One condition that affects the ears is Meniere's disease - shortened to MD, during this condition, problems inside the inner ear lead to other disorders like tinnitus-where ringing, buzzing, roaring, hissing or whistling type sounds are heard by the individual; in additions, the person may suffer from a sensation of fullness in the affected ear, and some hearing loss may be present, or it the loss of hearing may actually fluctuate-also common during MD are episodes of dizziness and imbalance because of vertigo. The underlying causes for this condition are not fully identified, even though in some cases it can be caused by physical trauma to the head or because of infection from syphilis.
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Nausea and vomiting are typical symptoms in people who have Meniere's disease and these come associated with the vertigo and spells of dizziness that affects such individuals from time to time. Difficulty in hearing, pressure in the affected ear, and a recurrent feeling of fullness in the affected ear are other common symptoms that often accompany the condition in all people. Persistent or intermittent forms of tinnitus are also commonly seen in individuals suffering from any form of Meniere's disease-this may occur alone or associated with other conditions. An accumulation of excess fluid in the inner ear that occurs because of an underlying condition called endolymphatic hydrops often accompanies the symptoms of MD in all patients. The condition is not considered full fledged MD, if the individual is only affected by only one of the symptoms associated with Meniere's disease-example tinnitus or vertigo. In such cases, the underlying reasons may be other conditions and diseases.
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The reduction of the symptoms associated with the related condition of endolymphatic hydrops is carried out through the use of a low-salt diet-a dietary regime containing no more than 800-1,000 mg sodium per day, taken along with diuretic medication, this same diet is advised for use by patients with MD as it may be beneficial to them as well. It is widely held that this particular dietary regimen leads to a stabilization of the symptoms associated with MD, however, the effectiveness and the benefits that the use of such a low salt diet along with diuretics might have on MD, has not been scientifically tested and still requires clinical trials in order to ascertain its efficacy. The progression of hearing los associated with MD may be slowed and reduced by the use of a low-salt diet-this observation was made on the basis of a controlled preliminary study on human test subjects.
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Preliminary reports carried out on patients also indicate that Meniere's disease as a condition is associated with allergies to all types of airborne particles, to allergens like mold, and certain foods in some individuals. Many types of food or inhalant allergies of some sort were present in at least 50% of participants with MD, during a survey done as part of a preliminary report. Statistically significant improvements were seen in all symptoms were observed during a controlled study, where the participants with MD were all administered treatments to treat their allergies, the regimen included the avoidance of all foods suspected or capable of provoking allergic reactions in patients, symptoms like tinnitus, vertigo, and hearing all perceptibly reduced and the results were appreciable. Wheat and soy were the foods identified during this study, as being the most common cause of the allergies. The other allergies present in such individuals tended to be allergies to milk, to corn, to eggs and yeast and a substantial number of test subjects also suffered from allergies to these foods.
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Abnormalities in the regulation of blood sugar due to diseases such as diabetes and hypoglycemia may be the reason for MD of some types, other cases of MD are often associated the elevation of high blood triglycerides and cholesterol. In a large number of patient who all suffered from some blood sugar abnormality, it was found during one preliminary study, that the consumption of a modified hypoglycemia diet that included a moderate to high intake of protein along with a moderate to low intake of fat and a restricted intake of complex carbohydrates reduced the symptoms associated with MD in all patients. During the study, overweight participants were put on a diet restricted in calories; other test subjects who had elevated levels of cholesterol were put on low cholesterol diets. The meal structure was changed to one where small portions were served but this was done frequently and the diet in addition, lacked all refined carbohydrates, and drinks like alcohol and caffeine was not allowed. The importance and the effect that these dietary changes made to the overall results cannot be measured as the majority of participants were also given supplements of calcium, fluoride, and vitamin. Further confirmatory test will have to be undertaken to gauge the effectiveness of these dietary changes in a controlled setting.
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According to a recent double blind study conducted on patients affected with MD, the administration of certain types of flavonoids, which are more commonly known as hydroxyethylrutosides (HR), led to a significant improvement in the symptoms of MD. Hearing loss was significantly improved or it was stabilized and did not deteriorate further during the study that made supplemental use of 2 grams of HR every day for the three months that the testing regime lasted. With regard to the treatment of MD, the use of other types of flavonoids have not been sufficiently investigated.
Incidences of otosclerosis which is a disease that affects the small bones in the inner often occurs along with some cases of Meniere's disease in certain susceptible individuals. Though the coexistence of these two conditions is well documented and verified in a lot of cases, incidences of the disorder called otosclerosis often goes undiagnosed in a lot of patients already suffering from some form of MD. The exact relationship between these two conditions remains unresolved; this is despite the fact that a lot of the preliminary reports suggest the actual cause of MD may be otosclerosis. The treatment of otosclerosis can reputedly be carried out through supplements of the mineral compound sodium fluoride, this compound is available by prescription alone and requires medical approval-the theory is that supplements of this mineral may lead to improvement in the severity of otosclerosis. People who underwent a preliminary study for period ranging from six months to five years, were given people supplements of 50 mg of sodium fluoride, 200 mg calcium carbonate, and a multiple vitamin supplying 400-800 IU of vitamin D per day-all the test subjects were suffering both from MD and otosclerosis. Because a significant number of patients also had additional blood sugar abnormalities-they were in addition required to follow a modified form of the hypoglycemia diet. Hearing loss required a long term treatment to show significant improvements in all patients and it was usually about two years of continual supplementation, however within six months of the supplementation, many patients reported significant improvement in the vertigo. However, the importance of fluoride, calcium, and the vitamin D to the overall results remains unresolved as the majority of the participants used both modified diets along with the supplements.
