Other non-surgical treatments
Diet and nutrition
Nutritional therapy is the use of diet, vitamins, minerals and supplements for healthy living.
Caffeine and alcohol
Coffee, tea and alcohol can be a problem as they cause the tiniest blood vessels at the very end of the system to contract and so restrict the blood supply to the inner ear. A cup or two is one thing but 10 or more strong coffees a day could make your symptoms much worse. Small amounts of alcohol - half a pint of beer, a glass of red wine or a pub measure of spirits - may actually improve the peripheral circulation, but any more has the opposite effect.
Salt reduction is widely recommended for many people with vertigo, as it is thought to result in a reduction of endolymphatic pressure. Reducing salt intake may help to reduce the frequency and severity of Ménière’s attacks. There is a strong belief that Ménière’s disease involves an excess pressure of the sodium-rich fluid (called endolymph) in the inner ear. It is thought that reducing salt in your diet may be helpful, because it may reduce the pressure of that fluid. The build up of this fluid accounts for the feeling of fullness in the ear before an attack. The sudden release of that pressure, with the chaos that ensues, accounts for the sudden attack of vertigo that you have, and for the sudden changes in hearing that happen. It is strongly recommended that you consult your GP before undertaking a salt restricted diet, particularly if you are taking medication for any other illness or if you are pregnant. Empirically, many patients will themselves know that if they have a particularly salty meal a few hours later they start to develop an attack.
Vitamins and supplements
If you’re unsure of your diet or if eating regularly is a problem, it is essential to make up any shortfall with a regular intake of good quality vitamin supplements. The antioxidants like A, C and E, a B complex for the nervous system, and a general multi-mineral formula are a good starting point. Garlic and ginger are available in tablet or capsule form and this is a good way of ensuring a regular intake. Increase the amount of vitamin C (good sources are citrus fruits, peppers, kiwis, tomatoes and most fruits and vegetables) and vitamin E (olive oil, sunflower seed oil, avocados, whole grain cereals, fresh seeds and nuts). Vitamin C is important for the structure of blood vessels and vitamin E helps maintain their elasticity. Omega 3 fatty acids from oily fish such as sardines, herrings, mackerel, pilchards, salmon (if tinned they should be in olive or sunflower oil not brine) are an excellent anti-inflammatory.
Epley manoeuvre for BPPV
The Epley manoeuvre is used to treat the commonest type of BPPV, where the chalk crystals are free-floating in the posterior ear canal. The Epley manoeuvre begins by making the patient dizzy with the appropriate Hallpike Test. The patient is then rolled over (in stages, pausing for about half a minute in each position) onto the opposite side (nose towards the floor), before being sat up again. This manoeuvre floats the chalk crystals round the affected canal and out of the far end, back to where they belong. Once there, they may reattach themselves, or possibly dissolve. They may however remain free-floating and liable to fall back into one of the semi-circular canals. Up to a third of patients may suffer one or more further bouts of BPPV at some time in their lives. This is not a major problem: the manoeuvre can be repeated as and when necessary, and in some cases, patients (or their relatives) can even be taught to do it themselves.
The manoeuvre is safe and can be carried out on anyone without severe neck or back problems, which would not necessarily prevent treatment but would need to be carefully assessed beforehand. Following treatment, a small number of patients will feel a bit dizzy and off-balance, occasionally for a day or two. This is rare. Patients who are liable to vomit when dizzy should take appropriate medication prior to treatment. This manoeuvre has offered instant relief of symptoms in nine out of ten patients; however some may need two or more treatments. Overall the Epley Manoeuvre has seen 95% of cases to be symptom free after the manoeuvre.
Meniett device for Meniere’s disease
The Meniett device is a portable, battery operated machine which creates a low pressure wave transmitted to the ear by an ear piece. In order to use the device, the patient must have a grommet fitted in the ear. The ear piece of the machine is placed in the ear canal by the user and the Meniett is switched on. A low pressure wave is created which is transmitted to the ear by the ear piece. The grommet allows the air pressure wave through to the middle ear where it can act on the inner ear via the round window membrane. The machine raises the pressure in the ear to 1.2kPa and then oscillates the pressure. Each pressure cycle takes about one minute followed by a 40 second pause. There are three cycles to each treatment, so each treatment lasts about five minutes. Patients should use the device three times per day, i.e. 15 minutes per day. Current availability of the Meniett device on the NHS is limited.
Often the perception of tinnitus can be diminished by providing information, understanding and low-level sound enrichment. Various white noise generators, which help mask the tinnitus, as well as retraining and counselling are available. This management would be provided by an audiologist or hearing therapist with specific skills.
For more information, visit British Tinnitus Association (external site).
Hearing aids are important for all people with hearing loss, whether it is in one ear (unilateral) or both ears (bilateral). There are specific hearing problems for people with Meniere’s but most can be helped by the range of aids available. Visit your audiology department/hearing therapist for advice on your own personal condition.
For more information, visit Action on Hearing Loss (external site).