President John F. Kennedy. He was also awarded the Distinguished Flying Cross.  Shepherd went on to hold many high level positions in NASA including Chief Astronaut for the Gemini and was slated for the Apollo 13 mission. 

The Meniere’s Disease

After being named a command pilot for the Gemini mission in 1963, Shepard began experiencing dizzy spells and, after various test was eventually being diagnosed with Ménière’s disease, reassigned to a NASA desk job and told that he would never fly again. Dr. Charles A. Berry, then the Chief Physician at NASA had to take him off the ready-for-flight list for what was thought to be due to an “infection” in his left ear.  He pursued treatment with Dr. Berry and his staff for about five years and had been told over that time that he would never fly again.  Altman (1971) indicates that Dr. Berry and his staff prescribed various medication so for Shepherd’s condition and he responded reasonably well for a time, but the condition got worse.  Shepherd did not give up believing he could be cured. After all, he was on a mission. “I didn’t like it at all,” Shepard recalls. “This problem is called Ménière’s disease. It causes dizziness, nausea, lack of balance and so on.” The prediction was, that in some cases, it was correctable. Shepherd said, “In my case, it is going to be correctable.”  For an astronaut this had to be a devastating diagnosis as his livelihood, career and further space flight and general well being was at risk.  (click on the picture for a dramatization of the devastation).

Meniere’s Disease, clinically called endolympatic hydrops and first outlined by Prosper Meniere in 1861 (exactly 100 years before Shepherd’s Freedom 7 flight), is typically the association of repeated attacks of vertigo that last for hours with a sense of aural fullness, fluctuating progressive hearing loss and tinnitus. The endolymphatic sac is thought to maintain the hydrostatic pressure and endolymphatic homeostasis for the inner ear and its dysfunction is thought to contribute to the pathophysiology of Ménière’s disease. One day a fellow astronaut, Tom Stafford, told Shepard in 1968 that he had heard from one of the NASA doctors that an ear, nose and throat specialist in Los Angeles had developed a surgical procedure to treat Meniere’s syndrome.  Stafford was referring to pioneer in the surgical treatment Meniere’s disease, Dr. William F. House, an Otologist at the House Research Institute was having success with endolymphatic shunt surgery. This surgical procedure is where a very small silicone tube is placed in the membranous labyrinth of the inner ear to drain excess fluid.  The procedure is based on the theory that endolymphatic hydrops causes the inner ear to become overloaded with endolymphatic fluid and that draining this fluid will relieve the symptoms. In the surgery, the fluid is drained by opening the endolymphatic sac, a pouch located next to the mastoid bone at the end of the endolymphatic duct, a canal that leads to the inner ear.  In today’s world, this is a commonplace surgery conducted by Otologists but in 1968 House was one of a the only surgeons that had written and conducted these surgeries.  

In Shepherd’s initial visit with Dr. House he was a candidate for surgery.  In his book, Moonshot describes Shepherd presents his rationalization to his wife, Louise, about having the surgery. He said,  “The doctor [House] can’t promise he’ll be successful. But I’m burning up inside, Louise. I want so badly to fly again in space. I’m willing to try anything.”  AcRelated imagecording to Hicks (1998), Shepard, demanded secrecy to avoid media attention, entered St. Vincent’s Hospital in Los Angeles under the name Victor Poulos. a name made up by one of House’s nurses.The surgery was highly successful and Shepard’s hearing returned completely over the next few months.  It took two years of medical scrutiny before NASA doctors would clear him to return to space.

Dr. Berry’s comments were that that Captain Shepherd had no problem with pressure tests like those encountered in space and therefore, “here was no reason that I could not say that he isn’t like anybody else”.  He was returned to flight status and Shepard immediately lobbied to get command of Apollo 13, scheduled for 1970. For a brief period, he was assigned to command that lunar mission. But NASA leaders cautiously decided to postpone Shepard’s flight to Apollo 14 the next year. (Apollo 13 in 1970, you’ll recall, is the one that almost never made it back.)

For Alan shepherd, the shunt surgery was successful and contributed the rest of along and very successful career, and a very successful Apollo 14 Mission.  Needless to say that Shepherd and House became fast friends and he was invited to various space launches and tours of the NASA facilities.

References:

Altman, L. (1971).  A tube implant corrected Shepherd’s Ear Disease.  New York Times.  Retrieved May 15, 2018.

Encyclopedia of Surgery (2018). Endolymphatic Shunt surgery. Retrieved May 16, 2018.

Hicks, J. (1998).  The Doctor Behind Shepard’s Apollo 14 Flight.  Los Angeles Times, July 25, 1998.  Retrieved May 16, 2018.

Koppel, L. (2015).  The Astronaut’s Wives Club.  American Broadcasting Company.  Retrieved May 16, 2018.

Shepherd, A., Slayton, D., & Barbree, J. (1994). Moonshot.  Turner Publishing company.  Retrieved May 16, 2018.

 

About Robert Traynor

Robert M. Traynor, Ed.D., MBA is the CEO and practicing audiologist at Audiology Associates, Inc., in Greeley, Colorado with particular emphasis in amplification and operative monitoring, offering all general audiological services to patients of all ages. Dr. Traynor holds degrees from the University of Northern Colorado (BA, 1972, MA 1973, Ed.D., 1975), the University of Phoenix (MBA, 2006) as well as Post Doctoral Study at Northwestern University (1984). He taught Audiology at the University of Northern Colorado (1973-1982), University of Arkansas for Medical Sciences (1976-77) and Colorado State University (1982-1993). Dr. Traynor is a retired Lt. Colonel from the US Army Reserve Medical Service Corps and currently serves as an Adjunct Professor of Audiology at the University of Florida, the University of Colorado, and the University of Northern Colorado. For 17 years he was Senior International Audiology Consultant to a major hearing instrument manufacturer traveling all over the world providing academic audiological and product orientation for distributors and staff. A clinician and practice manager for over 35 years, Dr. Traynor has lectured on most aspects of the field of Audiology in over 40 countries. Dr. Traynor is the current President of the Colorado Academy of Audiology and co-author of Strategic Practice Management a text used in most universities to train audiologists in practice management, now being updated to a 2nd edition.

2
Leave a Reply

1 Comment threads
1 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
2 Comment authors
  Subscribe  
newest oldest
Notify of
Douglas L. Beck Au.D.

THANKS BOB!
I can certainly verify and validate that the story is true and I believe it is instructive for all patients with Meniere’s Disease, as well as all hearing care professionals. Further, although endolympatic sac surgery has fallen a bit out of favor, there are other surgical and non-surgical treatments for SOME Meniere’s patients (i.e., vestibular neurectomy). Indeed, there are many treatments worthy of exploration. I will attach my 2011 interview with Dr House below, he was one of the most amazing people I have ever met, and had the PLEASURE of working with for a few years.
https://www.audiology.org/news/william-f-house-dds-md%E2%80%94-father-neurotology