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Meniere's disease, hearing loss, steroid injection. Is it blocked eustachian tube?

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Hi i have meniere's disease for 11 years. The last 5 years, no symptoms at all except for the hearing lost. Since feb 8, 2012, i have extremely loud tinnitus everyday with days of unsteadyness. I had steroid injection done feb 23, didn't work, made my tinnitus worse for a few days. I'm 36 yo, did some blood test, everything is perfect, i'm in good health.

My question is, since i feel my left ear is really blocked along with the tinnitus everyday, could it be just the eustachian tube that is blocked?? Acoustic neuroma?? I have an appointment with my ENT on may 3rd, but i would love to take an MRI of my ear to rule out anything else. I call the clinic for MRI, they need to know exactly what MRI to ask. Can an MRI identify eustachian blockage??

Posted Tue, 22 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query.

1. Meniere's disease is diagnosed on the following criteria:
a. Vertigo
b. Fluctuating hearing loss
c. Tinnitus
d. Fullness in the ear
There is usually nausea and vomiting, the hearing usually worsens during an attack and the tinnitus also worsens. Earache is not a usual symptom.

2. You should get a PTA (Pure Tone Audiogram) to document any hearing loss. Meniere's disease usually causes low frequency hearing loss initially ( Audiogram sloping to left).

3. Get a Tympanogram done to check middle ear pressures and Eustachian Tube function. If this Impedance Audiogram is normal, it may be Meniere's as it does not affect the middle ear.

4. If this Impedance Audiogram is abnormal, then a trial of medication should be taken for three to four weeks. If this does not work, a myringotomy with a grommet insertion may help. Steroid drops can e given for a longer duration through this ventilation tube.

5. An MRI Scan is usually advised in a patient of vertigo so as not to miss any major cause, one of which is an Acoustic Neuroma. I must emphasize that Acoustic Neuromas are rare and almost 99% of MRIs are normal. Acoustic Neuromas also have other symptoms depending upon their size. They are benign and extremely slow growing.

6. MRI Scans display anatomy and form, not function. The Eustachian tube is normally in a collapsed state. It can be voluntarily opened by yawning, swallowing, chewing gum, blowing your nose or performing the Valsalva maneuver. A Tympanogram and eardrum examination is more important.

7. Meniere's disease should normally respond to a salt restricted diet, acetazolamide (diamox) and betahistine (Vertin).

8. If you do go in for an MRI, try a 3 Tesla Scan. It may pick up the subtle changes due to Meniere's Disease in the inner ear.

9. If steroids have not controlled your Tinnitus and your middle ear is normal (no eustachian dysfunction), then you may try Caroverine (Tinnex) injectable or capsules.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

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