Meniere's Disease

Etiology

Meniere's syndrome is an umbrella term for such conditions as tinnitus, hearing loss, aural fullness, and recurrent, spontaneous episodes of vertigo. It may be caused by several etiologies: (1) Meniere's disease, also known as the idiopathic form; (2) trauma, perhaps after ear surgery or injury to the head; (3) viral infection, measles, or mumps, also known as the delayed-onset Meniere's syndrome; (4) syphilis in the latter stages; and (5) Cogan's syndrome. The most common cause of the syndrome is Meniere's disease. The patient is reported to have the disease only when medical examination has excluded the other four possible etiologies.^[8]

The underlying cause of idiopathic Meniere's disease is a condition known as endolymphatic hydrops. Hydrops is defined in Stedman's Concise Medical Dictionary as "an excessive accumulation of clear, watery fluid in any of the tissues or cavities of the body." The same source defines endolymph as the "fluid contained within the membranous labyrinth of the inner ear." Thus, in Meniere's disease, excessive fluid has accumulated in the inner ear, which also comprises the semicircular canals crucial to balance and the cochlea, integral to hearing.^[5]

Can Bonine Be Recommended for Meniere's Disease?
Pharmacists have often been puzzled about the difference in nonprescription Bonine (or generic meclizine) and prescription Antivert. The strengths are identical, yet one cannot be bought without a prescription. The difference hinges on the indications and labeling. Nonprescription meclizine is labeled only for motion sickness, a minor condition of known etiology considered by the FDA as self-treatable. On the other hand, Antivert is indicated for vertigo. Vertigo has many causes, some serious (e.g., ingestion of ototoxic medications). Thus, vertigo requires a physician's skill in differential diagnosis before meclizine can be considered useful. A patient using meclizine for vertigo without physician consultation could experience apparent relief but mask a serious underlying medical condition that would remain unchecked. For this reason, patients requesting meclizine or Bonine for vertigo should always be urged to consult a physician, if they have not already done so.

Can Bonine Be Recommended for Meniere's Disease?

Pharmacists have often been puzzled about the difference in nonprescription Bonine (or generic meclizine) and prescription Antivert. The strengths are identical, yet one cannot be bought without a prescription. The difference hinges on the indications and labeling. Nonprescription meclizine is labeled only for motion sickness, a minor condition of known etiology considered by the FDA as self-treatable. On the other hand, Antivert is indicated for vertigo. Vertigo has many causes, some serious (e.g., ingestion of ototoxic medications). Thus, vertigo requires a physician's skill in differential diagnosis before meclizine can be considered useful. A patient using meclizine for vertigo without physician consultation could experience apparent relief but mask a serious underlying medical condition that would remain unchecked. For this reason, patients requesting meclizine or Bonine for vertigo should always be urged to consult a physician, if they have not already done so.

Cite this: Meniere's Disease - Medscape - Jul 15, 2005.

Sidebar: Meniere's Disease - Take Caution During an Attack

An attack of Meniere's disease cannot be accurately predicted or prevented. However, pharmacists can help explain the use of prescribed medications, such as diuretics or antihistamines, to help manage attacks and to treat symptoms.

You or someone you know may suffer from a condition known as Meniere's disease. The condition causes you to have a sudden attack of vertigo (dizziness), hearing loss, ringing in the ears, and a feeling of fullness in the ear, perhaps along with nausea and vomiting. The first attack is extremely frightening, and you may have visited an emergency department in an attempt to discover what was wrong.

When an attack is ongoing, you may be unable to walk without assistance, and the nausea/vomiting can appear rapidly. It is helpful to lie down on a firm, nonmoving surface (a waterbed would be a poor choice). You should try to lie as still as you can while the attack is proceeding. Keep your eyes open during the attack, and try to focus your vision on a nonmoving object, such as a lamp or light fixture that is not turned on (not a rotating ceiling fan). Eventually, the spinning sensation will pass, and you may feel more normal. Sit up slowly, and if the dizziness returns, lie back down until you can sit up comfortably.

The nausea may be so severe that you cannot eat or drink anything during the attack without vomiting. There is no nonprescription product for the vomiting due to Meniere's disease; therefore, you should visit your physician for specific prescription medications.

Your physician may prescribe an antihistamine, such as meclizine, to manage the attacks. Be aware that the medication will make you drowsy. Do not attempt to drive while taking it until you find out how drowsy the antihistamine will make you.

If your physician prescribes medication for Meniere's disease, you should take it as directed. Sometimes, a diuretic (water pill) can help reduce the amount of fluid in your inner ear, preventing attacks. Triamterene/hydrochlorothiazide in combination is a popular choice.

Your physician may also provide advice about a special diet that can prevent attacks. Generally, you should limit your amount of salt and sugar intake each day. Both can affect the balance of fluid and chemicals in your inner ear, possibly leading to an attack. The recommended daily amount of sodium is 1,000 mg. Any meal with excessively high salt intake can start an attack. You should eat meals that are equally divided in the number of calories, and drink plenty of fluids each day. Try to eat and drink the same amounts of food from day to day, and avoid skipping meals.

In addition, you should avoid caffeine of all forms (soft drinks, tea, coffee, and chocolate). Caffeine increases the tinnitus that comes with a Meniere's attack and can trigger an attack of migraine headache. Alcohol should be limited to one can of beer or glass of wine daily, as alcohol can also trigger migraine.

Cigarettes shrink blood vessels; this can reduce your inner ear's blood supply, worsening your symptoms. Aspirin can cause tinnitus and should be avoided unless you are taking it because of a physician's recommendation.

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