PDC Test - Meniere's Disease

You can earn 0.25 PDC by passing the exam following this article, which has been approved for publication by NCRA's Council of the Academy of Professional Reporters.

The questions are based on the material in the article but some may require additional research. Send your answer sheet to NCRA's Continuing Education Office, 8224 Old Courthouse Road, Vienna, VA 22182, and enclose a check for $40 (member) or $50 (non-member) to cover the processing fee. 

Meniere's Disease

by Patty Archambault

Have you ever ridden a merry-go-round and then tried to walk? In most cases, it was difficult to walk, if not impossible. Add to that the feelings of vertigo, nausea, headache, hearing loss and ringing in your ears. Now you have an idea of what a person with Ménière's disease struggles with every day of their lives.

Ménière's is most commonly associated with vertigo, or dizziness, and tinnitus, ringing in a person's ears. Hearing loss experienced by Ménière's sufferers is described as low frequency and is accompanied by a full feeling in the ears as a result of fluid in the cochlea. Diarrhea, headache, nausea, and vomiting are all symptoms of Ménière's, as is nystagmus, an abnormal, side-to-side eye movement, and ataxia, which describes a person's unsteady walking gait.

Ménière's can be diagnosed through the use of several methods. Auditory testing of pure tones and speech recognition is one such way. Another way to test for Ménière's is to look for changes in loudness and/or clarity in a person's hearing after he or she drinks glycerol. Electronystagmography tests balance as seen through eye movement. Examination of the inner ear and hearing nerve is accomplished with the use of magnetic resonance imaging, which is used in diagnosing Ménière's, as is a general health evaluation.

Treatment for Ménière's is wide-ranging. Because excess liquid in the middle ear is a big concern, patients are asked to change their diets to reduce salt and water intake. Stress and anxiety are thought to make symptoms worse. Therefore, consumption of caffeine, chocolate and alcohol should be limited. Some people may use diuretics such as Dyazide, Lasix and Diamox to eliminate water retention. Antivert, Serc and Dramamine are examples of drugs recommended to alleviate feelings of nausea and vertigo, in addition to Valium, Antivan and Xanax to ease feelings of anxiety.

Use of steroids, known as synthetic glucocorticoids, may be attributable to suppressing the autoimmune response, supporting the idea that Ménière's may be the result of autoimmunity. Steroids have several effects on the body, including carbohydrate and protein metabolism, lipid metabolism, electrolyte balance, inflammatory responses and immune responses. Glucocorticoid receptors have been found in the tissues of the inner ear, giving credence to the possibility of steroids having a direct impact on fluid retention in the ear.

Calcium channel blockers, which dilate small blood vessels in the ear, are used by European doctors to treat Ménière's; although how they influence the symptoms and the function of the ear is not clear. Niacin, a drug that affects the expansion and contraction of blood vessels, is used in the treatment of Ménière's. Glycerol and isosorbide are osmotic agents. Glycerol is used during diagnosis and has short-term effects on hearing loss; the use of isosorbide does not have the side effects of glycerol, and hearing was improved in 38 percent of patients in one study over an eight-month period, but with no reported effect on vertigo. Ototoxic antibodies, such as gentamicin and streptomycin, are used to target and damage sensory hair cells of the vestibular system; thus, the brain no longer receives incorrect messages that the head is rotating. This method is also described as a chemical labyrinthectomy.

Nutritional supplements are widely used for a variety of illnesses and disorders, and there are some Ménière's patients who believe that they have found relief in their use. One such supplement is ginko biloba. There is no scientific data to prove its effectiveness on the symptoms or ear, but it probably will not make the situation worse. Ginger is used to curb feelings of nausea. While not used as a treatment in the United States, Japanese physicians give sodium bicarbonate intravenously as a treatment for an acute vestibular Ménière's attack.

If surgery is necessary, there are several options. Labyrinthectomy is 95 percent successful in eliminating major spells. In some cases tinnitus may worsen, and following surgery there is no hearing or balance in the ear operated on. Endolymphatic sac surgery relieves dizziness in 75 percent of cases, hearing is usually unchanged, and tinnitus remains the same. There is a risk of meningitis and spinal fluid leak with a vestibular nerve section, although the procedure curbs vertigo in 95 percent of patients. In addition, there is no hearing or balance in the ear operated on.

Like any disease, lifestyle plays a role in the management of Ménière's. Nicotine is toxic to the middle ear, so smoking should be eliminated. Doctors recommend a low sodium diet, a diuretic and reducing levels of caffeine, stress and fatigue. There is a theory that Ménière's spells are linked to allergies, so people diagnosed with Ménière's are encouraged to record the foods they ate and activities they participated in prior to feeling symptoms of Ménière's.

By making these lifestyle changes, Ménière's can be controlled in 70 percent of patients, meaning that attacks of vertigo may be minimal, if they occur. Tinnitus is rarely helped by life management techniques. If treatment is started early, symptoms of Ménière's can usually be lessened, and in more established cases, the symptoms may be stabilized. However, some patients' hearing will continue to deteriorate.

