Hydrochlorothiazide dosage menieres

http://pharmacy.hotloveonline.org/hydrochlorothiazide/ Hydrochlorothiazide, Hydrochlorothiazide and erections, Hydrochlorothiazide side effects, Bleeding and hemorrhoids and hydrochlorothiazide, Hydrochlorothiazide use, Effects of hydrochlorothiazide, Hydrochlorothiazide dosage menieres, Lisonpril hydrochlorothiazide side effects, What is hydrochlorothiazide, Hydrochlorothiazide triamterene

Hydrochlorothiazide
Menieres Disease AltHealth 26th July 2005 Email Page Print Page Save Basket Currency Convertor Menieres DiseaseInfo & Alternative Treatments Hydrochlorothiazide dosage menieres You should consult your Doctor Hydrochlorothiazide dosage menieres if you are taking Hydrochlorothiazide dosage menieres any medication. sections in this document Excellent Nutritional Benefits Very Good Nutritional Benefits Good Nutritional Benefits Aromatherapy Homeopathy Bach Flower Remedies Herbs Suggestions Other Information User Contributed Notes RELATED DOCUMENTS MISCELLANEOUS Menieres Disease : Menieres's Disease In The UK Menieres Disease : How To Cope Search for more documents... Search for related products... What is Meniere's Hydrochlorothiazide dosage menieres Disease? Menieres is classified as a inner ear disorder that causes repeated attacks of dizziness and the discomfort of fullness from the affected ear. This is due to increase pressure of the inner ear fluids. I f Hydrochlorothiazide dosage menieres you ' ve ever been so drunk that you feel like the Hydrochlorothiazide dosage menieres room is spinning, Hydrochlorothiazide dosage menieres you know exactly what someone experiencing an acute attack of Ménière ' s disease is going through. This disorder affects the part of the inner ear that controls balance: a tiny set of membranes and nerve endings that respond to motion. When this part of the ear is damaged, it sets off a reaction that results in stop-the-world-I-want-to-get-off vertigo that only time resolves. Fluids in the inner ear chambers are constantly Hydrochlorothiazide dosage menieres being produced and absorbed by the circulatory Hydrochlorothiazide dosage menieres system. If there are any disturbance in the delicate relationship, this results is over production or under absorption of the fluids. This leads to increase fluid pressure (which may be felt) that usually produces Hydrochlorothiazide dosage menieres dizziness which can be associated with fluctuating hearing Hydrochlorothiazide dosage menieres loss and ringing in the ear. It is rare for someone to be affected in both ears at Hydrochlorothiazide dosage menieres the same time. Evaluation by a Otolaryngolist (Ears, Nose and Throat Specialist) or Hydrochlorothiazide dosage menieres by a Otology @ Neurotolist (Inner Ear Specialist) is needed to determine the cause of the increase fluid Hydrochlorothiazide dosage menieres pressure. Circulatory, metabolic, toxic, allergic or emotional factors may play a part in an case. What are the symptoms? Menieres disease is characterized by severe attacks of dizziness that can vary from a few minutes to several hours or even days. Hearing loss and head noise (ringing in the ear) usually accompany the attacks. The dizziness attacks can occur suddenly without any warning. Violent spinning, whirling and falling sensations with nausea are the most common symptoms. For some, a sensation of pressure (fullness) in the ear is usually present. Sometimes if the pressure is severe, it can effect normal activities such as lack of Hydrochlorothiazide dosage menieres concentration and short term memory loss. These attacks may occur at irregular intervals. The individual can be free of symptoms for many years at a time. Occasionally Hydrochlorothiazide dosage menieres hearing impairment, ringing noise and ear pressure occur without dizziness. This type of Menieres disease is called cochlear hydrops. Dizziness and ear pressure Hydrochlorothiazide dosage menieres may occur without hearing loss and ringing, this is called Vestibular Hydrops. Treatment for both of these is the same Hydrochlorothiazide dosage menieres as Menieres. SUPPLEMENT SUGGESTED DOSAGE COMMENTS Nutritionally BENEFICIAL Excellent Manganese As directed on Hydrochlorothiazide dosage menieres the label Deficiency of this mineral has been linked to ear disorders, and meniere's disease. Chromium Picolinate 200mcg daily For the control of Blood Sugar which are ofter high with sufferers of meniere's disease. Nutritionally BENEFICIAL Very Good Niacin (vitamin B3) 100mg 2 times dialy. Do not exceed this ammount To improve circulation and cholesterol ballance. Do not take if you have a liver disorder, gout or high blood pressure. Biostrath As directed on the label A tonic with rich source of B Vitamins to enhance brain function. Co Q 10 30mg daily Antioxidant for immune system & circulation to the ears. Nutritionally BENEFICIAL Good Vitamin C with Bioflavonoids 3,000-5,000 milligrams daily. Boosts the immune system. Antioxidants also help keep arteries open and free of plaque buildup. Mega B Complex As directed on the label For support of the nervous system, use time released formulation Beta Carotene 100,000 international units, taken as 2 divided doses The body can use beta-carotene to make vitamin A Vitamin A As directed on the Label Several studies, from 24 to Hydrochlorothiazide dosage menieres 74 percent of people with tinnitus reported at least partial relief from vitamin A supplements. Is found in high concentrations in the cochlea. " All special sensory receptor cells, including Hydrochlorothiazide dosage menieres the retina of the eye and the hair cells of the inner ear, depend upon vitamin A and Hydrochlorothiazide dosage menieres zinc to function properly Magnesium If you have heart or kidney problems, be sure to consult your doctor before supplementing magnesium. Calcium Hydrochlorothiazide dosage menieres 1,000 milligrams Magnesium As directed on the label 1,500 milligrams Calcium Stability of the nervous system and for muscle contraction. See article Selenium 50-200 micrograms work by helping to prevent oxygen-caused damage to cell membranes, Antioxidants also help keep arteries Hydrochlorothiazide dosage menieres open and Hydrochlorothiazide dosage menieres free of plaque buildup. Lecigran granules As directed on the label For brain function and cell proctection. Vitamin E If you are taking anticoagulant drugs, you should not take vitamin E supplements. 