Dear reader,

As Thanksgiving Day approaches, I thought I’d give some advice to those out there with Meniere’s disease. MD is a disorder of the balance of the fluids of the inner ear. It can be devastating, as it causes hearing loss, tinnitus (roaring in the ears), and spinning vertigo. Luckily, the symptoms are episodic and the patient is usually fine between episodes. Classically, MD affects young women starting in their 20s or 30s, but it can affect both genders and all ages.

The first episode of classic MD (with all three of the symptoms of hearing loss, tinnitus and vertigo) is terrifying for the patient and anyone who happens to be around. It’s often immediately followed by a trip to the ER. Once the patient gets to an otolaryngologist (ear-nose-throat specialist) or an otologist (ear specialist), appropriate targetted treatment can be started. This involves strict dietary restrictions of (1) salt to less than 2000 to 2500 mg of Sodium per day, (2) caffeine to no more than 1 or maximally 2 cups or cans per day, (3) nicotine to none, and (4) alcohol to minimal, with one glass of water to be consumed per alcohol equivalent [one beer, one wine, or one mixed drink] consumed. Patients should also try to drink a good amount of water (4 to 6 glasses per day) and minimize internalization of external stressors. Some MD patients respond to reduction in certain types of carbohydrates as well as sugars and/or artificial sweeteners.

I take umbrage (isn’t that a neat phrase?) with some of my colleagues who make dire predictions of the future to MD patients. No, this disease does not have to be quality of life-ending. The vast majority (over 80%) of MD patients have very nice control of their symptoms with the dietary and attitudinal changes described above, and perhaps with some medications taken either daily or when the symptoms crop up. Very few patients need injections into their ears of either steroids or gentamicin, or surgery. A very small minority of patients end up with disabling MD.

Holiday time is tough for anyone following a diet. As stress is a major factor in bringing on MD attacks, the holidays can offer a double whammy, with pressure placed to present the perfect holiday family and friends tableau. SO, here’s some advice:
1. Start this season by increasing your average water consumption. Water will flush away many of your upcoming dietary indiscretions!
2. Don’t overdo it. If you’re in charge of the giant Thanksgiving day feast, break the work up into manageable pieces and/or delegate some of the tasks. Make sure you get adequate rest.
3. Make wise choices. Often, the MD attack occurs in a ‘perfect storm’ of just a little too much salt PLUS a little too big a piece of chocolate cake [caffeine] PLUS an extra cup of tea or coffee PLUS a glass of wine PLUS your brother-in-law just saying the wrong thing about your child. Therefore, if you decide to eat the more salty option, hold off on the caffeine and/or alcohol, and develop a thick enough skin that your relatives can’t penetrate with foolishness. And add water. It works.
4. Listen to your ears. Long-term MD patients know when they’re prone to an episode by the funny feeling they get in their ears (doctors call it aural fullness). At the first sign of this, really pay attention to your diet, take your diuretic if you haven’t that day, and do whatever you need to do to alleviate stress.
5. If you experience an MD attack, lie down, put your head into a position where the spinning is minimal, open your eyes and focus on a point so that your eyes can tell your brain you’re not spinning and override the wrong message being sent from your ear. As soon as you can, take a vestibular suppressant such as Meclizine. Call it a day. You’ll be much better the next day.

Meniere’s Disease, in my mind, is not so much a disease as a liveable condition. Once you understand it a bit, the fear of vertigo loses much of its power over you. Patients rather quickly figure out how much they can ‘cheat’ on their diets and still be comfortable. Medications go from daily to only as needed. You might be happy to know that many prominent figures in science, politics, entertainment, etc. have MD and are managing pretty well!

I hope this helps, and I wish you and yours a very happy and healthy Thanksgiving.

Sujana Chandrasekhar, MD