Ménière’s Disease

The ear and your balance

The inner ear has loop-shaped canals that contain fluid and fine hair-like structures. These canals help in regulating your balance. The base of the canal has sensing cells which play a major role in monitoring the position of your head in a certain direction with respect to gravity. This is signaled to the brain and it helps you to be aware of the space around you. Example: tilting your head forward. The functions of the inner ear are:

• To monitor the body’s movements
• To convert the sound waves into nerve signals to transport to the brain
• Maintaining the body’s balance

A brief understanding of vertigo

• Vertigo is a state of perplexed and spinning dizziness.
• This is because of some problem with your inner ear or the brain or the signaling pathway between the two.
• It affects a person’s ability to function in daily life and can lead to depression or anxiety. It is usually rooted in psychological disorders.

What is Ménière’s disease?

Ménière’s disease is a condition that is a mash-up of vertigo, tinnitus (you tend to hear a ringing sound in your ears), and progressive deafness. In simple terms, this disease is the improper functioning of the inner ear. There is no cure, but there are some treatments that can ease this condition.

 Symptoms

• Vertigo is one of the most obvious symptoms of Ménière’s disease. The spinning feeling occurs even if you are not moving.The symptoms of Ménière’s disease vary from person to person. They can occur suddenly. The frequency and duration of this disease are
• The symptoms of Ménière’s disease are often referred to as an “attack”. This attack can range between 2 – 4 hours.
• You never know when a vertigo attack occurs. Vertigo can interfere with driving, while operating heavy types of equipment, climbing ladders, stairs, swimming, etc. So it is safe if you have vertigo medication in hand at all times. You can carry it in your pocket or your purse.
• If you have this disease, it is possible that you tend to experience anxiety, stress, and depression. Such a person will feel stressed or worried. It will definitely impact the working lifestyle negatively.
• You may find it difficult to interact with others due to the worsening hearing problems. It will affect your working tendency, jobs, driving, etc. It is important to communicate with your doctor about all this.

Stages of Ménière’s disease development

There are three stages:

Early stage

• Sudden and unpredictable episodes of vertigo
• Duration of the episodes: 20 minutes to 24 hours
• There will be some hearing loss during these episodes which will return to normal after the episode is over.
• Your ear feels uneasy and blocked.
• The ear will feel full or pressurized.
• This stage is also accompanied by

 Middle stage

• Vertigo episodes continue but become less intense.
• Worsening of tinnitus and hearing loss
• The symptoms might vanish for several months.

Later stage

• Lesser recurrence or vanishing of vertigo episodes
• Your balance related problems continue to exist.
• You may feel wobbly when it is dark.
• Hearing and tinnitus get worse gradually.

Why do changes in the fluid of ear occur?

For all the inner organs to function properly, the fluid must have the ideal pressure, volume, and chemical composition. The certain factors in Ménière’s disease that alter the properties of the inner ear fluid and this triggers the confusing effects. The following are the factors that contribute to changes in the fluid present in your ear.

• Any block in your ear or any flaw in your ear can lead to improper fluid drainage
• The improper functioning of the immune system
• Allergies
• Viral infection
• Changes in the gene related activities
• Head trauma
• Migraines

There is no single causative factor of Meniere’s disease. That is why it is a resultant of a combination of these above factors.

Complications

• The sudden onset of vertigo and the future hearing loss itself is a very depressing factor of Meniere’s disease.
• This disease can disrupt the normalcy of your life.
• You will feel very tired, emotionally stressed, and you might get into depression as well.
• Because this disease is characterized by vertigo, there will be more incidences of imbalances and falls or accidents.

How is it diagnosed?

The doctor will ask you about the following features:

• The severity of the symptoms
• The frequency of the symptoms
• Medications being consumed
• Past ear problems
• General health condition
• Any history of infectious diseases or allergies
• Any family history of inner ear problems

 Diagnostic tests conducted 

• Audiogram – The doctor will perform an audiogram to evaluate the hearing loss. This a hearing test where you will be subjected to varying levels of tones or pitches and this will help in determining the type, and degree of hearing loss. Here the individual listens with the headphones and indicates when a sound is heard or unheard. The data is then tabulated graphically.

Assessing your balance

•  Electronystagmography (ENG): The ear canal will be passed with warm and cool water or air. Then, the involuntary eye movements in response will be measured. Any abnormalities will indicate an inner ear problem.
•  Rotary-chair testing: Here, the individual will be made to sit on a chair in a small, dark booth. Electrodes are placed near the eyes. The computer-guided chair will rotate back and forth at varying speeds in a gentle manner. This will stimulate the inner balance system and causes eye movements that are recorded by a computer and monitored with an infrared camera.
• Vestibular evoked myogenic potentials (VEMP) testing: This test measures the function of certain sensors in the inner ear that detect acceleration.
• Posturography: You will be provided with a safety harness. Then, you will be made to stand barefoot on a special platform to test your balance under various conditions.