400 international units work by helping to prevent oxygen-caused damage to cell membranes, Antioxidants also help keep arteries open and free of plaque buildup. MultiVitamin & Mineral As directed on the label For a balanced supply of nutrients. Evening Primrose or Borage Oil 1000mg Hydrochlorothiazide dosage menieres 3 times daily For the correction of metabolic instabilities. Zinc with Copper As directed on the label. do not Hydrochlorothiazide dosage menieres exceed 100mg in all forms daily That finding has led some doctors to speculate that zinc deficiency may play a role in inner ear problems such as tinnitus. supplements have Hydrochlorothiazide dosage menieres been used to treat individuals who had both tinnitus and hearing loss (usually age-related). Of those who had initially low serum levels of zinc, about 25% experienced an improvement in tinnitus after taking zinc for three to six months. In another study, zinc was not more effective than placebo at relieving tinnitus. However, the participants in that study did not have low serum zinc levels. Vitamin D 400 iu Daily Immune system assistance. HERBS Gingko Biloba increases circulation to the brain, take as directed on the label. Butcher's broom combats fluit retention and improves circulation. Echinacea . Immune builder Sids poor equilibrium, reduces dizziness, fights infection and helps reduce congestion. Mullein or Garlic , Hydrochlorothiazide dosage menieres to soothe inflammation and fight infection. SUGGESTIONS Because of increased Hydrochlorothiazide dosage menieres visual dependency, it is a good Hydrochlorothiazide dosage menieres idea not to walk through dark rooms; keep lights or night-lights on at all times; do Hydrochlorothiazide dosage menieres not drive a car at night or during stormy weather when visibility is poor. Distribute your Hydrochlorothiazide dosage menieres food and fluid Hydrochlorothiazide dosage menieres intake evenly throughout the day and from day to day. Eat approximately the same amount of food at each meal, and do not skip meals. If you eat snacks, have them at regular times. Avoid cigarettes. The nicotine present in cigarettes constricts blood vessels and will decrease the blood supply to the inner ear, making your symptoms worse. Meniere's disease is often frustrating for people who have it. You may have to change the way you live to control the attacks. You must follow your doctor's advice about diet and alcohol, caffeine and smoking. You may also have to limit the stress in your life or learn how to deal with stress better, since stress may cause an attack. Let your family, friends and co-workers know about the disease. Tell them how they can help you if you have Hydrochlorothiazide dosage menieres an attack. A salt-restricted diet may help to reduce the frequency of attacks. The usual recommendation is to keep intake below 2 g a day. Avoid foods containing MSG (monosodium glutamate). This is often Hydrochlorothiazide dosage menieres present in pre-packaged food products and in Chinese food. It may increase symptoms in some patients. Avoid aspirin and medications that contain aspirin. Hydrochlorothiazide dosage menieres These can increase tinnitus and dizziness. Avoid caffeine, smoking, and Hydrochlorothiazide dosage menieres alcohol since these substances may aggravate symptoms. Avoid the additive monosodium glutamate (MSG), often present in Hydrochlorothiazide dosage menieres Chinese food, as it may trigger symptoms. Stress may aggravate the vertigo and Hydrochlorothiazide dosage menieres ringing in the ears associated with Ménière's disease and undermines the ability to cope with these symptoms. Stress reduction techniques may be helpful. Nibble away at fat . A damaged inner ear is particularly sensitive to high blood levels of cholesterol. Some researchers believe that fat in the blood actually makes the blood more viscous, or thick, and impairs blood delivery through the tiny artery that leads to the inner ear. So cut Hydrochlorothiazide dosage menieres fat, especially saturated fat, from your diet. This means filling up on fresh vegetables and fruits, whole grains, beans, low-fat dairy products, fish and Hydrochlorothiazide dosage menieres lean cuts of meat. Eat only the low-fat versions Hydrochlorothiazide dosage menieres of lunchmeats, mayonnaise, cheeses, frozen Hydrochlorothiazide dosage menieres desserts and baked goods. Hydrochlorothiazide dosage menieres Battle your sweet tooth . Loading up on sugar does several Hydrochlorothiazide dosage menieres things. It prompts your body to pump up insulin production. (Insulin is Hydrochlorothiazide dosage menieres a hormone that your body uses to get energy from sugar.) Too much sugar in your diet can also send your blood sugar level to extremes of high and low, Your ears don't like that.. It's easy enough to avoid the usual sugar-laden snacks: cookies, candy and soda. But the sweet stuff also lurks in some unsuspected foods. Low-fat cookies and other snacks, Hydrochlorothiazide dosage menieres fruit-flavored yogurt, flavored teas and breakfast cereals can all pack a sugar wallop. If you're really looking to curb your sweet tooth, enjoy these foods only in moderation. Try using onion powder or garlic powder as seasoning rather than salt. In fact, there's a whole world of tastes worth exploring. Try sage or savory on chicken and rosemary or marjoram on meats, and add dried mushrooms and tomatoes to casseroles. Know your salt sources . To cut salt, nutrition experts recommend reading labels carefully and avoiding foods with more than 150 milligrams of sodium per serving. Either eliminate potato chips, corn chips, pickles, olives, ham, hot dogs, canned foods (soups, beans and vegetables), hard cheeses, cottage cheese, tomato juice, tuna, lunchmeats, biscuits, pancakes, breads and pizza, or use low-sodium or no-sodium versions of these foods. You can reduce the salt in some canned foods up to 80 percent by rinsing and draining the food for one minute. OTHER INFORMATION Hydrochlorothiazide dosage menieres Treatment varies. This depends on several factors Hydrochlorothiazide dosage menieres according to the cause, magnitude and frequency of the symptoms. In order to improve the inner ear circulation and control the fluid pressure, treatment may consist of medication to stimulate the inner ear circulation. Such are vasodilating drugs (blood pressure pills) Diuretics (water pills) with anti-dizziness medication. People Hydrochlorothiazide dosage menieres with Menieres should void caffeine and nicotine for this has an opposite effect on drug treatment. Another form of treatment is special Hydrochlorothiazide dosage menieres diets such as reducing salt and or potassium. (would like more information about this) MEDICAL ALERT: Some diuretics, which are often prescribed for people with Ménière's disease, can deplete the body of potassium and magnesium . Before Hydrochlorothiazide dosage menieres taking supplements of either nutrient, however, talk Hydrochlorothiazide dosage menieres to your doctor. Too much of either mineral can be harmful. Surgery is only recommend where medical treatment fails to relieve the attacks of dizziness and pressure. Surgery is successful in relieving acute Hydrochlorothiazide dosage menieres attacks in the majority of patients. Endolymphatic Shunt : This operation drains excess fluids from the inner ear. This operation is advised