Dear Dr. Kato: I’ve had several instances where I get a severe vertigo attack that lasts for two hours. It hits me out of the blue, and the vertigo is very debilitating! I notice that before the spinning sensation starts, my ear feels full and rings, and my hearing gets plugged. These attacks have been more frequent. I’m 56, and have had a significant amount of emotional stress lately.

Dear Reader: There are many different causes of vertigo. The cause of your vertigo is most likely an inner ear disorder, called Meniere’s Disease.

Cause: In 1861, the French physician, Prosper Meniere, theorized that these bouts of vertigo, tinnitus, and hearing loss came from the inner ear, rather than the brain. Modern research has shown that many individuals with these symptoms have an excess of fluid (endolymph) inside the inner ear. The exact cause of this fluid buildup is unknown, but theories include: viral infection, autoimmune reactions, circulation problems, allergies, and genetics.

Symptoms: There is a wide spectrum of symptoms, varying from mild to severe. Meniere’s disease may begin with fluctuating hearing loss, and progress to attacks of dizziness and vertigo. Attacks are often preceded by an “aura.” Other symptoms can include: imbalance, nausea, vomiting, anxiety, diarrhea, headache, visual disturbances, and sensitivity to noise.

Duration and Frequency of Attacks: The unpredictable nature of this disease is frustrating and challenging. Attacks can last from 20 minutes to 2 days. They can occur weekly, or can be separated by months and even years. Most patients report “major” and “minor” (less debilitating) attacks.

Treatment: There are two general categories of treatment. The first is preventative. To prevent attacks, patients are recommended to stay on a strict, low-sodium diet (< 2000 mg sodium per day), and avoid caffeine, nicotine, alcohol, and highly concentrated sweets.

Medications used to reduce the severity of the vertigo and nausea and vomiting during an attack include: diazepam (Valium), promethazine (Phenergan), and meclizine (Antivert). These medications are NOT to be used on a daily basis, but only during an active attack.

For some patients, steroids can be helpful. Steroids can be given orally (e.g. prednisone), or delivered directly to the inner ear. The injection of steroid into the inner ear can be highly effective in reducing both the frequency and severity of the attacks. Finally, surgery can be performed for refractory cases.

Coping: Meniere’s disease can be a challenging disorder. The attacks are unpredictable, and can be severely debilitating. It impacts a person’s daily life: dietary restrictions limit dining out, unpredictable attacks make them leery of social events, and even simple tasks, such as grocery shopping and driving, can be uncomfortable and unsafe.

Educating family and friends can be helpful, and talking with others with Meniere’s disease can provide insight and support. One should also be under the care of a neurotologist, a physician who specializes in inner ear disorders.

Dr. Maya Kato is the founder of The Ear Institute in Palm Desert and can be reached at (760) 565.3900.

Sources:1) Dietary modification as adjunct treatment in Ménière’s disease: patient willingness and ability to comply. Luxford E, Berliner KI, Lee J, Luxford WM. Otol Neurotol. 2013 Oct;34(8):1438-43. doi: 10.1097; 2) Oral steroid treatment for hearing improvement in Ménière’s disease and endolymphatic hydrops. Fisher LM, Derebery MJ, Friedman RA. Otol Neurotol. 2012 Dec;33(9):1685-91.; 3) Meniere’s disease: New concepts, new treatments. Berlinger NT. Minn Med. 2011 Nov;94(11):33-6.Review.