What kind of diet changes can you include?

• When the meal you eat is uniformly distributed throughout the day, it helps in regulating the fluid. In simpler terms, you can divide your meal into small portions for a day. Instead of taking 3 larger meals, you can consume six smaller ones.
• Consume less salt. Less salt means less fluid retention. Here cells tend to absorb salt. As the salt is absorbed with the cell, the water molecule also gets absorbed easily (cells retain water). So more salt consumption means, more fluid retention and the converse is true as well.
• Reduce your intake of alcohol. Alcohol causes dehydration. Alcohol is a diuretic (causes tendency to urinate and even sweat). Frequent urination or sweating results in fluid This leads to dehydration. So, the cells will be of the notion to save the existing water content thereby retaining the fluid within them. The more severe the dehydration, harder will your body have to work to reserve water.
• You now know the concept of dehydration and how the body works to save water. Dehydration need not just be because of alcohol. A hot weather condition, diarrhea, physical exercises, or traveling, can result in water loss from your body. That is why it is important to hydrate your body. Drink lots of water. It also helps in flushing out the alcohol or the toxins.
• Refrain from foods rich in tyramine. Tyramine is an amino acid known to magnify the blood pressure thereby increasing the headaches, migraines, sweating, vision changes, vomiting, etc. It is best to avoid or limit the intake of tyramine-containingCheddar cheese, blue cheese, soybean curd, tofu, smoked meats or fish, ripe cheeses, red wine, yogurts, nuts, etc., are foods that contain tyramine.
• Ginkgo Biloba or the Maidenhair tree is native to China and is popular in the United States and Europe. It contains flavones, glycosides, and These compounds prevent the blood cells from sticking and helps in improving the blood circulation in the inner ear.
• Ginger – Ginger contains compounds called gingerol, and shogaols. They have good anti-clotting properties. These components prevent blood cells from clumping thereby improving the circulation of the blood around the inner ear. You can add it to tea or boil it with water and consume the extract with honey. There are many ways in which you can incorporate ginger into your diet.
• Butcher’s Broom – This is also called as Ruscusaculeatus. It contains compounds such as asruscogenin and neoruscogenin which improve the blood circulation.
• Cayenne pepper has a compound called capsaicin that reduces blood stickiness and helps improve the blood flow to the inner ear and the brain. It is considered as a thermogenic herb (enhances the metabolic rate thereby increasing the heat).

 What are the treatment options for Meniere’s disease?

Medications

• Drugs to treat motion sickness (spinning sensation along with nausea and vomiting)
• Drugs to treat nausea
• Diuretics to reduce fluid retention

Reduction of the amount of fluid the body retains, the fluid volume and pressure in the inner ear will improve, resulting in less severe and less frequent symptoms.

Middle ear injections

Some antibiotic or steroidal injections are made into the middle ear.

Surgery

Surgery may be an option if other treatments have not worked or if symptoms are severe. Surgery options include:

• Endolymphatic sac decompression – The endolymphatic sac is a fluid-filled membranous structure in the inner ear. The endolymphatic decompression surgery involves removal of a small portion of the bone from the endolymphatic sac to alleviate the pressure.
• Labyrinthectomy – a portion of the inner ear is surgically removed.
• Vestibular nerve section – In this surgery, the nerve is cut. The vestibular nerve is a nerve conveying the response of the ear to the brain.
• Vestibular rehabilitation therapy – This involves exercises and activities that help restore the balancing ability of your body and brain.
• If you have a hearing loss, you can be benefitted from a hearing aid.

How to treat the condition the Ayurvedic way?

Ayurveda advocates the use of Panchakarma therapy for healing the problems associated with Meniere’s disease. This treatment helps to deeply cleanse the tissues, wash out the toxins, tackles stress and reduces deep-rooted anxiety.

It is comprised of 5 methods:

• Removal of phlegm – Madanphala or Randiadumetorum is greatly used here as a version of medical vomiting.
• Cleansing of the digestive system – The roots of Trivrit (Operculinaturpethum) is done here for a medical or therapeutic cleansing of the digestive system.
• Herbal decoctions are used to inject in the abdomen as an enema procedure.
• Nasal administration of herbal medicine to treat migraines, sinusitis, etc.
• Blood purification is done.

All the above treatment measures help the patient achieve a balanced state of mind, body, and consciousness through detoxification and rejuvenation.

Patients undergoing this method must undergo oil massages and oil baths to sweat out the toxins. Panchakarma therapy helps in minimizing the symptoms and is also relaxing in nature.  You can consult a trained medical practitioner regarding tailoring this therapy to your body’s condition.

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