By: Dr. John Conde DC, DACNB Special to the Boca and Delray newspapers
Meniere’s disease, also known as endolymphatic hydrops, is a very rare vestibular disorder affecting less than 200,000 cases per year. It is believed that this disease is caused by the buildup of fluid (endolymph) in the compartments of the inner ear (labyrinth). The endolymph build up in the labyrinth interferes with the normal balance and hearing signals between the inner ear and brain. The genesis of this disease has seemed to evade researchers however vascular dysfunction, viral infections, allergies, autoimmune dysfunction, and genetics all have have been postulated.
The hallmark of Meniere’s disease is vertigo, ringing in the ear (tinnitus), fullness in the ear, and hearing loss. The dysfunction and resultant symptoms usually affect one ear but can affect both in some cases. The age of onset is anywhere between 20-50 years of age and affects men and women equally. Patients with Meniere’s disease usually describe constant low level symptoms with significant episodes that can last 20 minutes to four hours. Over time, some cases may develop into permanent hearing loss.
Diagnosis is usually clinical in nature as there are no specific laboratory tests or imaging studies that are sensitive for Meniere’s disease. The gold standard of diagnosis follows as such; a videonystagmography exam which allows to measure pathological changes in eye movements as they relate to the inner ear and the central vestibular system, computerized dynamic posturography which allows for specific measurements of balance, traditional neurological exam, and a bed side test for hearing or if need be an audiometric evaluation. Dizziness is quite often found in many neurological disorders therefore accurate diagnosis is key.
Treatment is multifaceted with focus on regulating the endolymphatic flow in the inner ear and on establishing proper neurological activity in the central vestibular system. It is recommended that several dietary products be eliminated or significantly reduced such as caffeine, alcohol, sodium, tobacco and chocolate. Quite often medication is prescribed to reduce the volume of fluid in the body in turn reducing the pressure in the ear. However, calibrating the function of the central vestibular system is of paramount importance in reducing the vertigo. Most of the current literature is looking at lateralizing the treatment to increase specificity and therefore increase positive outcomes. Meaning that typically one side is affected more than the other and the therapeutic intervention should be focused on that region not on both sides as it has been done for years. Treatment may involve eye movement exercises on a computer monitor, balancing activities, gentle spin techniques, head positioning maneuvers, and mental rehearsal exercises. If you feel dizzy it is recommended to seek medical attention.
Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach, FL and can be reached at 561-330-6096, firstname.lastname@example.org, and at www.thecondecenter.com