Published February 14, 2021, 12:09 AM

by Dr. Jose Pujalte Jr.


Dr. Jose Pujalte, Jr.

“What is vertigo? . . . It is the voice of the emptiness below us which tempts and lures us, it is the desire to fall, against which, terrified, we defend ourselves.” – Milan Kundera (1929-), French – Czech writer, The Unbearable Lightness of Being (1984)

It’s not true that only people in love feel that the world is spinning. Some suffer Meniere’s disease and its symptoms aren’t romantic at all.

And what are these? There are at least three – vertigo, tinnitus, and hearing loss. Vertigo is the sensation of “spinning” or the world around you moving when it is not. Vertigo is also experienced on watching game shows where normally sedate grown men (and women) make fools of themselves dancing or singing (or both) for a fistful of pesos.Tinnitus is ringing or roaring in the ears while hearing loss may occur during an attack.

What Happens. The inner ear or the labyrinth is a very delicate structure that is needed not only for hearing but also for balance. It has two parts – the bony and membranous labyrinth.  The latter is filled with a fluid called the endolymph. When the head moves, so does the endolymph. In the process, the brain is informed of motion in space thus allowing effortless balance. Now in Meniere’s disease, the membranous labyrinth ruptures. This allows the endolymph to mix with another fluid between the membranous and bony labyrinths (the perilymph). Researchers point to this deadly mix as the reason for the enfeebling symptoms. The exact cause of Meniere’s is unknown although head injuries and viral infections of the inner ear have been implicated.

Diagnosis.  Meniere’s equally affects males and females. It peaks in the 50s but the range is wide: from the 20s to 60s. Symptoms appear suddenly and all that the person can do is lie down and keep still until the vertigo subsides. Imagine being on a roller coaster but it is the outside that is spinning and not you. Of course, as in a roller coaster ride, nausea and vomiting can’t be far behind. The doctors to visit are the otorhinolaryngologist (ear-nose-throat or ENT specialist) and possibly the neurologist.

The good doctors will take a complete medical history. The examinations may include hearing tests (audiometry), and imaging studies like a CAT scan (computed tomography) or MRI (magnetic resonance imaging). Hearing loss and vertigo can result from tumors in the brain. For this reason, the causes must be uncovered.

Treatment. Meniere’s disease has no cure. However, treatment has evolved to make it manageable through the reduction of attacks. Nausea and vomiting can be controlled with anti-emetics while vestibular suppressants such as sedatives and antihistamines and scopolamine reduce vertigo. Surgery is the last option. The doctor may remove some of the bone around the inner ear (endolymphatic sac decompression), drain the inner ear fluid through a tube (endolymphatic shunt), cutting the nerve for balance (vestibular neurectomy), and the ultimate — removing the inner ear (labyrinthectomy).

Prevention. Vertigo is preventable in Meniere’s disease. Some doctors prescribe a low-sodium diet while others prescribe diuretics to rid the body of excess fluid. Both approaches try to lessen excess endolymph, hence making attacks less frequent. It also helps to remember avoiding CATS.That is Coffee, Alcohol, Tobacco, and Stress. All these stimulate the inner ear, bringing on the vertigo attacks.

I suppose that when love sours, spinning stops. To make the spinning of Meniere’s disappear will take more than familiarity (and contempt).

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