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Have meniere's disease. Experiencing fluctuating hear loss, dizziness and vertigo. Required treatment?

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I am struggling in between several diagnosis, and in the meantime have had absolutely no relief. For approximately 2 years, I have been experiencing mild off and on dizziness, often related to my migraines. But, at one point was diagnosed with Meniere's, even though I did not have extreme vertigo spells, just minor dizziness. At that point 2 years ago, my hearing was declining. So, I was put on a diuretic in hopes that it would treat the Meniere's. Since then, I still have mild dizziness, but nothing severe. But, my hearing has contiued to decline and around 6 months ago, I started to experience severe ear clogging and congestion /fullness and the worst is the ringing. It sounds like a loud ring or white noise. To the point where I can't hear anything else. It's literally driving me crazy and severely depressed. I want to pop my ears all of the time. Everything is severely muffled. It feels like pressure. As if i am stuck at a bad altitude on the airplane. And, the ringing happens on top of that. When I talk on the phone, it sounds like a tunnel sound in my ear. Loud noises hurt. I got a second opinion from another ENT who said that I didn't have Meniere's, but I in fact had only Hydrops. Due to the frequency levels I am hearing. And, he put me on a Vasodilator, I have been on it for 6 days. I am looking for any help, I am desperate.
Thu, 21 Feb 2013 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. This condition develops suddenly or slowly and erratically and varies from person to person.

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 (ETD). 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 be 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. MRI Scans display anatomy and form, not function. 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.

6. 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. What is your exposure to occupational noise and loud music / earphones / mobile phones? Exposure to loud noise is also a leading cause for tinnitus. How severe is your tinnitus on a scale of 1 to 10? Do you have nystagmus (abnormal eye movements)? Is the tinnitus pulsatile (matching with the heartbeat)? Does you have any other co-existing conditions including anemia (low hemoglobin), thyroid problems, blood pressure fluctuations, cervical spondylosis, nasal problems besides ETD or history of head injury? Have migraine associated vertigo and superior semicircular canal dehiscence syndrome been ruled out?

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. Use of hearing aids may help mask tinnitus.

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

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