Disease name confirmation
Meniere's disease — This is a medically recognized diagnosis.
1) Disease overview (causes and symptoms)
- Definition/pathophysiology: This is a disease in which excessive endolymphatic fluid in the inner ear (endolymphatic duct/cochlea and vestibular organs) causes the membranous labyrinth to expand (endolymphatic hydrops), affecting hearing and balance functions. The exact cause is unknown, but immunological abnormalities, viruses, genetic predisposition, and vascular, allergic, and migraine-related factors have been proposed.
- Main symptoms: Recurrent spinning dizziness (attacks), hearing loss in one ear (initially mainly affecting low frequencies), tinnitus (ringing in the ears), and a feeling of fullness or pressure in the ear. Nausea and vomiting may occur along with dizziness.
- Attack characteristics: The duration of attacks varies from several tens of minutes to several tens of hours (20 minutes to 24 hours or longer), and the frequency varies from once every several months to several times a month. Most cases initially begin in one ear, and some (approximately 10–20%) may progress to involve both ears. Over the long term, dizziness tends to decrease, but hearing loss may progress gradually.
- Epidemiological characteristics: It usually occurs in adults and is common in people in their 30s to 60s.
2) Treatment methods and precautions
- Conservative/medical treatment (first-line treatment)
- Lifestyle measures: A low-salt diet (salt restriction), limiting caffeine, alcohol, nicotine, and high-sugar foods, regular sleep, and stress management. Avoidance of attack triggers is recommended.
- Medications: During attacks, symptoms may be relieved with antiemetics, antihistamines (e.g., meclizine), short-term use of sedatives (benzodiazepines), and anticholinergic drugs. Long-term management may include diuretics (e.g., thiazide), sometimes combined with a diuretic and a low-salt diet.
- Supportive treatment: Otologic physical therapy (vestibular rehabilitation) and hearing aids (in cases of persistent hearing loss).
- Interventional treatment (when conservative treatment fails)
- Intratympanic (middle-ear) steroid injection: When an inflammatory or immune mechanism is suspected, this is used with the expectation of preserving hearing and has a relatively low risk of hearing damage.
- Intratympanic gentamicin injection (chemical vestibular ablation): Used to reduce dizziness in refractory unilateral Meniere's disease when hearing in the opposite ear is normal. Caution is needed because of the risk of hearing loss.
- Surgical treatment: Endolymphatic sac decompression (sac decompression/drainage), vestibular neurectomy, and labyrinthectomy (destruction of balance function in an ear without useful hearing), among others. The choice of surgery is determined based on symptom severity, hearing status, and patient preference.
- Precautions/risks of complications
- Intratympanic gentamicin carries a risk of permanent hearing loss.
- Hearing loss, tinnitus, and ear fullness may persist over the long term.
- When taking medications (such as diuretics and sedatives), existing cardiovascular or kidney disease and drug interactions should be considered.
- Recurrent dizziness increases the risk of falls → take precautions against accidents.
3) Checklist before an outpatient visit (items to bring and examples of records)
- Items to bring
- A list of all medications currently being taken, including prescription drugs, over-the-counter drugs, and supplements.
- Copies of previous hearing tests (audiograms) and previous otolaryngology records or test results, including CT/MRI results.
- A record of dizziness attacks: date and time of onset, duration, symptom intensity (on a scale of 0–10), accompanying symptoms (nausea, vomiting, tinnitus, ear fullness), and possible triggers (meals, stress, changes in posture, etc.).
- Lifestyle information: diet (amount of salt intake), caffeine, alcohol, and tobacco use, sleep patterns, and occupation (including whether driving is required).
- Items that are useful to record during the visit (including example questions)
- Timing and frequency of attacks: "When did the dizziness first begin? How many times has it occurred in the past month?"
- Changes in hearing: "Do you experience hearing loss along with the dizziness? Which ear is worse?"
- Response to medications: "Which medications made the symptoms better or worse?"
4) Examples of general questions to ask the doctor
- What are the expected benefits and side effects of this medication?
- What is the status of my hearing (hearing test), and what is the expected prognosis?
- What specific changes should I make to my lifestyle (diet, exercise, and sleep)?
- If medication does not control the condition, how likely is surgery, and what are its expected benefits and risks?
- Is it safe for me to drive or operate important machinery? How should I respond during an episode of dizziness?
5) Examples of disease-specific questions
- My hearing test shows low-frequency hearing loss. Which treatment is most appropriate for preserving my hearing in the future?
- If I have recurrent attacks, what short-term prescription medication (rescue medication) can I take or use immediately, and what are its side effects and precautions for use?
Note: Diagnosis and treatment vary depending on each person's symptom pattern, hearing status, and coexisting conditions. Based on the test results and symptom records provided during your visit, consult a specialist to establish the optimal plan.