Commonly called "glaucoma of the inner ear," Ménière's disease is related to the inner ear (labyrinth) in which the vestibular (balance) system is housed. The labyrinth contains three semicircular canal, a complex system of chambers and passageways in the temporal bone. Signals sent from the semicircular canals), travel along the nerve pathways to the brain. Inside the canals is a thin-walled membranous sac filled with a fluid called endolymph. Surrounding the sac is another fluid called perilymph. These two fluids constantly bath the vestibular and hearing organs and enable the person to keep his or her balance, and maintain normal hearing.

For unknown reasons, in Ménière's disease the endolymph is over-abundant. Like glaucoma of the eye, the pressure increases until the sac bursts. The mixing of endolymph and perilymph sends an unbalanced message down the vestibular nerve to the brain and the patient experiences severe spinning vertigo, nausea, hearing loss, tinnitus (ringing or buzzing sounds in the ear), and a feeling of fullness in the ear. As the disease progresses, hearing loss increases and the patient's confidence plummets as these attacks are frustratingly unpredictable. The disease affects one ear in 85% of patients and both ears in 15%. In 50% of cases, the attacks will subside after two years; in 70% of cases, they will disappear in eight years. Hearing loss may become progressively worse. Medical Treatments Although we do not know the cause of Meniere’s disease, we do know that various things trigger attacks of vertigo, stress, allergies, excess salt intake, caffeine, and migraine headaches and barometric changes in pressure.  When a diagnosis of Meniere’s disease has been made, doctors often suggest a diuretic such as Dyazide, reduction of salt in the diet, and the use of anti-vertigo drugs, such as, Meclyzine (Antivert), Compazine or Phenergan suppositories. While these may help quell the nausea and shorten the episodes, they do not cure the disease. One of the best new drugs to abort attacks of vertigo when they start is sublingual Ativan (Lorazepan) three time a day. The brand form of the drug is absorbed quickest into the blood stream.  All patients are skin tested for inhalant and food allergies. Fifty percent are found to have allergies that can be treated by injections. If migraine heads are found to be the cause they are treated with the appropriate medication.   Surgical Treatments   If the medical treatments fails to stop the attacks of symptoms of vertigo, hearing loss, ringing in the ear and pressure in the ear then there are surgical options that can improve the patients’ condition. In the sixties the only treatment was total destruction of the ear, which would cure the vertigo in almost all cases. The side effect was total loss of hearing. The second procedure that was developed was cutting the balance nerve to the brain which preserves the hearing and relieves the vertigo in 95% of cases. Dr Silverstein developed a safe approach to cut the vestibular nerve in 1978. Dr Silverstein has performed over 250 at the Si with great success. This is an excellent procedure and preserves the hearing in many cases. Because the procedure involves operating near the brain only the most serious cases were being done.   Minimally Invasive procedures developed at the Silverstein Institute   With the advent of minimally invasive surgery for many surgical procedures, a search was made to find an effective office procedure with minimal risk and discomfort to the patient. The Silverstein Institute was a pioneer in developing minimally invasive procedures that could  be performed in the office. The  MicroWick was one such procedure and was developed so that patients could treat themselves at home by placing medication in the ear canal. The wick absorbs the medication and carries it to the inner ear. The MicroWick has been used since 1997 and was patented in 1999.   Indications for the MicroWick Gentamicin Perfusion of the inner ear For patients that have persistent vertigo attacks and who want to be free of them, gentamicin, which is an ototoxic antibiotic, is used in dilute concentrations prepared as an ear drop and placed in the ear three times a day. The patient is usually tested and seen once a week to titrate the amount. The results are good, in that 81% are free of vertigo for 4 years. Some patients need to have the treatment repeated. In some patients the inner ear is resistant to gentamicin and a vestibular neurectomy (cutting of the balance nerve) or a labyrinthectomy will be needed. Fortunately, this happens in only six percent of patients.     Steroid perfusion of the inner ear For patients whose main complaint is hearing loss, pressure and tinnitus, the drug used is dexamethasone that is made into a drop at a compounding pharmacy.  Dexamethasone is a powerful steroid that reduces inflammation, decreases the allergic reaction and may reduce fluid pressure in the ear.  The hearing is monitored every 2 weeks and the treatment usually lasts 4 weeks. In many cases the symptoms are relieved or improved. The risks and complications are minimal.  Rarely does the hearing get worse from the treatment. Occasionally after the MicroWick is removed the ear drum fails to heal and needs to be patched in the office.                                                                         Vestibular Neurectomy procedure developed at the Silverstein Institute If minimally invasive procedures fail to alleviate the patients vertigo symptoms and the hearing is still present in the ear a vestibular neurectomy procedure may be indicated., Dr. Silverstein developed a surgical procedure in 1978 that has provided help and hope to thousands of Ménière's sufferers. The original approach, called the retrolabyrinine approach (RVN), was improved in 1985 and called the combined retrolabyrinthine/retrosigmoid vestibular neurectomy (RRVN).  The RRVN offers immediate and permanent relief from the vertigo caused by Ménière's disease in over 95% of patients, while preserving the hearing in 99% of patients. The procedure involved making an small opening just behind the mastoid and exposing just a small portion of the mastoid bone. This allowed the surgeon quicker access to the hearing and balance nerve.  He then micro-surgically severs the balance nerve in the affected ear. The surgery is delicate, since the hearing nerve and balance nerve are close to the facial nerve. The facial nerve controls the movement of the face. No patient has had an injury to the facial nerve at the Si. Dr. Silverstein developed a facial nerve monitor in 1985 that warns the surgeon when he or she is close to the facial nerve. In over 9000 cases using this monitor at the Si, no facial weakness has occurred. After the surgery, the human body is so adaptive that it will allow the unaffected side to take over the balance function following a RRVN. Vestibular and balance rehabilitation helps the patient quickly recover from the surgery. Since 1978, he has performed over 250 procedures and estimated 6000 procedures were performed by other surgeons by 2000. While the vertigo is usually cured, the hearing sometimes continues to deteriorate do to the progression of the disease. No patient has had a facial weakness, meningitis or has died from the surgery.

A problem commonly called "glaucoma of the inner ear," Ménière's disease is related to the inner ear (labyrinth) in which the vestibular (balance) system is housed. The labyrinth contains three semicircular canal, a complex system of chambers and passageways in the temporal bone. Signals sent from the semicircular canals), travel along the nerve pathways to the brain. Inside the canals is a thin-walled membranous sac filled with a fluid called endolymph. Surrounding the sac is another fluid called perilymph. These two fluids constantly bath the vestibular and hearing organs