Preliminary studies have also reported that significant reduction in the symptoms of tinnitus, vertigo and hearing loss that results from unclear causes linked to inner ear problems may be improved by supplements of the ginkgo biloba extract (GBE); the effect of this extract of the gingko specifically on cases of MD has however not been thoroughly investigated. Therefore further research is needed in this area, and only controlled research that utilizes GBE will help determine whether MD can be treated using this extract.
Associated disorder of the muscoskeletal system are often observed to be present in individuals affected by Meniere's disease, this may include disorders of the head and neck. Problems such as cervical spine disorders- shortened to CSD and other disorders to the joints of the neck are also often seen in such patients. CMD-craniomandibular disorders or CMD which are problems with the jaw and its articulation is also often present in such patients. One preliminary report suggested that symptoms resembling those that are present during MD can possibly be relieved through physical therapy of the cervical spine. This is not conclusive as research on MD patients has not been done as yet, and even if spinal manipulation has been shown to reduce vertigo in preliminary human studies, confirmation studies still have to be carried out to determine its feasibility as far as individuals with MD are concerned.
Because MD patients suffer from a lot of stress as they cope with the situation, and significant emotional distress is caused by living with this disorder, most counselors suggest psychological therapy as a concomitant treatment method along with physical cures; the efficacy of such stress reducing treatment have not been studied to any depth as far as MD is concerned and controlled studies on this aspect of the condition are still awaited. While it is not known, if stress leads to an increase in the frequency or the intensity of symptomatic attacks during MD; it has been positively established that MD is not brought about by psychological factors alone. Vertigo that is a normal symptom during Meniere's disease is acute and its awareness increases during stressful periods in the patient, aside from this fact, a preliminary study found that stress also increased the awareness of other symptoms that accompany MD. Three patients who had MD and who suffered tinnitus were participants in a controlled human study of tinnitus, here it was observed that during a one hour weekly session of relaxation and techniques for coping with stress that occurred over ten weeks-all patients reported that annoyance due to tinnitus and the disturbance due to tinnitus were reduced. It remains unclear if the techniques would benefit people with MD, because of the fact that the testing group included only three individuals with the condition; a larger study on these lines will no doubt prove or disprove the effectiveness of this technique in patients with Meniere's disease.
In addition many counselors also recommend the use of vestibular rehabilitation exercises, in patients with MD-these techniques are primarily used to aid in recovery from vertigo and are applied to all classes of patients; in this cases as in previous cases, controlled research and the efficacy of this technique on patients with MD has not been carried out as yet. In addition, the authorities recommend that during active phases of the symptoms, it is best not to carry out the exercises, and they recommend further that in all patients with MD the exercises should begin after all symptoms have been stabilized with other treatment methodologies. It is important that some supervision is there when the person exercises, the patient should consult a qualified musculoskeletal healthcare specialist who can play a supervisory role when these techniques are being worked by the patient.
Preliminary studies also report that patients with MD benefited from a reduction of tinnitus through the use of transcutaneous electrical nerve stimulation (TENS), which is a form of physiotherapy carried out by many musculoskeletal healthcare specialists to treat tinnitus in people. Since tinnitus is a problem of the inner ear, the treatment method of TENS improves the circulation to the inner ear and this is the way the treatment worked in the reduction of tinnitus. Over a testing period of three to five weeks, patients with tinnitus due to various causes, including some suffering from MD, received two 25- to 30-minute treatments to the ear every week as a part of a large preliminary study testing this treatment methodology. Many of the participants in the trial reported that a reduction in the pressure within the ear, and over sixty percent of the test subjects with MD reported significant improvement in the tinnitus. Similar results were obtained in controlled trials that compared the effectiveness of TENS as a treatment methodology to another method called applied relaxation or AR; which is essentially the use of an audiotape that guides the participant through a series of muscle relaxation exercises-all the participants had reported some beneficial effect and all of them suffered from MD, the results are not confirmed however; because placebo effects could not be discounted in the case. The treatment moreover was conducted with each of the participants treating themselves with three 30-minute TENS treatments on to the hand per day for two weeks of the trial and reporting the results; one participant continued the treatment for three months. Thus the results were self reported and may not all be correct nor can they be confirmed.
Preliminary studies have also indicated that MD patients may receive significant reduction in the symptoms of MD via an alternate technique like acupuncture. Acupuncture techniques used during one trial, led to improvements in the hearing among patients and in a group of 34 patients the incidence and severity of vertigo was eliminated after one to three treatments undertaken during the trial. These results however, need to be confirmed via controlled research on patients with Meniere's disease in a stable environment.
The elimination of caffeine, nicotine and alcohol from the diet are also suggested as major lifestyle changes and the elimination of these substances from the lifestyles of MD patients is strongly recommended. The frequency of symptomatic attacks due to MD is side to increase when these substances are consumed; this is not scientifically verified, and controlled test will be required to prove or disprove these claims. The mechanisms in the inner ear that are responsible for maintaining balance are reported to be impaired during animal studies, where the test subjects were administered both alcohol and caffeine on a regular dosage regimen; thus these claims may have some basis and require further investigations using human subjects.
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