when hearing is relatively Hydrochlorothiazide dosage menieres good. An incision is made behind the ear, through the Hydrochlorothiazide dosage menieres mastoid (bone section behind the ear) and a tube is inserted to control the abnormal fluid pressure. In cases in which the hearing is already poor in the affected ear, the surgeon may recommend a labyrinthectomy, in which the balance canals are removed completely. This procedure results in the highest rates of control of vertigo but will render the affected ear permanently deaf. Surgical treatment is more difficult in those people with Ménière's disease affecting both ears. Depending on test results, your doctor may recommend Hydrochlorothiazide dosage menieres the surgery for the ear Hydrochlorothiazide dosage menieres that is most affected, which may prevent recurrence of the most severe attacks of vertigo. More recently, techniques involving the judicious application of ototoxic medication to the ear have been refined, providing a valuable form of Hydrochlorothiazide dosage menieres treatment of vertigo for patients who are not candidates for surgery. The use of diuretic medication such as hydrochlorothiazide may help to reduce fluid buildup in the inner ear. If diuretic therapy prevents recurrence of the vertigo, it can be discontinued after 1 year. In those people for whom dietary salt restriction and diuretics fail to adequately control symptoms, inner ear surgery to control the vertigo may be Hydrochlorothiazide dosage menieres necessary. A procedure called endolymphatic Hydrochlorothiazide dosage menieres sac drainage usually preserves hearing; attacks of vertigo are controlled in one-half to two-thirds of cases. In severe cases where the shunt in unsuccessful, it is sometimes necessary to remove the inner ear membranes. When this is done, there is total loss of hearing in the operated ear. Other surgical options include Hydrochlorothiazide dosage menieres cutting the balance nerve (a vestibular neurectomy) as it leaves the inner ear and courses to the brain. This procedure may permanently cure the vertigo and often preserves hearing. It is found that once a person has been diagnose with Menieres, permanent Hydrochlorothiazide dosage menieres hearing loss is the result once the disease in in the final stages. Fluid pressure eventually damages the inner ear chambers, resulting in hearing loss. Hearing loss varies from person to person. As well, time plays no factor in this degenerative disease. As much as 50 to 95 percent hearing loss has been reported. There are many causes of dizziness and pressure. If you feel that some of the symptoms Hydrochlorothiazide dosage menieres matches yours, please see your specialist. MY ACCOUNT Lost your password? - SIGN UP - HEALTH HEADLINES Why most vitamins won't be banned by the EU - but it's not over yet. Nab those free radicals with Time Defiance Fish oil supplements ease arthritis pain - MORE NEWS - PRODUCT OFFERS The Natural Push-Up - 3 for the price of 2 Glucosamine Sulfate 500mg - 3 for the Price of 2 Milk Thistle 250mg Standardised - 3 for the Price of 2 Propolis 1000mg One-A-Day - 3 for the Price of 2 Garlic Odourless One-a-Day - 3 for the Price of 2 - MORE OFFERS - CLASSIFIEDS User Contributed Notes There are no approved comments for this page.Click the button below to see your contribution here. Add a Comment Home | Comments & Suggestions | Contact Us | Copyright | Privacy Policy | Security | Terms & Hydrochlorothiazide dosage menieres Conditions Site Developed By Barratt & Wilders Ltd. Copyright © 2000 - 2005 AltHealth. All Rights Reserved. The statements which appear Hydrochlorothiazide dosage menieres on AltHealth.co.uk have not been evaluated as medical cures. The information on this web site is not intended to diagnose, treat, cure or prevent Hydrochlorothiazide dosage menieres any disease. Hydrochlorothiazide dosage menieres Although every effort has been made to ensure that information is accurate, please note that some information may be outdated by more recent scientific developments. The information presented is meant for Nutritional Benefit and as an educational starting point only, not as a substitute for personal consultation with a qualified healthcare professional. Meniere's Syndrome Meniere's Syndrome Terry D. Fife, MD Current Treatment Options in Neurology 1999, 1:57-67Current Science, Inc. ISSN 1092-8480Copyright © 2005 by Current Science, Inc. Hydrochlorothiazide dosage menieres Opinion StatementThe primary goals of treatment in Meniere's syndrome are to control attacks of vertigo and, if possible, to arrest the progression of hearing loss. Initial treatment consists of rigid dietary sodium restriction, possibly with the addition of a thiazide diuretic. If disabling attacks of vertigo persist despite Hydrochlorothiazide dosage menieres sodium restriction, surgical intervention should be considered. Endolymphatic shunting is an option for patients who desire a less invasive surgical remedy, but recurrence of vertigo occurs in about 40% of cases. Vestibular nerve ablative surgery is the definitive Hydrochlorothiazide dosage menieres surgical treatment for patients with intractable attacks of vertigo who still have useful hearing on the affected side. Labyrinthectomy is a surgical option when there Hydrochlorothiazide dosage menieres is no serviceable hearing in the damaged Hydrochlorothiazide dosage menieres ear. Intra-aural gentamicin instillation is an option in carefully selected cases.Introduction In 1861, Prosper Ménière first described the symptom complex now known as Meniere's syndrome. In 1938, Hallpike and Cairns reported the mechanism as being related to dilation of the endolymphatic space (endolymphatic hydrops, Fig. 1) with Hydrochlorothiazide dosage menieres resultant cochlear and vestibular degeneration. Although subsequent study Hydrochlorothiazide dosage menieres has provided confirmatory evidence of endolymphatic dilation, the reason for the attacks of vertigo and a strategy Hydrochlorothiazide dosage menieres for reversing the disturbance in endolymph fluid regulation have remained elusive. The term Meniere's disease Hydrochlorothiazide dosage menieres refers to idiopathic endolymphatic hydrops resulting in the symptoms just outlined. When a known underlying condition such Hydrochlorothiazide dosage menieres as autoimmune inner ear Hydrochlorothiazide dosage menieres disease or syphilis leads to the same clinical syndrome, the terms secondary Meniere's syndrome and delayed or secondary endolymphatic hydrops are sometimes used to distinguish them from idiopathic Meniere's disease. Table 1: Criteria for diagnosing Meniere's disease modified from AAO-HNS definition Vertigo Recurrent, well-defined episodes Hydrochlorothiazide dosage menieres of spinning or rotation Duration ranging from 20 min to 24 h Nystagmus associated with attacks Nausea and vomiting during vertigo spells common No