By Keith Foley-Chell B.App.Sc. (Acupuncture), Cert.Adv.Ac. (Guangzhou)

Abstract

The structure and function of the inner ear is defined and the disorder known as Meniére's Disease is described from the point of view of Western medicine and Traditional Chinese medicine. These perspectives are compared, with the aim of finding rationalizations of the two theoretical viewpoints. Using a single case study of a female patient the of validity of the medical examination and Traditional Chinese examination are discussed. Changes to her condition are described, listed and charted. Conclusions are drawn with reference to both strengths and weaknesses of the findings, and suggestions are made regarding further appropriate research.

Introduction

In the condition known as Meniére's Disease, the fluid volume in the semicircular canals is increased, leading to elevated pressure. Typically, this causes attacks of dizziness (or vertigo), creating a feeling of violent spinning or rotation, whirling and falling. This is usually the most disabling and distressing symptom of Meniére's Disease.

During these attacks of dizziness in the early stages of the disorder, hearing in the low ranges usually deteriorates and returns to normal or near normal after an attack. While the frequency and duration of attacks vary between individuals, these episodes usually re-occur over a few years. Once the disease is established however, hearing loss may fail to recover fully after an attack. In the later stages of the disease, hearing loss is relatively constant and irreversible, and affects hearing in all ranges.

Another distressing symptom which often manifests from Meniére's Disease is tinnitus. This ringing in the ears will not be noticed during the attacks and by the later stages may become constant. Nausea, vomiting and sensation of fullness or pressure in the affected ear are commonly experienced.

The pattern and incidence of the symptoms may vary from case to case, but the general indications are the same, vertigo, tinnitus, nausea, sensation of pressure in the ear and progressive deafness in the affected ear, often leading to permanent hearing disability or total hearing loss, usually unilaterally.

This disorder is quite common, occurring in approximately one in a thousand of the population. It is equally common in both sexes, and most commonly occurs in the age range of 30 to 60 years, with 65% of cases occurring before the age of 50. In the majority of cases (about 85%) only one ear is affected, however the longer the condition lasts the more chance there is that the other ear will also become affected (Victorian Deaf Society, 1992).

One of the important points about Meniére's Disease is that medically, there is very little knowledge of it's aetiology. It is believed that there may either be an overproduction or underabsorbtion of endolymph in the cochlear duct. However, it is still not clear what factors lead to this condition. Medical therapy available for this condition is limited. In many cases sufferers are advised to be patient and wait for spontaneous recovery (which does occur in many cases).

In contrast, the aetiology of Meniére's according to traditional Chinese medicine is very clear. In theory at least, it can offer an effective acupuncture treatment program for the disorder.

The Treatment of Meniére's Disease by Acupuncture

Meniére's Disease is believed to result from the dilation of the lymphatic channels in the cochlea. The usual symptoms are tinnitus, heightened sensitivity to loud sounds, progressive loss of hearing, headache and vertigo. In the acute stage there may be severe nausea with vomiting, profuse sweating, disabling dizziness and nystagmus. Frequency of attacks is highly variable and the disease usually lasts a few years, with progressive loss of hearing in the affected ear (Miller & Keane, 1983, p.686).

Meniére's Syndrome ... is characterized by an increased amount of endolymph that enlarges the labyrinth. Among the symptoms are fluctuating hearing loss, attacks of vertigo, and roaring tinnitus. Etiology of Meniére's Syndrome is unknown. It is now thought that there is either an overproduction or underabsorbtion of endolymph in the cochlear duct. The hearing loss is caused by distortions in the basilar membrane of the cochlea (Tortora et al, 1990, p.491).

Meniére's Syndrome is essentially a disease of medically unknown origin. It is characterised by a variety of symptoms, all related to inner ear dysfunction, and seems to entail a retention of endolymph in the affected ear. There is also no known hereditary link in the onset of Meniére's Disease.

The syndrome of recurrent paroxysmal vertigo with associated feeling of fullness in the ear, tinnitus, and depression of hearing on a background of progressive hearing loss, and depression of labyrinthine function has been shown to be due to an intermittent elevation of endolymphatic pressure. When this occurs idiopathically, this is known as Meniére's Disease (Ell, 1991, p.30,32).

While no actual medical cause is known, several factors have been linked with Meniére's Disease.

• Tension and Anxiety can lead to attack.
• A high salt intake (probably due to increased fluid retention).
• Some women have attacks pre-menstrually which are associated with fluid retention.
• There is a direct link with migraine in 30% of recorded cases.
• Head injury severe enough to cause a concussion.
• Syphilis.
• Glandular or hormonal imbalance (including hypothyroidism).
• High cholesterol levels.
• Allergies.
• Common factors such as chocolate, smoking, alcohol, dairy products and wheat.
• High doses of aspirin (from 14 to 16 tablets per day) can cause ringing in the ears. This type of tinnitus is reversible, simply by withdrawing the intake of aspirin.
• (Victorian Deaf Society, 1991, p.2).

Medical treatments utilised include diet, medication and surgery.

Dietary measures involve reducing cholesterol, reducing fluid intake, stopping alcohol, and eliminating added salt from the diet. This reduction in salt intake is most important, as salt increases fluid retention. Stopping coffee and cigarettes is also important because they constrict the blood vessels (Victorian Deaf Society, 1991, p.2).

Drug therapy centres around vasodilation to increase cochlear and labyrinthine blood flow, diuretics to remove water from the body with the aim of decreasing the supposed elevated intralabyrinthine fluid pressure, symptomatic antivertiginous antihistamines, and psychotherapeutic drugs to offset attacks which may be precipitated autonomically (Avery, 1980, p.354).

Some clinicians have used diuretics alone, while others prefer to combine a salt restricted diet with a diuretic. These therapies are aimed at reducing intralabyrinthine pressure.

Endolymphatic hydrops can be treated with the combination of a sodium depleting diuretic and a low salt diet. Acute attacks may respond to 20 to 30 g of urea taken and dissolved freshly in water. This causes a rapid osmotic shift which can acutely lower endolymphatic pressure (Ell, 1991, p.30).

At present, 5% of people suffering from Meniére's Disease require surgery of the inner ear. With each operation, hearing is at risk and the symptoms of vertigo and tinnitus may actually worsen rather than improve.

Conservative surgery is mainly designed to control vertigo but, in some cases, also seeks to improve hearing. The patient should have useful hearing in the non-operable ear as loss of hearing may be a caused to the ear (which is subject to surgery). Conservative surgery usually involves decompression and drainage of the fluid system in the balance mechanism, often using a drainage shunt to relieve the pressure in the inner ear. These operations require considerable skill and are not always successful (Victorian Deaf Society, 1991, p.3).

Destructive surgery is designed to destroy the inner ear completely. Vertigo is usually relieved and tinnitus sometimes relieved, but the procedure obviously entails complete and permanent hearing loss from the affected ear. For this reason, destructive surgery will only be employed when there is severe hearing loss in the affected ear and useable hearing in the other ear (Victorian Deaf Society, 1991, p.3).

The eventual outcome of Meniére's Disease is unpredictable. In many cases the symptoms spontaneously disappear, in others however, "... the natural course of Meniére's Syndrome may stretch out over a period of years, with the end result being almost total destruction of hearing" (Tortora et al, 1990, p.491).