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ENT SURGICAL CONSULTANTS
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SOURCES OF INFORMATION
Meniere’s Disease; What You Need To Know.
PJ Haybach. $24.95, Available through the Amazon Books or
Vestibular Disorders Association, PO Box 4467, Portland, OR 92708 http://www.vestibular.org/
American Academy of Otolaryngology-Head & Neck Surgery
Coping support website for Meniere’s Disease: http://www.menieres.org/ Meniere’s Page
. The Department of Otolaryngology Washington University School of Medicine St. Louis, MO,
National Institute on Deafness and Other Communication Disorders (NIDCD
), National Institutes of Health,
Bethesda, MD http://www.nidcd.nih.gov/health/balance/meniere.asp
TREATMENT OF ACUTE SPELLS
Sedative medication (Valium, Ativan
Anti-nausea and anti-vomiting medication (Tigan, Phenergan, Compazine
, Zofran, etc.).
MEDICAL PREVENTIVE TREATMENT
Stress management. Exercise. Avoidance of caffeine, tobacco and alcohol. Low-sodium diet 1500-2000 mg/day. Lipoflavins and vitamins (Lipo-Flavonoid Plus™
) available over the counter (OTC). Diuretic medications (Dyazide™)
once or twice daily. Fluid intake Vestibular or labyrinthine exercises. Allergy treatment. Treatment with local overpressure with the Meniett Low Pressure Pulse Generator (www.Meniett.com)
Medtronics Xomed (800) 874-5797. Non-destructive, non-invasive, safe, portable, simple.
Trial of migraine medication (as vestibular migraines can mimic Meniere’s disease)
Extra strength Lipo-Flavinoid Plus, DSE Healthcare Solutions, LLC (Edison, NJ) 800-338-8079 Stress Management
While no one believes that stress causes Meniere's Disease, most people with the disease recognize a relationship
between stressful events and the recurrence of their symptoms. Many patients believe that stress is a factor in how
well they can prevent recurrent attacks and cope with the disruption caused by Meniere’s Disease. Not knowing
when the next attack of vertigo may occur is a significant stress all by itself. For these reasons, patients with
Meniere’s Disease are advised to manage their stress as much as possible. Professional counseling may be helpful in
The value of a low-sodium diet in treating Meniere’s Disease has been known since 1931, and many patients notice
they develop vertigo after eating salty foods. The FDA recommends an intake of no more than 2,400 mg of sodium
per day, yet most people consume 3,000 to 4,000 mg a day. People can safely get by with a 240 mg/day sodium diet.
Experts do not agree about the ideal level of sodium for individuals with Meniere’s Disease— some say 1,800
mg/day, others say 1,500 mg/day. Either diet level takes effort to be successful.
Diuretics (water pills) reduce the body's total sodium count and, with it, the amount of water in the body. Because
fluids shift from compartment to compartment, loss of salt and water into the urine will shrink the amount of fluid in
the body generally as well as in the inner ear. This approach makes sense because people with Meniere’s Disease
have too much fluid in the inner ear. However, some individuals do not tolerate diuretics well and others do not
appear to benefit from them. Diuretics cause the kidneys to increase the amount of sodium, chloride, potassium, and
other chemicals in the urine. These chemicals are called electrolytes because they are electrically charged. A side
effect of the sodium and other electrolyte removal is a passive increase in the amount of water in the urine. This type
of treatment is known as diuresis. There are several classes of diuretic agents. The most widely used type for
Meniere’s Disease is the thiazide class, which includes hydrochlorthiazide (HCTZ). This is often combined with
another, potassium-sparing agent, triamterene, in a drug called Dyazide™. Dyazide™is probably the most frequently
prescribed diuretic for Meniere’s Disease because it is safe, effective, and does not require taking extra potassium.
Dyazide™is a combination of triamterene (37.5 mg) and hydrochlorthiazide (25 mg). Fluid Intake
Adequate fluid intake, particularly water, is vital for proper kidney function, and may be equally important for proper
inner ear function. The part of the inner ear that forms the endolymph contains cells that have the same structure and
function as the distal tubule cells of the kidney. In fact, many drugs that affect kidney function can also affect fluid
regulation in the inner ear. Thus, adequate water intake may be as important to inner ear function as it is to kidney
function. For individuals who take diuretics, adequate water intake is especially important. There has to be enough
fluid flow to remove the extra salt excreted as a result of diuretic treatment. Diuretics cannot work if the volume of
water in the body is low.
If medical therapy fails, surgical treatment may be indicated. Two distinct strategies have been employed. One
approach is directed toward increasing the absorption of endolymph (the fluid in the hearing and balance canals of
the inner ear), since there is an excess of endolymph in patients with Meniere’s Disease. The other approach aims at
decreasing the inner ear's vestibular balance function in order to reduce symptoms of vertigo. Endolymphatic sac surgery
In principle, endolymphatic sac surgery is a non-destructive, surgical manipulation of the endolymphatic sac aimed at
increasing fluid drainage from the inner ear. The effectiveness of this approach varies. Vestibular nerve section
This surgical technique decreases vestibular function to control symptoms of vertigo, either by denervation or
destruction of the affected ear. It is a more serious and costly operation, which includes the risk of meningitis and a
leak of spinal fluid. In 95% of cases, control of vertigo is achieved. Hearing is preserved in over 90% of cases. Chemical labyrinthectomy
This treatment has recently become widely used because of its associated low cost and low risk. For unilateral cases,
intratympanic gentamicin reduces vertigo by decreasing residual balance function on the affected side, but with a
30% risk of hearing loss. For bilateral cases, intramuscular streptomycin has been used. All destructive procedures
result in decreased vestibular function on the treated side, which many patients consider a fair exchange once central
compensation has stabilized their balance function. Labyrinthectomy
In cases where hearing can be sacrificed or is already lost, surgical removal of the labyrinth (the balance organs of
the inner ear) has a 95% success rate in eliminating major vertigo attacks. After this surgery is performed, the
hearing and balance functions of the operated ear are completely and permanently destroyed. The unoperated ear
will provide hearing and balance, as long as the disease or other conditions do not affect it.
Eur J PediatrDOI 10.1007/s00431-009-0978-0Clinical trial showing superiority of a coconut and anisespray over permethrin 0.43% lotion for head louseinfestation, ISRCTN96469780Ian F. Burgess & Elizabeth R. Brunton &Nazma A. BurgessReceived: 16 February 2009 / Accepted: 23 March 2009# Springer-Verlag 2009Abstract Permethrin is the most widely used pediculicide,head louse infestation a
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