neurologic symptoms with vertigo Deafness Hearing deficits fluctuate Sensorineural hearing loss Hearing loss progressive, usually unilateral Tinnitus Variable, often low pitched and louder Hydrochlorothiazide dosage menieres during attacks Usually unilateral on the affected side Hydrochlorothiazide dosage menieres Subjective Modified from Pearson and Brackmann [1] and Alford [2]. AAO-HNS--American Academy of Otolaryngology, Head and Neck Surgery. Table 2: Vestibular suppressant, anti-motion sickness, and antinausea medications Generic name Brand name Form and dosage Sedative effects Antiemetic effects Precautions Meclizine Antivert, Bonine (Pfizer, New York, NY) 12.5-50 mg PO qid ++ + Prostate hypertrophy, glaucoma Dimenhydrinate Dramamine (Pharmacia/Upjohn, Kalamazoo, MI) 50 mg PO qid + + Prostate hypertrophy, glaucoma Promethazine Phenergan (Wyeth-Ayerst, Philadelphia, PA) 25-50 mg PO or IM q 4-6 h; 50 mg suppos. PR qid +++ ++ Seizures Diazepam Valium (Roche, Nutley, NJ) 2.0-7.5 mg PO qid ++ + Dose-related sedation Lorazepam Ativan (Wyeth-Ayerst, Philadelphia, PA) 0.5-2 mg PO tid ++ + Dose-related sedation Clonazepam Klonopin (Roche, Nutley, NJ) 0.25-0.5 mg PO tid +++ + Dose-related sedation Scopolamine Transderm Scop (Novartis Consumer, Summit, NJ) Patch, 1 q 3 d + + Prostate hypertrophy, glaucoma Metoclopramide Reglan (Robins Pharm., Richmond, VA) 10-20 mg PO q 4-6 Hydrochlorothiazide dosage menieres h; 10-20 mg IV q 6 h + Hydrochlorothiazide dosage menieres +++ Extrapyramidal effects Prochlorperazine Compazine (Smithkline Beecham, Philadelphia, PA) 10 mg PO q 6 h; 10 mg q h IM; 25 mg suppos. PR q 6 h + +++ Extrapyramidal effects IM--intramuscular, IV--intravenous, PO--oral, PR--rectal. Figure 1Depiction of endolymphatic duct occlusion as the likely cause of endolymphatic hydrops. CSF--cerebrospinal fluid.View larger image Episodes of vertigo occur when Hydrochlorothiazide dosage menieres there is a sudden asymmetry in vestibular tone, presumably due to sudden tears in the scala media and saccule. Abrupt decrease (or Hydrochlorothiazide dosage menieres occasionally increase) in vestibular signals from the affected ear result in vertigo, nystagmus, and unilateral tinnitus and hearing loss. Clinically, this results in sudden episodes Hydrochlorothiazide dosage menieres of unilateral tinnitus Hydrochlorothiazide dosage menieres and muffled hearing associated with spinning vertigo that last 30 minutes to 8 hours. Most patients are incapacitated during these episodes. Over time, unilateral Hydrochlorothiazide dosage menieres low-frequency (250 to 1000 Hydrochlorothiazide dosage menieres Hz) sensorineural hearing loss develops and is Hydrochlorothiazide dosage menieres detectable by pure tone audiometry Hydrochlorothiazide dosage menieres even between the attacks. Vestibular Hydrochlorothiazide dosage menieres loss also usually follows in time. Specific criteria for diagnosis and reporting treatment results have been published (Table 1) [1, 2]. The Hydrochlorothiazide dosage menieres classic triad of Meniere's disease consists of hearing loss, tinnitus, and vertigo. The hearing loss is often most prominent during episodes of vertigo. Initially, hearing loss is noticed only during attacks but with time becomes noticeable even between attacks of vertigo. Unilateral tinnitus and hearing loss may precede the onset of vertigo by several years in some cases, but progression or fluctuating unilateral hearing loss Hydrochlorothiazide dosage menieres is Hydrochlorothiazide dosage menieres very suggestive of the diagnosis. The diagnosis should be made with caution unless there is characteristic low-frequency hearing loss or a history of fluctuating hearing loss on one side. Some patients experience otolithic crisis of Tumarkin, Hydrochlorothiazide dosage menieres which causes a sudden perception of violent tilting or flipping that causes the patient to fall suddenly. These "drop attacks" usually occur without warning and can be another manifestation Hydrochlorothiazide dosage menieres of Meniere's disease.Figure 2Algorithm for the treatment of unilateral Meniere's disease.View larger image Management of the recurrent episodes of vertigo in this disease is twofold: symptom relief and prevention of attacks. The first task is to make the patient more comfortable by using vestibular suppressants (Table 2) such as meclizine, dimenhydrinate, Hydrochlorothiazide dosage menieres and scopolamine. Diazepam in low doses tends to have fewer side effects Hydrochlorothiazide dosage menieres but may not Hydrochlorothiazide dosage menieres be sufficient to suppress nausea. Hydrochlorothiazide dosage menieres Promethazine in oral, suppository, or parenteral form is useful in reducing the nausea associated with vertigo. The second component of treatment in Meniere's disease is prevention of vertiginous spells. For patients with infrequent bouts of vertigo, a sodium-restricted diet and a regimen of vestibular suppressant medications (see Table 2) is the preferred treatment. The definition of "infrequent" or "tolerable frequency" depends on the patient. Patients should be instructed to minimize their sodium intake to 1000 to 1500 mg/d as a nonsurgical and generally healthful method of preventing attacks and possibly preserving hearing. The addition of a thiazide diuretic may improve Hydrochlorothiazide dosage menieres vertigo control slightly. Medications such as selective H1-antihistamine blockers and nicotinic acid have been recommended by some despite lack of scientific evidence that they are effective. Hence, when diet and diuretics do not adequately reduce vertigo attacks, surgical intervention is Hydrochlorothiazide dosage menieres necessary (Fig. 2). In the exceptional circumstances of secondary endolymphatic hydrops caused by syphilis or autoimmune inner ear disease, specific treatment of the underlying cause is indicated. Intravenous penicillin for luetic otitis and immunomodulating treatments for autoimmune inner ear disease, such as high-dose pulse (1 g) intravenous methylprednisolone, azathioprine, or methotrexate, should be considered in these specific conditions. Such treatments are not part of the standard pharmacologic armamentarium for idiopathic Meniere's disease. Although corticosteroid administration Hydrochlorothiazide dosage menieres has become popular in recent years, a double-blind study using intravenous dexamethasone perfusion in 10 patients with Meniere's disease showed no changes in the audiometric or caloric vestibular responses in the Hydrochlorothiazide dosage menieres patients, as compared with 10 controls [3*, Class II]. Larger studies of corticosteroids or other immunomodulating agents such as Hydrochlorothiazide dosage menieres methotrexate in the treatment of idiopathic Meniere's disease are lacking. Before a surgical Hydrochlorothiazide dosage menieres or other destructive Hydrochlorothiazide dosage menieres