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toma5
 #1 
Hi everybody,
I'd really appreciate if somebody could answer these questions. My questions are not exactly on tinnitus but I don't seem to be able to get any straight answers from anywhere. I've tried websites, my ENT but I still don't have the feeling that I understand. I've got the feeling that whatever I read or hear doesn't apply to me totally. My ENT told me that she 'thinks' I have vestibular migraines. She said that if I have constant tinnitus and hearing loss (as opposed to episodes) it is because my inner ear has been damaged by the vertigo attacks.
Questions:
  • what is the difference between Meniere's disease and vestibular migraines?
  • how could my inner ear be damaged by vertigo attacks when the only vertigo attack I had was 2 weeks before starting with tinnitus?
  • I take Betahistine at the moment but get pretty sick on it. It had stopped my vertigo, though. Does anybody know what the common treatment for Meniere's disease/vestibular migraines is in countries other than the UK?
  • what is the difference between Meniere's disease and Meniere's syndrome?
  • Can vertigo be triggered by tinnitus? Or is it a totally different issue alltogether? Does the fact that Betahistine work prove that I have an inner ear disorder?
Anybody able to answer any of these questions would make me very happy and possibly less lonely!  
Thatch
 #2 
Dr. N is the best to answer those,
The only thing i can add is that i was put on SERC aswell, and the best way to deal with the nausea is to eat first, don't take that on an empty stomach or it will really irritate it. I tried eating a good size meal or decent size snack before i took it and that seemed to help.
As for Tx of Menieres, as far as i know, if the betahistine hydrochloride doesn't tackle to the vertigo anymore, that in extreme cases you can get surgery done or gentamicin injections into your ear. I think my doc's mentioned that as a "last stage" effort though since it basically destroys the vestibular apparatus in your inner ear to try and reclaim balance
DrNagler
 #3 
Sorry, Toma.  I really don't know enough about Meniere's to answer your excellent question with any confidence.  I've asked Jim Chinnis to stop by and lend a hand if he has the time.

smn
jchinnis
 #4 
  • what is the difference between Meniere's disease and vestibular migraines?
There's a presumption that the causes are different. Vestibular migraines involve episodic partial disruption of blood flow in an artery that feeds the inner ear. The cause of Meniere's remains unknown but is thought to involve disturbances to the physiology of the inner ear. Meniere's includes progressing hearing loss while VM tends not to. Meniere's tends to involve gradual loss of balance function, whereas VM does not.
  • how could my inner ear be damaged by vertigo attacks when the only vertigo attack I had was 2 weeks before starting with tinnitus?
It isn't exactly the vertigo attacks that cause hearing loss. In Meniere's, it is presumed that the disruption of normal physiologic function in the inner ear makes one of the inner ear fluids toxic to hair cells. During an attack, the toxicity rises suddenly and then abates. But it isn't absent (normal) between attacks. I'll add that, in my opinion, the sorts of damage that can cause tinnitus can be very slight.
  • I take Betahistine at the moment but get pretty sick on it. It had stopped my vertigo, though. Does anybody know what the common treatment for Meniere's disease/vestibular migraines is in countries other than the UK?

There are two main schools of thought. One treats Meniere's (and some other vestibular problems) with betahistine. The other focuses on sodium restriction (and consistency of intake). The latter also uses diuretics to help reduce sodium and control fluid balance. Neither treatment has unequivocal data showing that it works.

In the US, sodium restriction and diuretics are the mainstay. Betahistine is not available except from compounding pharmacies, and not many doctors here prescribe it. It is a close relative of histamine and can cause a variety of symptoms.

  • what is the difference between Meniere's disease and Meniere's syndrome?
I think it's a matter of preference in terminology, though people take various strong positions on the terms.
  • Can vertigo be triggered by tinnitus? Or is it a totally different issue alltogether? Does the fact that Betahistine work prove that I have an inner ear disorder?
Most vestibular disorders have signs and symptoms that vary and follow erratic paths. Your symptoms may have improved without betahistine having anything to do with the improvement. Betahistine may or may not be working for you. If it is working, that doesn't prove an inner ear problem. Tinnitus does not trigger vertigo, but they increase and occur together in an attack. In Meniere's, there is a fairly typical pattern of build-up of ear pressure and tinnitus, followed by a violent vertigo attack during which hearing falls off strikingly (not that anyone notices...), followed by a phase where hearing returns to previous levels or almost so, tinnitus diminishes, and the spinning is replaced by slight imbalance or normal balance function.

I don't know if it is still available, but a very good and readable book on Meniere;s is the one by Patty Haybach: Meniere's Disease--What you Need to Know. It was published by the Vestibular Disorders Association, and they may still have copies available.

Jim
DrNagler
 #5 
Thanks, Jim.

smn
CPW151
 #6 
Not that I understood most of the above post but I do want to note that to have a board like this, where we can go and get our questions answered from the top experts of the field make this one fine board.  We are indeed blessed to have this level of expertise to answer our questions.

