April 2019 Noted

Menieres

Although the inner-ear disorder can be very distressing, there are effective treatments for Ménière’s disease.

The first time Fiona Fraser had an attack of Ménière’s disease – a disorder of the inner ear that causes severe vertigo (dizziness) as well as tinnitus, partial hearing loss and a feeling of fullness in the ear – she dismissed it as “one of those things” and pretty much forgot about it. For the next four years, it seemed that the attack was indeed a one-off mystery. Then, in 2015, she had a spate of similar attacks – including one in which she ended up on the bathroom floor of an apartment she was sharing with a colleague on a work trip. She also developed permanent hearing loss and tinnitus in her left ear – a high-pitched squealing and buzzing that is particularly noticeable when she is trying to get to sleep.

Eventually, after a number of tests, including an MRI scan to rule out the possibility that her one-sided hearing loss was caused by a brain tumour, she was diagnosed with Ménière’s disease. First described by French doctor Prosper Ménière in the 19th century, it’s thought to be caused by a build-up of fluid that creates pressure on the parts of the inner ear that control balance and hearing.

In 2016, Fraser moved with her family from Auckland to Hawke’s Bay in pursuit of a less-stressful lifestyle – “I knew that stress can be an aggravator for Ménière’s” – and for about two years, she was attack-free. However, as is often the case with Ménière’s, which tends to come and go, she recently had another spate of attacks. “Without warning, my left ear blocks, I’m deafened, I lose all of my balance, the world darkens and spins violently, the blocked ear emits a high-frequency scream,” she wrote in a Facebook post about her experience with Ménière’s. “I can’t move. I can’t walk. I can’t think straight.”

Ménière’s affects one or two people in a thousand, particularly those aged 40 to 60. In most cases, it affects only one ear; an attack can last for a few minutes to several hours. For about 70% of sufferers, Ménière’s is an occasional – if unpleasant – inconvenience rather than a serious health problem. Some people may have one or two attacks, then never have another. However, they may eventually develop permanent, low-frequency hearing loss and tinnitus in the affected ear.

The good news for the 30% whose Ménière’s is more intractable or distressing is that there are treatments that will ease the symptoms.

“There are a lot of things we can do for Ménière’s disease,” says Hawke’s Bay ear, nose and throat specialist Stephen Toynton. “Don’t think you can’t treat it – it’s quite the opposite.” The possibilities include drugs that can be taken during an attack to reduce the nausea and vomiting associated with vertigo. Many doctors also prescribe a drug called betahistine, which is thought to increase the blood flow around the inner ear and may reduce the severity and frequency of the attacks.

Toynton says recent studies suggest betahistine is not as effective as previously thought, though it is a safe drug and taking it is unlikely to cause any side effects. In his opinion, there are more effective treatments, such as using a combination of oral steroids and steroids that are injected into the middle ear, from where they are absorbed into the inner ear. This can provide relief to people who are experiencing a spate of attacks. It’s also possible to inject an antibiotic called gentamicin through the ear drum to selectively destroy the hair cells that affect balance and reduce the likelihood of experiencing vertigo – though there’s a small risk it may also damage hearing. Toynton has found that inserting a grommet into the affected ear can also be effective for the small group whose Ménière’s is triggered by changes in atmospheric pressure.

He says the decision about when to try any of these treatments is up to the individual. “The key is to inform people early on what the options are and let them decide when they want to take the next step. I prefer to leave it in their hands – people are very different in terms of what they can tolerate.”

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