procedure is contemplated, it should be remembered that about 25% of patients with Meniere's disease develop similar involvement of the Hydrochlorothiazide dosage menieres other ear. Hence, hearing preservation is always a premiere consideration when selecting a treatment. When Hydrochlorothiazide dosage menieres hearing is already so poor that a hearing aid is not useful, Hydrochlorothiazide dosage menieres this of course becomes of low consideration, and labyrinthectomy is often the easiest and most reliable management option. Surgical intervention often alleviates or eliminates further attacks of vertigo and may Hydrochlorothiazide dosage menieres consist of endolymphatic sac procedures, vestibular nerve sectioning, or destructive labyrinthectomy. Gentamicin and streptomycin have been used because they are selectively vestibulotoxic and can Hydrochlorothiazide dosage menieres produce a vestibular loss on one side Hydrochlorothiazide dosage menieres when instilled in the middle ear to diffuse into the inner ear. The Hydrochlorothiazide dosage menieres natural history of Meniere's disease is variable, and spontaneous remissions can occur. In one often-cited retrospective Hydrochlorothiazide dosage menieres report by Torok [4*, Class III], the remission rate for Meniere's disease ranged from 60% to 80% in patients who received a variety of treatments. In a follow-up study of 50 patients with medically refractory Meniere's disease who declined surgery, 59% of patients were free of vertigo attacks at 2 years, and 70% were symptom free at 8 years [5, Class II].TreatmentDiet and lifestyle •Dietary sodium restriction is the most critical factor in preventing attacks of vertigo and possibly in forestalling hearing loss. The importance of sodium restriction is often underemphasized, but it should be considered first-line treatment and even more important than diuretic therapy. This therapy requires monitoring total Hydrochlorothiazide dosage menieres daily sodium intake and avoiding fast foods and monosodium glutamate. •In some patients, caffeine and stimulants appear to trigger Meniere's episodes. Patients should be made aware of this possible association. Hydrochlorothiazide dosage menieres •Menstrual periods have been associated with Meniere's exacerbations in some cases, although use of estrogen-containing birth-control medications Hydrochlorothiazide dosage menieres is not standard therapy. •Most patients retain their ability to drive but should be Hydrochlorothiazide dosage menieres cautioned to pull to the side of the road if a vertigo attack Hydrochlorothiazide dosage menieres begins. Most episodes come on abruptly but build over a period of minutes, allowing sufficient time to seek a safe position. •Occasionally, Tumarkin otolithic crisis can result in recurrent Hydrochlorothiazide dosage menieres unexplained falls in Meniere's. Sudden mechanical deformation of the otolith of the affected ear causes a sensation Hydrochlorothiazide dosage menieres of violent tilting of the environment. Patients feel abruptly compelled toward one side, often losing balance but retaining consciousness. Those who experience these attacks should take appropriate Hydrochlorothiazide dosage menieres workplace and lifestyle precautions. •Periodically, hearing should be monitored for the need for hearing aids, for progression on the affected side, and for hearing loss in the other ear, which may suggest bilateral Meniere's disease. Hydrochlorothiazide dosage menieres Dietary sodium restriction Standard of care is to advise patients to restrict sodium intake to 1000 to 1500 mg/d. Despite the general consensus that dietary sodium restriction is important, few studies have been undertaken to prove the effectiveness of sodium restriction in the diet. One retrospective study of patients found subtantial control of vertigo in 79% of 54 patients after 2 years and suggested, based on audiometry, that Hydrochlorothiazide dosage menieres low salt intake and the diuretic may have slowed the progression of hearing loss [6, Class III].Pharmacologic treatment •Provides immediate alleviation of nausea and vertigo. •Limits the progression of hearing loss. •Prevents recurrent attacks of vertigo. Diuretics: hydrochlorothiazide, chlorthalidone, acetazolamide, glycerol Diuretics have been used in conjunction with dietary sodium restriction for many years, based on the hypothesis that they alter sodium and fluid balance, resulting in a reduction in endolymph volume. Chlorthalidone, however, did not produce a Hydrochlorothiazide dosage menieres demonstrable reduction in scala media fluid volume when used in a model of endolymphatic hydrops [7]. One double-blind study using hydrochlorothiazide in 30 patients with Meniere's disease reported significant improvement [8, Class I]. Subsequent reanalysis of Hydrochlorothiazide dosage menieres these data by Ruckenstein et al. [9*, Class II] pointed out that the original paper incorrectly compared patients who improved with patients who deteriorated, rather than comparing those who improved to all patients, including those who remained the same. This Hydrochlorothiazide dosage menieres revision found hydrochlorothiazide to be of Hydrochlorothiazide dosage menieres no significant benefit. Another double-blind controlled trial compared hydrochlorothiazide to triamterene; no clear conclusion could be reached because of a paucity of attacks of vertigo in both groups [10, Class I]. In patients treated with chlorthalidone for up to 7 years, 76% reported improvement in the intensity and frequency of attacks [11, Class III], although this long-term amelioration can be attributed at least in part to the Hydrochlorothiazide dosage menieres natural history of the disease. Another Hydrochlorothiazide dosage menieres nonblinded, retrospective study of 204 patients treated with a diuretic found that 79% had fewer attacks of vertigo and 75% had improvement or stabilization of hearing [12, Class III]. Acetazolamide, which was initially approved for the treatment of glaucoma, has been used Hydrochlorothiazide dosage menieres in patients with Meniere's disease, although no double-blind controlled trial exists to support this use. In one report, oral acetazolamide was found ineffective [13, Hydrochlorothiazide dosage menieres Class III]. Oral acetazolamide produced some improvement in experimentally induced endolymphatic hydrops [11]. Clinical trials of glycerol and urea do not indicate that these osmotic diuretics reduce hydrops acutely or affect electrocochleogram results Hydrochlorothiazide dosage menieres [14, 15, Class III]. In conclusion, despite the common use of diuretics in the treatment Hydrochlorothiazide dosage menieres of Meniere's disease, evidence strongly favoring their use is still lacking. Standard dosage Hydrochlorothiazide, 25 mg/d orally; chlorthalidone, 25 mg/d orally; acetazolamide, 250 mg orally bid; glycerol, 1.2 mg/kg