Treatment for Vertigo May Provide Effective, Non-Surgical Relief for Meniere's Disease

A non-invasive procedure used to treat the most common cause of vertigo in the elderly may also be effective in alleviating the symptoms of Meniere's disease, a condition characterized by vertigo, nausea, vomiting, tinnitus, and progressive deafness due to swelling of the endolymphatic duct, a small membranous canal in the inner ear.

The exact cause for Meniere's disease has never been determined. Control of the symptoms is usually attempted by a change in diet. For more severe cases, the otolaryngologist--head and neck surgeon will perform endolymphatic sac surgery, involving the shunting of the sac into cerebrospinal fluid and mastoid. However, even surgery proponents differ on how much management of the sac is required.

A new research study suggests examination of related inner ear physiology and disorders to seek an alternative treatment for Meniere's disease. There is a consensus that particles and debris from that region become trapped in the posterior semi-circular canal, resulting in benign paroxysmal positional vertigo (BPPV). BPPV and Meniere's disease often co-exist, and the intermittent occurrence of the latter condition could be prescribed to clogged endolymphatic duct canal. Therefore, like the treatment for BPPV, repositioning or shaking the trash from the duct could produce a beneficial result on the course of the disease.

This is the hypothesis articulated in "Mastoid Oscillation in Meniere's Disease -- A New Treatment," written by Paul Dutcher MD, from the University of Rochester Medical Center, Rochester, NY. His findings are to be presented at the American Academy of Otolaryngology--Head and Neck Surgery Foundation Annual Meeting and OTO EXPO, September 22-25, 2002, at the San Diego Convention Center, San Diego, CA.

Methodology: twenty-nine patients, with a mean age of 51, expressing spinning vertigo, fluctuating unilateral low frequency sensorineural hearing loss, tinnitus, and aural fullness were included in this study. All subjects received a comprehensive work-up and adhered to a diet of low salt, low caffeine, Dyazide, and vestibular sedatives. Patients displaying the disorder in both ears were excluded from the study.

Mastoid oscillation was conducted by placing an oscillator over the mastoid in the post-auricular region of the involved ear. The patients were placed in the position of lying face upward and rolled onto their contralateral side with their head and face turned 45 degrees to the floor and the top of their head tilted slightly to the floor. The oscillator was activated for 30 minutes; patients underwent four of these sessions.

Results: Twenty-five of the subjects experienced some subjective sense of improvement during the course of the treatment, as evidenced by fewer or less severe attacks of vertigo. Four patients experienced no change in their Meniere's disease whatsoever; none found a worsening of symptoms. The treatments produced no pain or negative side effects.

The author utilized an accepted classification system that compares the number of vertigo spells per month in a six month period, 18 to 24 months after treatment, divided by the number of vertigo spells per month in the six months prior to treatment, multiplied by 100. With these guidelines, the findings revealed 13 of 29 patients (44 percent) achieved complete control, ten of 29 achieved substantial control, and two, limited control.

Conclusions: Dr. Dutcher reminds patients with this disorder that the fleeting nature of the Meniere's disease symptoms may preclude an exact determination for the cause of this disorder. To date, there has been no clinical or histopathological evidence that debris clogs the endolymphatic outflow; however, this may be due to the decalcification of the temporal bones, obtained post-mortem, which destroys the debris.

The findings suggest that mastoid oscillation may be a viable alternative for the conservative management of Meniere's disease. Further study is required but if temporary obstruction of the endolymphatic canal is a contributor to this disorder, then relief is available for those who are debilitated by this inner ear problem.

Learn more about this balance disorder, at http://www.entnet.org/healthinfo/balance/meniere.cfm.