Stick a tube in your ear to banish dizzy spells
07:45 GMT, 29 May 2012
A simple 15-minute procedure combined with a hand-held device can help reduce chronic dizziness.
Sue Parker, 64, a retired school dinner lady from Milford, Surrey, describes her treatment.
At first, it felt as if my right ear was full of water. I had dizzy spells, too — maybe one a day — when I’d have to sit down.
I thought it was some kind of infection, and when it didn’t clear I saw my GP, who referred me to a specialist.
He went through various checks including hearing tests and told me I had Meniere’s, a disease of the inner ear.
Tube in the ears: A simple 15-minute procedure combined with a hand-held device can help reduce chronic dizziness
He explained that the inner ear controls our balance and with Meniere’s, fluid can build up there, making you feel dizzy.
I didn’t worry too much at that point, and found that the anti-vertigo drug he prescribed, betahistine, helped. But over the next four years the attacks got worse.
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Betahistine tablets are prescribed to treat Meniere's disease – the drug increases the blood flow in the inner ear and reduces vertigo
The condition may be caused by a build-up of a fluid called endolymph around the inner ear channels, which play an important role in balance and hearing.
Normally, there is a slow turn-over of this fluid, so the volume is kept fairly constant, but for some reason in Meniere’s it gets too high or it may suddenly clear from the back of the ear into the inner ear, causing an attack.
The attack combines terrible vertigo, ringing in the ears and reduced hearing. It can last for many hours.
As the disease progresses, the hearing loss and tinnitus become permanent, though many patients do have periods without attacks.
While there is no cure, there are lots of treatments we can offer to reduce the frequency and severity of attacks.
The first is to control diet — we know salt can be an important trigger because it causes fluid retention. We may offer diuretics so excess salt passes out in urine.
We can also prescribe betahistine, a drug that increases the blood flow in the inner ear and reduces vertigo, or anti-sickness drugs, as injections or tablets taken under the tongue.
These methods work well in most patients.
For the others, we can try more invasive methods, but all involve some risk of destruction of the inner ear — and we know that in up to half of patients, Meniere’s eventually affects both ears, so losing hearing in one ear is a big risk.
These other options include an injection of an antibiotic into the ear; while this can reduce the frequency of attacks, it may also affect the balance function and damage hearing permanently.
The surgical options include endolymphatic sac decompression, where the bone that covers the endolymphatic sac — where the endolymph fluid is building up — is removed, to try to reduce the pressure. But this, too, risks balance and hearing.
As a final option we can cut the nerve leading from the inner ear to stop the abnormal messages reaching the brain.
This is a brain operation with significant risks that many patients cannot face.
The Meniett was developed in the U.S. in the Nineties, but is not generally offered to patients on the NHS except as part of a trial, perhaps because the device costs around 2,000.
I would like to see it offered more widely, because for many patients it can put the condition into remission without invasive surgery.
The device is a simple battery-powered pulse-generator that emits waves of low pressure. The patient can use it at home.
First, they need to have a grommet fitted into the eardrum.
This is simple: I fill the ear canal with local anaesthetic, then make a small 2mm incision in the ear drum, and use forceps to insert the grommet. This will keep the hole in the eardrum open, so the pressure waves can pass through the middle ear to the inner ear.
The grommet will eventually be pushed out by the ear drum’s repair process, usually within a year, but can be reinserted.
The patient goes home within the hour, and the next day they can start using the Meniett device. It has a clear plastic tube or earpiece — rather like an earphone — which the patient puts into their ear three times a day.
Most people should continue to use the device once the condition starts responding, though patients often develop their own routines and have a sense of when they need to use it.
Many patients find they go into remission, which we hope will last for years until the disease has run its course, and can start to live normal lives again.
The procedure costs around 600 privately or on the NHS — the Meniett costs 2,000. For more information, contact menieres.org.uk; 0845 120 2975.