From the very first day of my journey with Meniere's disease, I have emphatically believed I was having an immunological response to some kind of low-grade, chronic infection. Doctors kind of acknowledged an immune component to the disease, but really didn't seem to know what to do about it, understandably so since it has been poorly defined up to now. So when I see studies like this, it makes me want to jump for joy!
Gene expression demonstrates an immunological capacity of the human endolymphatic sac.
Authors
Møller MN1, Kirkeby S, Vikeså J, Nielsen FC, Cayé-Thomasen P.
Author information
Journal
Laryngoscope. 2015 Mar 16. doi: 10.1002/lary.25242. [Epub ahead of print]
Affiliation
Abstract
OBJECTIVES/HYPOTHESIS: The purpose of the present study is to explore, demonstrate, and describe the expression of genes related to the innate immune system in the human endolymphatic sac. It is hypothesized that the endolymphatic sac has a significant immunological function in the human inner ear.
STUDY DESIGN: DNA microarrays and immunohistochemistry were used for analyses of fresh human endolymphatic-sac tissue samples.
METHODS: Twelve tissue samples from the human endolymphatic sac were obtained during translabyrinthine surgery for vestibular schwannoma. Microarray technology was used to investigate tissue sample gene expression using adjacent dura mater as control. The expression of genes specific for the innate immune system was determined and results for selected key molecules verified by immunohistochemistry.
RESULTS: A comprehensive overview of expressed genes of the innate immune system was obtained. Multiple key elements of both the cellular and humoral innate immune system were expressed, including Toll-like receptors 4 and 7, as well as beta-defensin and lactoferrin.
CONCLUSIONS: The present data provides the first direct evidence of an immunological capacity of the human endolymphatic sac. At the molecular level, the endolymphatic sac is capable of antigen recognition and processing for initiation of an immune response. In addition, potent molecules directly toxic to invading pathogens are expressed by the sac epithelium. This evidence strongly supports the endolymphatic sac as a significant immunological entity of the inner ear.
LEVEL OF EVIDENCE: N/A. Laryngoscope, 2015.
© 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Friday, March 20, 2015
Sunday, March 8, 2015
Video Presentation About Vestibular Disorders
This video popped up on the Meniere's Disease Team's FaceBook page this morning. I haven't watched it yet, but the comments are very positive. Since Meniere's Disease is a diagnosis of exclusion, or a bucket diagnosis, people can be told they have MD when in reality that have one of many other underlying causes for the same set of symptoms. I think this video will help to distinguish between the subtleties of various vestibular disorders.
Monday, March 2, 2015
A New Blog I Really Like
Mind Over Meniere's popped up on a Facebook feed and after reading through it, I think I found a kindred spirit - one who writes much better than I do and who has a knack for sharing many of the same techniques I've found helpful while learning to live with this disease. I hope you'll check it out.
Thursday, February 5, 2015
Managing a Vertigo Attack - Stuff I Wish I Had Been Told by My Doctors
Despite seeing a couple of very highly-respected neurotologists and at least two caring ENTs since being diagnosed with Meniere's disease almost six years ago, much of what I know today about the the disease and how to cope with it has come from online forums and Meniere's and hearing loss websites. Among the contradicting advice I've received over the years involves the use of hearing aids (don't get me started), vestibular suppressants (doctors say don't use them, but the following article - and most sufferers - will beg to differ), and information on the underlying causes (the doctors tend to quickly say 'we don't know', implying they have no idea, but the literature offers at least a few good working theories which the doctors will only talk about if pressed). Anyway, I digress.
Today I received the following article in my email inbox and found it to contain information I wish I had been given the day I was diagnosed with this miserable disease, I hope someone finds it at least a little bit helpful during their next attack.
Editor’s Note: Today’s post appeared last month at the Dizziness Depot. We thought it was worth sharing this week at Hearing Views in case you missed it. In today’s post, Dr. Desmond discusses how to manage the debilitating dizzy spells, or “attacks”, caused by Meniere’s disease.[1]
By Alan Desmond, AuD
If you have the flu or a bad cold, the natural response would be to drink fluids and to go to bed until you are feeling better. If you have a bad migraine, lying down in a dark room often provides some relief. Of course, due to the contrarian nature of Meniere’s disease, these activities will most likely make you feel worse. First, I will reprint a short passage from Dr. Tim Hain’s website (I highlighted some text), followed by an explanation of why his advice makes sense.