orally mixed with grapefruit or orange juice at onset of vertigo attack. Contraindications Thiazide diuretics (hydrochlorothiazide and chlorthalidone) and acetazolamide are contraindicated in patients with hypersensitivity to sulfonamides. Main drug interactions Hydrochlorothiazide dosage menieres Diuretic hypokalemia can increase the risk of cardiac arrhythmias in patients taking quinidine. These diuretics have few serious drug interactions. Main side effects Acetazolamide often Hydrochlorothiazide dosage menieres causes tingling of the extremities and alteration in the taste of carbonated beverages. Special points Hydrochlorothiazide is often used in combination with a potassium-sparing diuretic, such as triamterene, amiloride, or spironolactone. A small percentage of patients Hydrochlorothiazide dosage menieres develop significant electrolyte disturbances, such as hypokalemia or hyponatremia, when taking these medications. Measurement of electrolytes is recommended in the initial phase of treatment. Hydrochlorothiazide dosage menieres Acetazolamide Hydrochlorothiazide dosage menieres alkalinizes the urine and can increase the likelihood of nephrolithiasis over a period of years. Liberal fluid intake of juices containing vitamin C and cranberry can help to minimize the risk of calculus formation. Cost effectiveness Hydrochlorothiazide in 25-mg pill form costs $1.49 for 100 tablets; chlorthalidone in 25-mg pill form costs $2.78 for 100; Hydrochlorothiazide dosage menieres acetazolamide in 125-mg pill form costs $5.10 for 100; and glycerol powder is $13.30 for Hydrochlorothiazide dosage menieres 454 Hydrochlorothiazide dosage menieres g.Vasodilators: histamine, carbogen, betahistine, nicotinic acid Vasodilating medications have been advocated on Hydrochlorothiazide dosage menieres the theory that there are metabolic and ischemic abnormalities Hydrochlorothiazide dosage menieres associated with Meniere's disease that might improve with increased blood flow to the stria vascularis. There are conflicting Hydrochlorothiazide dosage menieres data on their clinical applications; several double-blind studies favor their use, and several longitudinal studies do not favor their use. Three double-blind trials have reported reduction of vertigo attacks with betahistine [16, 17, 18, Class II]. In another double-blind experiment, Thornton et al. [19, Class Hydrochlorothiazide dosage menieres II] found that betahistine normalized the traveling auditory brain response wave that appears to correlate with endolymphatic hydrops; placebo had no similar effect. Weintraub et al. [20, Class III] Hydrochlorothiazide dosage menieres retrospectively reviewed 47 patients treated with vasodilators, subcutaneous histamine, vitamins, or nothing and found no differences, suggesting that most remissions are spontaneous. Bertrand [21, Class III] reported success in controlling Meniere's disease in more than 80% of patients treated with betahistine for periods of more than 10 years. In a double-blind comparison study of betahistine Hydrochlorothiazide dosage menieres and flunarizine, patients taking betahistine were found to have significantly fewer attacks of vertigo and vegetative symptoms than patients taking flunarizine; however, some of the patients did Hydrochlorothiazide dosage menieres not meet all diagnostic criteria for Meniere's disease [22, Class II]. Most studies of vasodilators have used betahistine, which Hydrochlorothiazide dosage menieres has not yet been approved for release in the United Hydrochlorothiazide dosage menieres States. There is Hydrochlorothiazide dosage menieres little scientific study of the use of histamine, carbogen, Hydrochlorothiazide dosage menieres or nicotinic acid in Meniere's disease. Standard dosage Betahistine is not available in the United States. Histamine diphosphate, 0.275 mg/mL, is dispensed sublingually, 2 to 4 drops bid before meals. Nicotinic acid, 50 to 150 mg, is given orally bid. Carbogen is a gaseous mixture of 95% oxygen and 5% carbon dioxide that is inhaled during attacks. Contraindications Betahistine and histamine should not be used in patients with peptic ulcer disease, asthma, or serious allergies; nicotinic acid should be used with caution in patients with liver disease or diabetes. Main drug interactions There are no significant drug interactions. Main side effects Nicotinic acid produces an intense flushing reaction with pruritus, usually involving the face and upper body. Premedication with aspirin, 325 mg, can diminish the flushing. Histamine produces flushing, pruritus, bronchospasm, nausea, and headache. Cost effectiveness Histamine diphosphate powder costs $32.90 for 5 g; Hydrochlorothiazide dosage menieres nicotinic acid costs $7.20 for 100 g in powder form.Interventional procedures •In the case of gentamicin instillation Hydrochlorothiazide dosage menieres in the middle ear, the goal is to reduce vestibular function selectively without an appreciable loss of hearing. The following discussion focuses on gentamicin because it is much more readily available in the United States than streptomycin. •Gentamicin is generally used in the Hydrochlorothiazide dosage menieres same patients who would be candidates for destructive labyrinthectomy but either elect not to have surgery or are poor surgical risks because of heart or respiratory disease. •Gentamicin can cause hearing loss, and it may take a series of injections to achieve enough reduction in vestibular function to eliminate attacks of vertigo. •In patients with residual vestibular function in the Hydrochlorothiazide dosage menieres ear undergoing the procedure, one can expect some vertigo Hydrochlorothiazide dosage menieres and dysequilibrium after the procedure. Compensation takes place usually within 2 to 6 weeks and can be accelerated by vestibular exercises. Transtympanic instillation of gentamicin Local injection of gentamicin into the middle ear has been used as a minimally invasive method of producing unilateral ablation of vestibular function. This is because Hydrochlorothiazide dosage menieres the gentamicin is absorbed across the round window into the inner ear and is more vestibulotoxic than cochleotoxic. In Hydrochlorothiazide dosage menieres addition to this ablative effect, gentamicin may also work by damaging the dark cells of the cristae ampullaris, which Hydrochlorothiazide dosage menieres secrete Hydrochlorothiazide dosage menieres endolymph. By these mechanisms, attacks of vertigo can be reduced or stopped in patients with Meniere's disease. No double-blind studies on gentamicin therapy have been completed to date, but several papers have documented its usefulness in effecting a chemical vestibular ablation, usually without significant hearing Hydrochlorothiazide dosage menieres loss [23, 24, 25, 26, 27]. The advantages of intratympanic gentamicin include the avoidance Hydrochlorothiazide dosage menieres of general