A 60-year-old male patient presented to Dr. Lixin Zhang at Dent Neurologic’s Dizziness, Balance, and Tinnitus Center. He explained that sometimes he gets a loud ringing in his ear and his ear would feel plugged. Then, out of nowhere, it would feel like the entire room was spinning. He’d have to crawl to his bathroom as he’s hit with waves of nausea. After he got over this last episode, he noticed that his hearing is much worse. The spinning plugged ear and ringing all went away in a few hours, but he can’t hear his wife talking in the next room anymore.
What can be done to help the patient?
After hearing his story, Dr. Zhang ordered the patient balance testing. Dr. Zhang already suspected a diagnosis, but wanted to confirm his suspicions were correct. His vestibular testing was performed by Dr. Zhang’s trained audiologist where the audiologist maneuvers the head in certain positions and tracks his eye movements. The results from the vestibular testing done at his balance center confirmed Dr. Zhang’s suspicions.
This patient was diagnosed with Meniere’s disease
Meniere’s disease is diagnosed at a Dizziness and Balance Clinic that is a diagnosis of the middle ear and is characterized by episodic vertigo, or room spinning, and ear symptoms. Many patients are bed-ridden or stuck near a toilet during their vertigo attacks. Some patients experience some warnings before a vertigo attack, but for some patients, it comes on suddenly. Typically Meniere’s vertigo episodes last from 20 minutes to 12 hours.
Common Symptoms of Meniere’s Disease
Ear symptoms include ringing also known as tinnitus, ear fullness, and fluctuating hearing loss. Patients can experience these symptoms even if they’re not having a vertigo episode. The hearing loss in Meniere’s disease is especially unique because it affects the low frequencies primarily. Low frequencies are those involved the most in recognizing speech.
Hearing loss caused by aging or loud noises tends to start with high frequencies and progress over time. Typically, with early episodes, the hearing will rebound after an attack, but continued attacks may lead to permanent damage to the hearing nerve and patients can experience permanent hearing loss.
How common is Meniere’s Disease?
Meniere’s disease affects about 12 in every 1,000 people. Currently, our Dizziness Center has no FDA-approved drug for Meniere’s treatment. Doctors, including Dr. Zhang, typically prescribe medications to help with symptoms like anti-vertigo and anti-nausea medications. Right now there is no accepted medication to prevent symptoms, only those to help reduce them once a patient is already experiencing them.
The most effective current treatment option for Meniere’s disease involves invasive surgery and can lead to long-term damage to the hearing and balance nerves. Thus, these surgeries are typically only recommended in severe cases and/or if the patient already has significant hearing loss.
What can trigger a vertigo episode?
Many patients have found that certain triggers can cause a vertigo episode. Some commonly reported triggers for vertigo attacks to include salt, alcohol, and stress. If patients can identify specific triggers, doctors recommend avoiding them, but it’s not always possible. Some patients even notice changes in symptoms with the weather.
The Dizziness, Balance & Tinnitus Center findings
In his Dizziness clinic, Dr. Zhang has found that lamotrigine, an anti-seizure medication, may work to prevent Meniere’s vertigo attacks. He’s completed multiple research projects that support this finding and is continuing his work to hopefully obtain FDA approval. Most patients can tolerate lamotrigine without major side effects.
The main side effect to look out for is a skin rash, which can become serious if patients do not discontinue the medication. To help minimize the chance of skin rash, Dr. Zhang’s clinic has patients slowly increase their dose of lamotrigine. If there is any sign of a rash, the patient is advised to stop the medication and offered a similar medication.
Dr. Zhang theorizes that lamotrigine works by calming down the activity of the brain, like how it does with a seizure. It’s been found that in Meniere’s Disease, there is an excess of fluid in the middle ear. This fluid is past the ear drum, so it can’t be removed without invasive surgery and can build back up even if drained.
This excess of fluid isn’t what causes Meniere’s disease, but it is involved
Dr. Zhang believes that this fluid buildup causes the structures in the middle ear to become stretched in the affected ear. This stretch puts pressure on the balance and hearing nerves, which causes the nerves to become activated. When the nerves send the activation to the brain it causes the symptoms associated with Meniere’s disease like vertigo and ear issues.
Lamotrigine works by stopping this activation from spreading to the brain and stops symptoms from starting. This can potentially stop long-term damage to hearing and balance caused by continuous activation of the brain.
Keep an eye on your stress and anxiety levels
Dr. Zhang and previous research have seen that patients with stress or anxiety are more likely to have more severe and frequent symptoms. Dr. Zhang believes this is because stress or anxiety makes the brain more prone to hyperactivity. Thus, Dr. Zhang may prescribe some patients an anti-anxiety medication as a relaxation technique to help further calm down the brain. This may help the patient to have more relief in combination with lamotrigine.
Dr. Zhang and his team are dedicated to helping people with Tinnitus, Meniere’s, or any Dizziness and Balance issues. Call to schedule an appointment with our tinnitus and vertigo team at 716-250-2000.
The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.