Tuesday, September 28, 2010

Something that ends in Disease can't be good . . .

That was my thought last week when I was at my third doctor in as many weeks to try and figure out what was wrong with my right ear. It had felt "plugged" for almost a month.

I went to a dr. at Prompt Care, and he said it was a middle ear infection and gave me prescription for Amoxicillan and a nasal steroid and to take Claritin during the day and Benedryl during the night. I did that for 10 days. No change.

I went to my regular dr. and he said that it was probably related to my allergies. He said to continue the allergy meds and the nasal steroid, but he prescribed a stronger antibiotic, and Prednisone. No change.

I told a friend about what I had been experiencing, and she said to go to her ENT, that he was great. So I called, and got an appointment for the next day due to a cancellation. The dr. looked at my ears, tested the fluid level in both my ears, and gave me a hearing test.

And then he said "You have Ménière's disease."

(If you are like me, then you have probably never heard of it. Here is a condensed version from Wikipedia.)

Ménière's disease (pronounced /meɪnˈjɛərz/) is a disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo and tinnitus and progressive hearing loss, usually in one ear.

The symptoms of Ménière's are variable; not all sufferers experience the same symptoms. However, so-called "classic Ménière's" is considered to comprise the following four symptoms:

*Periodic episodes of rotary vertigo or dizziness.
*Fluctuating, progressive, unilateral (in one ear) or bilateral (in both ears) hearing loss, usually in lower frequencies.
*Unilateral or bilateral tinnitus.
*A sensation of fullness or pressure in one or both ears.

Ménière's often begins with one symptom, and gradually progresses. Attacks of vertigo can be severe, incapacitating, and unpredictable and can last anywhere from minutes to hours, but no longer than 24 hours.This combines with an increase in volume of tinnitus and temporary, albeit significant, hearing loss. Hearing may improve after an attack, but often becomes progressively worse. Nausea, vomiting, and sweating sometimes accompany vertigo, but are symptoms of vertigo, and not of Ménière's.

Some sufferers experience what are informally known as "drop attacks"—a sudden, severe attack of dizziness or vertigo that causes the sufferer, if not seated, to fall without warning. Drop attacks are likely to occur later in the disease, but can occur at any time. Patients may also experience the feeling of being pushed or pulled. Some patients may find it impossible to get up for some time, until the attack passes or medication takes effect.

Ménière's typically begins between the ages of 30 and 60, and affects men slightly more than women. Hearing loss can affect both ears either simultaneously or with a variable interval between the first and the second ear.

Because Ménière's cannot be cured, treatments focus more on treating and preventing symptoms. Some doctors recommend lipoflavonoids. Most patients are advised to adopt a low-sodium diet, typically one to two grams per day. Patients are advised to avoid caffeine, alcohol and tobacco, all of which can aggravate symptoms of Ménière's. Patients are often prescribed a mild diuretic (sometimes vitamin B6). Many patients will have allergy testing done to see if they are candidates for allergy desensitization, as allergies have been shown to aggravate Ménière's symptoms.

Treatments aimed at lowering the pressure within the inner ear include antihistamines, anticholinergics, steroids, and diuretics. Sufferers may be advised to take a specific drug, based on their needs, during an attack to prevent symptoms.

Typical remedies:

*Antihistamines considered antiemetics such as meclizine and dimenhydrinate
*Antiemetic drugs such as trimethobenzamide.
*Antivertigo/antianxiety drugs such as betahistine and diazepam.
*Herbal remedies such as ginger root.

Some Ménière's disease sufferers, in severe cases, may end up losing their jobs, and will be on disability until the disease burns out. However, a majority (60-80%) of sufferers will not need permanent disability and will recover with or without medical help.

Hearing loss usually fluctuates in the beginning stages and becomes more permanent in later stages, although hearing aids and cochlear implants can help remedy damage. Tinnitus can be unpredictable, but patients usually get used to it over time. Ménière's disease, being unpredictable, has a variable prognosis. Attacks could come more frequently and more severely, less frequently and less severely, and anywhere in between.


I experienced mild vertigo over the summer, and then a drop attack about 6 weeks ago. But it happened a couple weeks before the ear "fullness" problem, so I thought that they were unrelated, and I haven't (thankfully) had another one.

He advised me to continue exercising if I could tolerate it, but that I should try and exercise at the gym so that if I had a drop attack, it wouldn't be outside 3 miles from my house, etc. I should also continue eating fruits and vegetable, up my protein, and eat as little processed/canned food, etc. as possible to keep my sodium levels down (again, something I don't normally do, but I'll have to be even more diligent now.)

I'm currently on a diuretic, antihistimines, and I just finished up a round of prednisdone. I go back in a month to the ENT to talk about how things are going. Right now, I'm hoping that either it will resolve itself or I'll end up with a mild case.

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