During an acute attack, lie down on a firm surface. Stay as motionless as possible, with your eyes open and fixed on a stationary object. Do not try to drink or sip water immediately, as you’d be very likely to vomit. Stay like this until the severe vertigo (spinning) passes, then get up SLOWLY. After the attack subsides, you’ll probably feel very tired and need to sleep for several hours.
If vomiting persists and you are unable to take fluids for longer than 24 hours (12 hours for children), contact your doctor. He can prescribe nausea medication, and/or vestibular suppressant medication. He/she may wish to see you or even admit you to the hospital if you are dehydrated. Meclizine (Antivert), Lorazepam and Clonazepam are commonly used vestibular suppressant medications and Compazine, Phenergan or Ondansetron are commonly used medications for nausea. In our practice in Chicago, we commonly prescribe an “emergency kit,” consisting of a small prescription of lorazepam and ondansetron, to be taken sublingually for an acute attack.”
During a Meniere’s attack, the inner ear is telling you that you are moving. When you are in bed, you have reduced tactile cues about movement and position. Think about how much more difficult it is to maintain your balance of a soft surface like a pillow or foam cushion. The brain is searching for reliable information and tactile feedback, which is much more reliable when received from a solid, ungiving surface. I recommend patients lie down on the floor, up against the wall in a corner and give themselves as much tactile feedback as possible.
The nystagmus (rapid involuntary jerking eye movements) generated from the asymmetric output of your two labyrinths during an attack is what is making you feel as if you are (or your world is) spinning around. By staring at a fixed object, you can slow down the speed of the nystagmus, more so if you look out of the corner of your eye, opposite the direction that the nystagmus are beating. You have to experiment with this: Look out of the right corner of your eye for several seconds, then the left. Make a judgment about whether one side seems better or worse than the other.
1. Nystagmus of labyrinthine origin is suppressed by visual fixation –meaning the eye movements (nystagmus) and associated vertigo slow down when the eyes are open and staring at a target.
2. Nystagmus of labyrinthine origin increases in speed when gaze is directed toward the fast phase, and decreases when gaze is directed toward the slow phase –meaning that the eye movements and associated vertigo slow down when the eye is directed away from the direction that the nystagmus is beating. That direction isn’t always predictable and may change during an attack, so you have to experiment with this.
Vestibular suppressants may help reduce nausea during an attack.
The nausea is nature’s way of telling you that something is wrong with your vestibular system and that you should probably stay home. You are unsafe to be out hunting or gathering or whatever. Vestibular suppressant medication dampens the information received by the brain from the labyrinths. During a Meniere’s attack, that information is asymmetric, incorrect and making you miserable, so a vestibular suppressant reduces that asymmetry, and reduces the nausea. Of course, the effects will linger after the attack is over and you need to be cautious about sedating effects of the medication if you try to drive. Most people just want to sleep for several hours.
Once an attack starts, medications must be taken sublingually or through a suppository because the vomiting response won’t allow anything to stay down very long.
The bottom line – During an acute Meniere’s attack the inner ear is telling you that you are moving, while the brain, the eyes, and the sense of touch tell you that you are not. This sensory conflict produces nausea and disorientation. Shutting down the labyrinthine response and increasing the visual and tactile feedback will most effectively combat the error signal coming from the affected ear.
Footnotes
Ménière’s disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. Ménière’s disease usually affects only one ear.
Today I received the following article in my email inbox and found it to contain information I wish I had been given the day I was diagnosed with this miserable disease, I hope someone finds it at least a little bit helpful during their next attack.