anesthesia and of surgery itself. The disadvantages include the possibility of hearing loss, difficulty in Hydrochlorothiazide dosage menieres titrating the number of injections needed for control of symptoms, Hydrochlorothiazide dosage menieres and the need for careful monitoring of auditory and vestibular function during the course of treatment. Standard dosage Gentamicin, 40 mg/mL in parenteral formulation, is injected into the middle ear through the tympanic membrane, generally in a volume of 0.5 Hydrochlorothiazide dosage menieres to 1.0 mL. There is no clear consensus on the frequency of Hydrochlorothiazide dosage menieres injections, but they are usually administered once daily to once weekly. Repeat injections are discontinued after sufficient vestibular ablation has been accomplished. Contraindications Caution should be used in patients with serviceable hearing on the affected side because hearing loss can occur in some cases. Main drug interactions There are no significant drug interactions. Main side effects If some of the gentamicin solution drains into the pharynx, there may be an Hydrochlorothiazide dosage menieres unpleasant taste. As vestibular loss ensues, vertigo is to be expected and continues until the brain has adapted to the deficit. Special points This procedure places 0.5 to 1 mL of fluid into the middle ear. The tympanic membrane should be anesthetized locally, then injected under direct observation. To avoid drainage from the middle ear into the pharynx through the eustachian tube, the patient may be placed in the supine position with the head turned toward the injected ear for 30 to 60 minutes. The toxic effects of gentamicin are cumulative, and patients who have received a systemic aminoglycoside within the previous 6 weeks are more predisposed to greater vestibular loss. Cost effectiveness No information is available on the cost effectiveness of the whole procedure. Gentamicin solution (40mg/mL, 2-mL vials) costs $58.48 per vial. Although the Hydrochlorothiazide dosage menieres cost of this treatment is much lower than that of surgery, it may require much more Hydrochlorothiazide dosage menieres auditory and vestibular testing to Hydrochlorothiazide dosage menieres monitor progress, and the time necessary to complete control of vertigo is much longer than for vestibular nerve sectioning Hydrochlorothiazide dosage menieres or labyrinthectomy.Surgery •Endolymphatic sac Hydrochlorothiazide dosage menieres surgery is still controversial but is the only surgical procedure that Hydrochlorothiazide dosage menieres can theoretically delay or stop the progression of hearing loss and maintain Hydrochlorothiazide dosage menieres vestibular function while eliminating episodes of vertigo. •Endolymphatic shunting may be effective in the hands of experienced surgeons, but it has a much higher rate of recurrent symptoms than vestibular nerve sectioning. The advantages of endolymphatic shunt surgery are that it is a more limited, nondestructive procedure. •Vestibular nerve sectioning Hydrochlorothiazide dosage menieres selectively transects the vestibular component of the vestibulocochlear nerve at a point where it can be distinguished from the auditory portion. •Vestibular nerve sectioning is the definitive procedure to eliminate attacks of vertigo in patients with useful hearing in an affected ear. Although it carries some risk of significant hearing loss, the incidence of this is fairly low. Recurrence of vertigo after vestibular nerve sectioning is uncommon, unless the contralateral ear becomes affected. •Labyrinthectomy comprises the removal or pithing of the inner ear contents. It predictably results in total deafness and complete vestibular loss on the operated side. •Labyrinthectomy is usually the safest and easiest method of stopping vertigo attacks in patients who already have no useful hearing Hydrochlorothiazide dosage menieres in the affected ear. •The choice of surgical procedure depends on residual hearing in the affected ear, likelihood of eventual involvement of the contralateral ear, age, general health, and disease severity. Endolymphatic-mastoid Hydrochlorothiazide dosage menieres shunt surgery Although the effectiveness of endolymphatic shunting is uncertain, it is commonly offered to Meniere's patients with serviceable hearing in Hydrochlorothiazide dosage menieres the affected ear. Controversy regarding efficacy is based on the lack of controlled trials comparing the procedure to medical therapy and on the negative results of a study published in 1981. Thomsen et al. [28**] reported that patients who underwent "sham" mastoidectomy Hydrochlorothiazide dosage menieres had 80% improvement in symptoms, compared with 73% improvement in those undergoing actual shunt placement. A follow-up report from the same investigators reinforced these results [29]. Pillsbury et al. [30*], however, offered an alternative analysis of the data in the original Thomsen paper, concluding that only 47% Hydrochlorothiazide dosage menieres of patients had improved with simple mastoidectomy (placebo surgery), whereas 87% Hydrochlorothiazide dosage menieres had improved after Hydrochlorothiazide dosage menieres shunt placement. Despite complaints Hydrochlorothiazide dosage menieres that the study by Thomsen and colleagues included an inadequate sample size of only 30 patients, it remains the only controlled trial to date. Of 100 consecutive patients with unilateral Meniere's disease who underwent endolymphatic shunt placement, Moffat [31] reported 42% with complete resolution Hydrochlorothiazide dosage menieres of vertigo and 37% with substantial improvement. Another group found 65% with improvement of vertigo at 3 years of follow-up and 50% with improvement Hydrochlorothiazide dosage menieres at 10 years of follow-up after endolymphatic shunt surgery [32]. This and other reports favor the use of endolymphatic shunt surgery in patients with serviceable hearing and recurrent vertigo due to Hydrochlorothiazide dosage menieres unilateral Meniere's disease. Standard procedure Endolymphatic sac decompression and shunting is designed to produce a permanent conduit between the sac and either the mastoid or the subarachnoid space. Most commonly, shunting is achieved by exposing Hydrochlorothiazide dosage menieres the endolymphatic sac through a mastoidectomy and placing a tube between the Hydrochlorothiazide dosage menieres sac and the mastoid cavity. Contraindications None. Complications Some hearing loss occurs in 29% of cases, but significant hearing loss generally occurs in less than 5% of patients. Hearing is actually improved in about 15% of cases. Special points In carefully selected patients, this surgery offers the possibility of stabilizing hearing and resolving attacks of vertigo. Reported efficacy ranges from 35% to 90%. Hydrochlorothiazide dosage menieres Stabilization of hearing is not achieved by any of the