o t ol a r y n g o lo g y Relief from Severe Symptoms of Ménière’s Disease May Include Lifestyle, Surgical Options Ménière’s disease is a disorder of the inner ear that affects balance and hearing. An estimated 615,000 people in the United States have the condition, and more than 45,000 new cases are diagnosed each year. A lthough the signs of Ménière’s disease rarely occur until people reach their 40s or 50s, the disorder may eventually result in debilitating symptoms that literally throw patients off balance. “Ménière’s patients may suddenly feel like the room is spinning around rapidly, sometimes for hours at a time,” says neurotologist- otolaryngologist Akira Ishiyama, MD, UCLA head and neck surgeon. Such episodes of extreme dizziness (vertigo) are often associated with nausea and vomiting. “The symptoms can be so devastating that patients can no longer drive or work or participate in other normal activities,” Dr. Ishiyama adds. Ringing in the ear (tinnitus), feeling of fullness or pressure in the ear, fluctuating hearing loss and pain similar to migraine headaches are also associated with Ménière’s disease. The timing of Ménière’s episodes is unpredictable. Extreme symptoms can cause patients to lose their balance and fall. These episodes, known as “drop attacks,” may result in serious injury. “Patients say it feels like a giant hand comes from the sky and smashes them to the ground,” says Dr. Ishiyama. UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) The exact cause of the disease is unknown and no cure exists. Symptoms of Ménière’s disease result from the buildup of fluid in the compartments of the inner ear called the labyrinth. Diagnosis usually includes documentation of symptoms, a physical examination, hearing tests to establish the extent of hearing loss and imaging tests to rule out other diseases. At UCLA, a team of specialists including otolaryngologists (ear, nose and throat surgeons), neurologists and neurosurgeons work together to diagnose the disease and related disorders and to develop the most appropriate treatment plan. According to Dr. Ishiyama, relief for some patients may be as simple as restricting salt intake and taking diuretics (water pills) to control water retention. Used in combination, this regimen is the most common long-term treatment for Ménière’s disease. If this first- line treatment fails, however, medication to regulate inner ear fluid pressure, injections of antibiotics or corticosteroids into the middle ear to control vertigo, or surgical interventions may be required. “Some patients can no longer tolerate their symptoms and choose more aggressive therapies to improve their quality of life,” explains Dr. Ishiyama. Because Ménière’s disease may cause permanent hearing loss, treatment varies on hearing function. For patients with good hearing, a surgical treatment to clip the vestibular nerve may be recommended, while surgical removal of a portion of the inner ear may be indicated for patients with poor hearing function. Both operations address vertigo. These procedures relieve symptoms in more than 95 percent of appropriate patients, according to Dr. Ishiyama. He cautions that a comprehensive evaluation to understand the nature and extent of the disease should always precede surgical intervention. To watch a video about treatment for Ménière’s disease, go to: uclahealth.org/meniere