Managing a Meniere’s Attack
By Editor On February 4, 2015
Editor’s Note: Today’s post appeared last month at the Dizziness Depot. We thought it was worth sharing this week at Hearing Views in case you missed it. In today’s post, Dr. Desmond discusses how to manage the debilitating dizzy spells, or “attacks”, caused by Meniere’s disease.[1]
By Alan Desmond, AuD
If you have the flu or a bad cold, the natural response would be to drink fluids and to go to bed until you are feeling better. If you have a bad migraine, lying down in a dark room often provides some relief. Of course, due to the contrarian nature of Meniere’s disease, these activities will most likely make you feel worse. First, I will reprint a short passage from Dr. Tim Hain’s website (I highlighted some text), followed by an explanation of why his advice makes sense.
“How do I manage an attack?”
During an acute attack, lie down on a firm surface. Stay as motionless as possible, with your eyes open and fixed on a stationary object. Do not try to drink or sip water immediately, as you’d be very likely to vomit. Stay like this until the severe vertigo (spinning) passes, then get up SLOWLY. After the attack subsides, you’ll probably feel very tired and need to sleep for several hours.
If vomiting persists and you are unable to take fluids for longer than 24 hours (12 hours for children), contact your doctor. He can prescribe nausea medication, and/or vestibular suppressant medication. He/she may wish to see you or even admit you to the hospital if you are dehydrated. Meclizine (Antivert), Lorazepam and Clonazepam are commonly used vestibular suppressant medications and Compazine, Phenergan or Ondansetron are commonly used medications for nausea. In our practice in Chicago, we commonly prescribe an “emergency kit,” consisting of a small prescription of lorazepam and ondansetron, to be taken sublingually for an acute attack.”
Why a firm surface rather than going to bed?
During a Meniere’s attack, the inner ear is telling you that you are moving. When you are in bed, you have reduced tactile cues about movement and position. Think about how much more difficult it is to maintain your balance of a soft surface like a pillow or foam cushion. The brain is searching for reliable information and tactile feedback, which is much more reliable when received from a solid, ungiving surface. I recommend patients lie down on the floor, up against the wall in a corner and give themselves as much tactile feedback as possible.
Why keep your eyes open and fixed on a stationary target?
The nystagmus (rapid involuntary jerking eye movements) generated from the asymmetric output of your two labyrinths during an attack is what is making you feel as if you are (or your world is) spinning around. By staring at a fixed object, you can slow down the speed of the nystagmus, more so if you look out of the corner of your eye, opposite the direction that the nystagmus are beating. You have to experiment with this: Look out of the right corner of your eye for several seconds, then the left. Make a judgment about whether one side seems better or worse than the other.
This advice incorporates two basic rules of vestibular science:
1. Nystagmus of labyrinthine origin is suppressed by visual fixation –meaning the eye movements (nystagmus) and associated vertigo slow down when the eyes are open and staring at a target.
2. Nystagmus of labyrinthine origin increases in speed when gaze is directed toward the fast phase, and decreases when gaze is directed toward the slow phase –meaning that the eye movements and associated vertigo slow down when the eye is directed away from the direction that the nystagmus is beating. That direction isn’t always predictable and may change during an attack, so you have to experiment with this.
Why take a vestibular suppressant?
Vestibular suppressants may help reduce nausea during an attack.
The nausea is nature’s way of telling you that something is wrong with your vestibular system and that you should probably stay home. You are unsafe to be out hunting or gathering or whatever. Vestibular suppressant medication dampens the information received by the brain from the labyrinths. During a Meniere’s attack, that information is asymmetric, incorrect and making you miserable, so a vestibular suppressant reduces that asymmetry, and reduces the nausea. Of course, the effects will linger after the attack is over and you need to be cautious about sedating effects of the medication if you try to drive. Most people just want to sleep for several hours.
Why take the medication sublingually?
Once an attack starts, medications must be taken sublingually or through a suppository because the vomiting response won’t allow anything to stay down very long.
The bottom line – During an acute Meniere’s attack the inner ear is telling you that you are moving, while the brain, the eyes, and the sense of touch tell you that you are not. This sensory conflict produces nausea and disorientation. Shutting down the labyrinthine response and increasing the visual and tactile feedback will most effectively combat the error signal coming from the affected ear.
Footnotes
Ménière’s disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. Ménière’s disease usually affects only one ear.
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