Prognosis and course | Therapy of Meniere’s disease

Prognosis and course

Usually, as the disease progresses, the hearing loss is progressive and can even lead to deafness. The dizziness, however, decreases in severity. In 10% of patients, both inner ears are affected.

Prophylaxis

The patient can be prepared for a seizure with the following measures:

• It may be useful to carry tablets or suppositories to combat nausea and vomiting, as well as a bag if vomiting occurs despite taking medication; if the patient has a self-help card with him/her (available from the German Tinnitus League), he/she can identify him/herself as a Ménière’s sufferer in an acute attack, so that he/she is not mistaken for drunk because of the dizziness; a cell phone provides the security of being able to call for help immediately if a Ménière’s attack occurs.
• To prevent further seizures, psychological stress situations that can lead to seizure symptoms in the patient should be eliminated (trigger). Likewise, problems in coping with the illness can occur that require professional psychological care. Many patients are frightened and insecure because they cannot foresee the onset of the symptoms.

  Many patients experience this as an enormous burden and are always accompanied by the worry that a seizure might occur. Against this background, many Menière patients withdraw from their social contacts and remain alone in their insecurity. To prevent dizzy spells caused by the patients’ fear and insecurity, i.e. those with a psychological cause, psychological care can provide assistance.

• The consumption of nicotine, caffeine and alcohol promotes the occurrence of seizures, so that coffee, smoking and alcohol consumption should be avoided.
• A low-sodium diet can reduce fluid accumulation in the membranous labyrinth.

  However, if these measures do not improve the frequency and severity of the seizures, a hearing-preserving surgical intervention should be discussed.

• From a surgical point of view, there are various measures for Menière treatment. When the inner ear is opened, the so-called saccotomy, the saccus endolymophaticus is opened so that the fluid can be drained to the outside. This counteracts the increase in pressure caused by the accumulation of fluid in the membranous labyrinth (the cause of Meniere’s symptoms), to which the endolymphatic saccus belongs.

  Other, less frequently performed procedures as part of the surgical treatment of Menière’s disease are firstly, the elimination of the vestibular organ with drugs that are harmful to the inner ear (ototoxic), such as gentamicin (antibiotic), which is introduced into the inner ear via the external auditory canal and the eardrum. Secondly, the procedure of selective neurectomy of the vestibular nerve is used, in which the vestibular nerve is cut and removed. These procedures are aimed at eliminating the dizziness by switching off the vestibular organ of balance while maintaining the patient’s hearing. Due to the close proximity of the auditory and vestibular organs, a complication of the operation can be damage to the inner ear, which causes hearing loss.

• The last therapeutic option is the destruction of the membranous labyrinth, in which the inner ear and the organ of equilibrium are removed from the bony environment. This operation is only performed when the patient’s hearing has practically ceased.