CPW
aQuieterBreeze
 #7 
CPW-
you said-
I do want to note that to have a board like this, where we can go and get our questions answered from the top experts of the field make this one fine board.  We are indeed blessed to have this level of expertise to answer our questions
You have an excellent point!

Jim- Thank you for giving us some clues as to what happens, or may happen - when someone has Menier's. I have wondered for awhile, and find your post really interesting.

Thanks for taking the time, and for sharing your knowledge.
Maccy
 #8 
I was originally prescribed Bethahistine for my T back in March. I queried the fact that it wasn't usually given for T but my GP said that it sometimes helped. It's quite difficult to know if it had any effect at all. All I know is that my symptoms became less, the T setteld to a lower pitch and nothing happened when I stopped taking it.

I do however know someone who works with my Husband and she has T from a mistake made during and Ear operation. She takes Bethahistine and her T increases terribly when she tries to stop taking it.

Mandy
toma5
 #9 
Thank you very very much, especially Jim. Made things much clearer.
Maybe I should have added that at the beginning of the treatment, my ENT gave me furosemide (potent diuretics) with the betahistine. It seemed that it helped but because of the dangerous side-effects (eg. it has an effect on the heart, or if combined with some antibiotics you can become half-deaf) she decided to withdraw it after 2 months.
Have a nice day everybody! (We have a typical English weather today )
Thatch
 #10 

CPW-
you said-
I do want to note that to have a board like this, where we can go and get our questions answered from the top experts of the field make this one fine board.  We are indeed blessed to have this level of expertise to answer our questions

i couldn't agree more.. i can for one say that finding this site has made a difference in my life. I've received better attention and answers through here then any of the very numerous doctors, specialists and others i've seen.


 

DrChip
 #11 
Evidence show that the effect's of Menieres is due to a build up of endolymphatic pressure (due to over secretion/under asorbition, NOT oto toxicity.

vestibulocochlear disorders do NOT have random symptoms:  there are clear cut causes with most:  BPPV. Migrane induced. orthostatic hypotension, etc.

The first two (BPPV) and migrane variant are the two most common.  Vestibular Rehab depends on the cause.

Diuretics and low salt are the main line of treatment for Menieres, as well as the Meniett device.

reference:  "Balance Function Assessment and Management" Plural Publishing, 2008.
jchinnis
 #12 

DrChip, the evidence I've seen, which is admittedly not very clear at all, seems to indicate that the pressure buildup in endolymph causes a toxic shift in electrolytes--a flow between the endolymph and perilymph, essentially. But I don't think anyone has the precise mechanism down pat yet.

DrChip
 #13 
Quote:
Originally Posted by jchinnis

DrChip, the evidence I've seen, which is admittedly not very clear at all, seems to indicate that the pressure buildup in endolymph causes a toxic shift in electrolytes--a flow between the endolymph and perilymph, essentially. But I don't think anyone has the precise mechanism down pat yet.


I am open to anything!  I am reading madly!  I know that Meniere's is not fully understood.  And I do not want to confuse readers of this forum.  But they should know that we do not always understand conditions.

I am as passionate about balance disorders as I am Tinnitus and Hyperacusis:  Balance is and has been the "other half" of my professional life.  I see the suffering each cause, an I just want to help!  cb


jchinnis
 #14 

Quote:
Originally Posted by DrChip

I am open to anything!  I am reading madly!  I know that Meniere's is not fully understood.  And I do not want to confuse readers of this forum.  But they should know that we do not always understand conditions.

If my response above indicated that we understand Meniere's, that is not what I meant to convey, and I apologize.

Jim

DrChip
 #15 
No, I did not take it that way.  I think you expressed the uncertainty that we all have.

I have always understood that Meniere's is a build up of endolymphatic pressure and the effects of this pressure on the end organs of balance.

..but I have been reading since your post, and have learned that there is a relatively high percent of evidence of hydrops in post mortem studies of temporal bones in which vertigo was not reported! So build up of pressure does not always explain it, as thought!

so back to the books for me!  cb

jchinnis
 #16 
DrChip, I believe it is also the case that endolymphatic hydrops has been induced in animals without vertigo developing. I really don't think we know if hydrops is a cause of Meniere's or a result of it or something else altogether. (And yes, an alternative term for Meniere's is idiopathic endolymphatic hydrops...)

Confusion abounds. It's nice to find someone with an open mind!

Best regards,

Jim
DrNagler
 #17 
Well, I confess that I don't know enough about this topic to even begin to know what it is that I don't know!

