Dear Dr Nina: This diagnosis has left my husband without hope. He says there's no cure and there's no point talking about it anymore
Q My husband was recently diagnosed with Meniere's disease and the diagnosis has made him so despondent that I am worried about him. All he has told me is that there is no cure and that there is no point talking about it any more. Could you give me some advice on how he can manage the condition and possibly offer us some hope? Are there therapies or things he can do to help live a normal life?
Dr Nina replies: Dizziness is one of the most common reasons that people attend their GP. It encompasses a range of different symptoms, varying from feeling faint or lightheaded, weak or unsteady, or the sensation that the room is spinning. Despite the fact that dizziness only rarely signifies a serious underlying condition it is frightening and can cause much distress.
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Vertigo causes a feeling of dizziness or spinning even when one is not moving. A person may also experience vomiting or nausea. The inner ear contains a maze of loops and pouches called the semi-circular canals and otolithic organs. These make up what is called the vestibular system. The semi-circular canals contain fluid and are located at right angles to each other .When we change position the movement of the fluid in these canals sends messages to the brain which, combined with messages sent from the eyes, gives us our sense of position and balance. One of the most common causes of vertigo is dehydration. Ensuring that you drink at least 1.5litres of fluid daily (more if you sweat due to exercise or heat or are using more fluids such as when breastfeeding) can help avoid or improve symptoms greatly.
Meniere's disease tends to cause a chronic vertigo that is associated with ringing in the ears (tinnitus), hearing loss and a feeling of fullness in the ear. It is thought to be caused by changes in the composition and amount of fluid in the vestibular system. Vertigo comes on suddenly and lasts up to 24 hours. Attacks often occur in clusters with long periods of feeling well in between. Hearing loss is initially intermittent but over time may become permanent.
Meniere's disease is diagnosed based on the following criteria: There must have been at least two episodes of vertigo, each lasting 20 minutes or longer but not longer than 12 hours. Hearing loss should be verified by a hearing test. There should be associated tinnitus or a feeling of fullness in the ear. Other causes of these problems should be excluded.
Treatments vary and include fluid tablets (to adjust the fluid and mineral balance in the inner ear), hearing aids, steroids or other local treatments.
Medication can be prescribed to reduce the symptoms of vertigo. A high salt diet may increase fluid retention, exacerbating the symptoms of Meniere's, so keep this to a minimum. Avoiding smoking and keeping caffeine and alcohol to a minimum may also help. Hearing aids sometimes help reduce symptoms in those with hearing loss.
Vestibular rehabilitation is a form of physiotherapy that helps reset the balance cells in the inner ear. This may help. Steroids are occasionally used in severe attacks. For severe Meniere's surgical options are sometimes considered as a last resort.