Only 20 percent of patients experience Ménière's in both ears. If Ménière's affects both ears, it will usually present itself in the first two to three years. Treatment is most effective in the first two months of the onset of symptoms. If treatment is not sufficient, surgery may be necessary.

The cause of Ménière's draws widespread speculation. It is not believed to be hereditary, meaning it is not passed on to the next generation by a family member. It is also not contagious. There is no conclusive evidence that a virus is the culprit. Although flying puts pressure on the entire body, that does not mean flying can change the pressures in a person's head permanently and cause Ménière's. Everyday activities such as standing, sneezing and lifting have a direct impact on internal head pressure. However, patients have reported a worsening of symptoms when driving up a mountain or when a weather front moves through.

About the Author:

Patty Archambault, RPR, is a captioner from Mason, Michigan

CEU Exam

1. The process of developing Ménière's begins with _______.
   

   a. wearing earrings
   b. damage to the inner ear
   c. scuba diving
   d. listening to loud music

    

2. Symptoms of Ménière's include all of the following except:
   

   a. fainting
   b. headache
   c. nausea
   d. dizziness

    

3. Ataxia is:
   

   a. abnormal, side-to-side eye movement
   b. unsteady walking gait
   c. nervousness
   d. ringing in the ears

    

4. Ménière's disease is more common in people over age 40.
   

   a. True
   b. False

    

5. Electronystagmography tests:
   

   a. heart rhythm
   b. breathing rates
   c. hearing levels
   d. balance

    

6. Diamox is an example of a(n):
   

   a. antidepressant
   b. steroid
   c. diuretic
   d. calcium channel blocker

    

7. The three bones that form the middle ear include all of the following except the:
   

   a. malleus
   b. incus
   c. clavicle
   d. stapes

    

8. Which of the following is used in the treatment of Ménière's:
   

   a. sodium
   b. niacin
   c. iron
   d. potassium

    

9. What percentage of patients had improved hearing after the use of isosorbide?
   

   a. 28
   b. 38
   c. 48
   d. 58

    

10. One out of ______ people in the United States has a hearing loss.
    

    a. 7
    b. 8
    c. 9
    d. 10

     

11. Which of the following is used to alleviate feelings of nausea?
    

    a. ginger
    b. sodium bicarbonate
    c. gentamicin
    d. glycerol

     

12. The cochlea is:
    

    a. snail-shaped
    b. heart-shaped
    c. box-shaped
    d. triangle-shaped

     

13. After a vestibular nerve section, hearing in the ear operated on:
    

    a. returns to normal
    b. diminishes minimally
    c. diminishes greatly
    d. is nonexistent

     

14. Ménière's disease can be controlled in what percentage of patients?
    

    a. 50
    b. 60
    c. 70
    d. 80

     

15. Ménière's disease was first described by Prosper Ménière in __________.
    

    a. 1860
    b. 1861
    c. 1862
    d. 1863

     

16. A person specializing in hearing loss is a(n):
    

    a. audiologist
    b. optometrist
    c. oncologist
    d. epidemiologist

     

17. What percentage of patients will not experience Ménière's in both ears?
    

    a. 20
    b. 40
    c. 60
    d. 80

     

18. How many Americans have a hearing loss?
    

    a. 24 million
    b. 26 million
    c. 28 million
    d. 30 million

     

19. What are signs of Ménière's disease?
    

    a. ear feels plugged
    b. ringing in the ear
    c. hearing diminishes
    d. all of the above

     

20. What is used to examine the hearing nerve?
    

    a. MRI
    b. electrocardiogram
    c. angiogram
    d. stethoscope

     

21. Ménière's patients experience no change in symptoms or symptom severity.
    

    a. True
    b. False

     

22. Steroids affect the body in the following ways:
    

    a. lipid metabolism
    b. immune response
    c. both a and b
    d. neither a nor b

     

23. Symptoms may worsen with increased:
    

    a. stress
    b. fatigue
    c. water retention
    d. all of the above

     

24. Injections of anesthesia are administered as a treatment of Ménière's.
    

    a. True
    b. False

     

    Answer Sheet for Ménière's Disease Exam Circle the correct answer Name ______________________________________________ Address ____________________________________________ Membership ID Number _______________________________ 1.   a    b    c    d 2.   a    b    c    d 3.   a    b    c    d 4.   a    b 5.   a    b    c    d 6.   a    b    c    d 7.   a    b    c    d 8.   a    b    c    d 9.   a    b    c    d 10. a    b    c    d 11. a    b    c    d 12. a    b    c    d 13. a    b    c    d 14. a    b    c    d 15. a    b    c    d 16. a    b    c    d 17. a    b    c    d 18. a    b    c    d 19. a    b    c    d 20. a    b    c    d 21. a    b 22. a    b    c    d 23. a    b    c    d 24. a    b