So I'd like to thank you both - Jim and Chip - for carrying the ball here!

smn
DrChip
 #18 
Quote:
Originally Posted by toma5
Hi everybody,
I'd really appreciate if somebody could answer these questions. My questions are not exactly on tinnitus but I don't seem to be able to get any straight answers from anywhere. I've tried websites, my ENT but I still don't have the feeling that I understand. I've got the feeling that whatever I read or hear doesn't apply to me totally. My ENT told me that she 'thinks' I have vestibular migraines. She said that if I have constant tinnitus and hearing loss (as opposed to episodes) it is because my inner ear has been damaged by the vertigo attacks.
Questions:
  • what is the difference between Meniere's disease and vestibular migraines?
A: two different disease. Migraine induced vertigo are a "migrane variant" and may be present without headache.  Migraine vertigo is the second most common form of vertigo second only to Beneign Paraxomal Positional Vertigo (BPPV).

The  physical basis for Maigraine vertigo and Meniere's are very different.
  • how could my inner ear be damaged by vertigo attacks when the only vertigo attack I had was 2 weeks before starting with tinnitus?
It is the commonly  held belief that Meniers is a build up of fluid pressure in the inner ear.  This  puts pressure on the nerve endings for balance and hearing.  This prolonged pressure can do damage to the hair cell nerve ending receptors in the inner ear: both the hearing portion (cochlea) and the balance (vestibular) portion.  Remember, the inner ear contains BOTH the balance AND hearing sensory nerve endings.

One of the FIRST indications of damage to the inner ear is tinnitus, and later hearing loss.  These symptoms fluxuate and the pressure builds up and then decreases (on it's own or by mediacl/surgical intervention).

The tinnitus is a SYMPTOM, not the cause.

Migraine vertigo does not create this pressure in the inner ear that I know of. It could be VASCULAR (blood vessel) pressure vs the endolymph of the inner ear-not sure.
  • I take Betahistine at the moment but get pretty sick on it. It had stopped my vertigo, though. Does anybody know what the common treatment for Meniere's disease/vestibular migraines is in countries other than the UK?
Some meds are used to treat the SYMPTOMS of the vertigo, not the cause. This is to stablize the patient's symptoms of nausea, vertigo and vomiting.
Front line medical treatment continues to be a VERY LOW salt diet, and diuretics.  Surgery is considered if the symptoms cannot be medicially treated and managed.
  • what is the difference between Meniere's disease and Meniere's syndrome?
Meniere's disease can be COCHLEAR (inner ear hearing) effecting the hearing and causing tinnitus, VESTIBULAR (inner ear balance) causing vertigo/dizziness/balance disorders, or BOTH!

Menier's disease will cause the signs and symptoms of what is bein effected (balance/hearing/both).

Meniere's SYNDROME is all or some of these symptoms:  nausea, vomiting,balsce disorders  (vestibular) tinnitus, hearing loss (cochlear) and aural fullness/pressure (both).  The classic Meniere's (named after the French physician Prosper Meniere's that first described the disease in the 1800's) includes ALL of these symtoms, thus it is a SYNDROME.
  • Can vertigo be triggered by tinnitus? Or is it a totally different issue alltogether? Does the fact that Betahistine work prove that I have an inner ear disorder?
NO!!!!!!!!!!!  Tinnitus and vertigo are the SYMPTOMS of an underlying disease, NOT the cause.  The cause is increased inner ear fluid pressure: Meniere's.

My questions to you as a patient would be:  do you have a ringing/roaring/cricket like sound (tinnitus)?  yes/no.  right ear/left ear/both/in your head? Do you have hearing loss?  yes/no?  right/left/both? Do you have vertigo/off balance/dizziness?  yes/no?  what triggers the balance problems : rolling over: yes/no?  which direction?  looking up? yes/no?  standing up quickly?  yes/no? do you have nausea with the episodes?  do you have vomiting with the episodes?do you have pressure/fullness in your ear(s)?  Right/left?  Are you sensitive to light (photophobia)  do you have sensitivity to sound (phonophobia?)

Do the symptoms fluxuate: hearing loss/vertigo/tinnitus?  How long do the symptoms last?

"Blanace disorders" cause as much pain and suffering as tinnitus does.  In addition to the Emory Tinnitus and Hyperacusis Center with Dr. Jastreboff, we have the "Dizziness and Balance" disorder Center with Dr. Herdeman and Dr. Tusa. 

You are not alone.  I see several patients a day with balance disorders and tinnitus/hyperacusis!

Hope this helps.  cb
would make me very happy and possibly less lonely!  

toma5
 #19 
So much attention I'm getting from you Dr Chip, I almost feel important again (joking!!!).
When you said "my questions to you as a patient", do you actually mean that you would be interested to know more precisely about my symptoms, or did you mean that I should get asked all of that by my ENT?
Of course, I would love answering those questions, as nobody ever really bothered asking me any, if it could bring me closer to understand. I think probably it is the fact that I still don't know what is happening with my ear (and my ENT told me that she can't give me any prognosis for my hearing loss) that stops me from finding any closure and therefore, not accessing the path to recovery.
But Dr Chip, if you are willing to hear my answers just let me know.
Thank you again.
Thatch
 #20 

thank you very much dr.chip!

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