My Theory

If you are unacquainted with Meniere's Disease (MM), then start here.

If one buys into this theory that MM is a disorder of inner ear fluid balance which can be affected by dietary sodium intake, and I do for now for lack of a better explanation, then here is what I have concluded happened to me:

For approximately two years prior to my first vertigo attack, I had been to my doctor on several occasions complaining of my ears feeling plugged up.  Deep inside the ear.  No pain, I just couldn't hear well and I felt a lot of pressure.  Despite my insistence that I did not have sinus pressure or congestion nor did I have any other signs or symptoms of allergies, she recommended I try several different allergy medications and decongestants over the years.  None seemed to make a bit of difference and my ears continued to plug up randomly.  I generally woke up with the feeling in the morning and by noon, I think, the pressure subsided and I forgot about it until it happened again.  I think I went months in between without problems and even when I had that plugged up feeling, it occurred very erratically.  So I just lived with it.  I began sleeping with my head elevated and stopped using my down comforter.  In hindsight, I believe it was the initial stage of MM.

I also believe it is significant that I had a meal at a restaurant the night before my first vertigo attack that was so salty I, one, even noticed it, and, two, remembered it.  I can remember to this day how salty that otherwise delicious gourmet organic vegetable dinner tasted.

As the theory goes in MM, the inner ear loses the ability to regulate the passage of fluid across the endolymphatic membrane and a diet high in sodium can lead to the sac becoming so engorged with fluid that it ruptures.  The fluid builds up, causing pressure and muffled hearing.  Eventually the sac ruptures and it is the sudden decompression of the endolymphatic sac that is thought to cause the little vestibular hair cells (and hearing hair cells, for that matter) to become so disturbed as to lead to intense vertigo and hearing loss.  As the membrane heals over the next several hours, the vertigo subsides and hearing is gradually restored.  Over time, however, permanent damage can occur from repeated attacks and balance and hearing are eventually compromised beyond repair.

In my case, and everyone is different, I believe that the first few attacks I had left a permanent weak spot in the endolymphatic sac, causing it to rupture every 3 or 4 days like clockwork.  This continues to occur regardless of how little salt I eat.  I know I have gone as low as 1,200-1,500 mg a day for months with no change in the pattern or intensity of my symptoms.  I have had periods of relief with some treatments, and I will write about each in other posts, but I believe that little sac is so damaged that it does not allow for the longer periods of relief that some other classic MM sufferers experience.

I still watch my sodium carefully.  I think I hover around 2,000 mg most days.  And I continue to take the diuretic.  I do these things just in case my good (left) ear is even thinking about going bad.  I hope that if I do become bilateral someday, and some days I suspect it is misbehaving, that I will at least be able to minimize the frequency of attacks and that that ear will respond better to more conservative treatment.