It’s time again for some disorganized thoughts that surface periodically. Hopefully, one of them will be helpful.
In Which Ear Do You Have Meniere’s?
There is nothing simple about Meniere’s disease. It is the least understood, most debilitating, and least responsive to treatment of all inner ear disorders. It is also over-diagnosed. I have seen hundreds of people over the years that have been given a diagnosis of Meniere’s disease, when their symptoms did not remotely match the criteria for the disease.
Some studies indicate that only one of ten people that believe they have Meniere’s disease, in fact, have the disease. My personal experience has been that about one half of patients with a history of diagnosed Meniere’s disease actually have it. Many have been treated with restricted diets, diuretics and vestibular suppressant medications for a condition they did not have.
A recent article on Medscape, describes the situation:
“The worldwide incidence of Meniere’s disease is approximately 12 out of every 1,000 people. Perhaps 100,000 patients develop Meniere’s disease every year. The overall number affected is about 0.2% of U.S. citizens, a figure of about 615,000 individuals. Despite that, 2% of people living in the U.S. believe they have symptoms that would indicate a diagnosis of Meniere’s disease. These people either have the disease, and it has not been formally diagnosed, or they have symptoms suggestive of Meniere’s that are actually attributable to another condition.”
I have found a simple way to identify these people. When someone tells me they have Meniere’s disease, I ask, “In which ear do you have Meniere’s disease?” If they can’t immediately tell me with confidence which ear is affected, the odds are very good that they don’t have and never had Meniere’s disease.
Here’s Looking at You, Kid
One simple piece of advice for those of you doing Dix-Hallpike (positional) testing without the benefit of video goggles: When you use goggles, the eyes are projected up on a TV screen. When you do the test without goggles, you have to look at the patients eyes directly. The problem arises in that the patient is supine with his/her head hanging over the exam table. The examiner is usually standing over the patient (some examiners sit in a chair at the end of the exam table and view the eyes upside down). When standing over the patient, there is a natural tendency for the patient to look back up at you. For example, in the Right Dix-Hallpike, they will be looking up, out of the left corner of their eye. This is a potential problem because they direction of gaze changes the nystagmus pattern. In right posterior canal BPPV, the nystagmus is rotary, upbeating and counter-clockwise. However, if the patient looks out of the left corner of their eye, the nystagmus changes to mostly vertical, losing quite a bit of the rotary component.
To counter this effect, all you need to do is use a pen light, (or even your finger) and have the patient direct their gaze at the light which is held down in front of them.