other surgical procedures used in treating Meniere's disease. The less invasive nature of this nondestructive procedure must be weighed against the complications of shunting, which include hearing loss, failure to eliminate symptoms, and late recurrence of vertigo as a result of shunt occlusion. Cost effectiveness No information is available.Vestibular neurectomy Vestibular neurectomy is based on the principle that deafferentation Hydrochlorothiazide dosage menieres of the vestibular apparatus eliminates the fluctuations Hydrochlorothiazide dosage menieres in vestibular input that cause the characteristic bouts of vertigo in Meniere's disease. To disconnect vestibular signals selectively without affecting hearing, the two components of the eighth cranial nerve must be separated. This can be achieved over a small neural segment in the internal auditory canal. The procedure carries a relatively low morbidity and is highly effective in eliminating disabling attacks of vertigo. This and other surgical procedures are not effective in reducing chronic dysequilibrium experienced by some patients on the basis of peripheral vestibular hypofunction. Indeed, this procedure completely eliminates peripheral vestibular Hydrochlorothiazide dosage menieres function on one side, so that chronic dysequilibrium and oscillopsia may actually increase. This is especially true if the contralateral vestibular function is also poor. It is beyond the scope of this article to review the historical and technical aspects of this procedure. Brookes [33**] has recently reviewed much of this information. Standard procedure The internal auditory canal Hydrochlorothiazide dosage menieres is Hydrochlorothiazide dosage menieres surgically exposed through the middle cranial fossa, permitting visualization of the vestibular division of the eighth cranial nerve. The procedure disconnects the peripheral vestibular apparatus from Hydrochlorothiazide dosage menieres the brain stem while preserving cochlear inputs. Contraindications Bilateral Meniere's disease should prompt particularly careful consideration in proceeding with this surgery. Complications Significant hearing loss in about 4% of patients, facial nerve paresis in 3% to 7%, and cerebrospinal fluid leakage or Hydrochlorothiazide dosage menieres meningitis in a small percentage. Unilateral vestibular loss is universal. Patients develop acute vertigo, but most can compensate within several months. Central vestibular compensation is accelerated by Hydrochlorothiazide dosage menieres specialized exercises. Special points Hydrochlorothiazide dosage menieres Some otologic surgeons consider this first-line treatment for medically refractory vertigo in patients Hydrochlorothiazide dosage menieres with serviceable hearing. The reported effectiveness of vestibular neurectomy in controlling vertigo in patients with unilateral endolymphatic hydrops ranges from 91% to 99%. Most failures of this procedure arise from an incorrect diagnosis, incorrect lateralization, or bilateral Meniere's disease. Incomplete nerve sectioning Hydrochlorothiazide dosage menieres occurs infrequently. Cost effectiveness No information is available.Labyrinthectomy Labyrinthectomy is the obvious choice to eliminate recurrent vertigo attacks in patients not responding to medical therapy who are already deaf in the affected ear. A number of case series have documented its effectiveness and relatively low morbidity [34, 35, 36, Class III]. Candidates for Hydrochlorothiazide dosage menieres labyrinthectomy should have normal middle and inner ear function in the contralateral ear. Standard procedure The most commonly used procedure is a transmastoid labyrinthectomy. The vestibule is exposed by openings made in the anterior and lateral semicircular canals. Hydrochlorothiazide dosage menieres The contents of the vestibule and both canals are then removed. The failure rate of this procedure is less than Hydrochlorothiazide dosage menieres 1% in cases of properly diagnosed Meniere's disease. Contraindications This procedure should not be performed if there is serviceable hearing on the affected side, because it ablates the entire contents of the inner ear. Bilateral Meniere's disease or deafness in the Hydrochlorothiazide dosage menieres contralateral ear are contraindications unless the patient is already completely deaf. Complications Complete ipsilateral hearing loss is universal and permanent. Unilateral vestibular loss is also universal, but most patients can compensate for this within several months. Special points This procedure is Hydrochlorothiazide dosage menieres indicated in patients without any serviceable hearing on the side affected by endolymphatic hydrops. It is less complicated than vestibular neurectomy and does not require intracranial exposure. Recovery is usually fairly prompt, particularly if vestibular rehabilitation exercises are performed Hydrochlorothiazide dosage menieres after surgery. Cost effectiveness No information is available.Assistive Hydrochlorothiazide dosage menieres devices •Cochlear implants can be used to improve hearing in adults whose audiogram shows hearing loss of more than 90 dB and speech Hydrochlorothiazide dosage menieres discrimination of less than 10% who have experienced minimal benefit from hearing aids. •Hearing aids can be used in any patient with hearing loss but are most likely to be helpful in those without profound asymmetric loss. Patients with excellent hearing in one ear and poor hearing in the other usually find that the amplification in the deficient ear is more annoying than useful. An audiologist should help determine the need for a hearing aid. Cochlear implantation Standard procedure An Hydrochlorothiazide dosage menieres intracochlear implant provides sound-induced electrical signals to the spiral ganglion. Candidates for implantation should have severe pure-tone hearing loss of 90 dB or greater, speech Hydrochlorothiazide dosage menieres discrimination scores of less than 10% for single words, no improvement with conventional hearing aids, and perception of sound with promontory stimulation. Contraindications Implantation should be avoided in all patients who do not meet strict criteria for implantation. Complications There are no significant complications. Special points Cochlear implants are indicated in patients with bilateral deafness who meet the criteria given previously. Some patients who have Hydrochlorothiazide dosage menieres undergone labyrinthectomy may benefit from implants because there may be some surviving spiral ganglion cells. This topic is reviewed in several recent publications [35, 37, 38, Class III]. Cost effectiveness No information is available.Physical therapy •Physical therapy in the form of balance and head motion exercises is helpful in speeding recovery from vertigo after labyrinthectomy or vestibular neurectomy. Such therapy is not effective in eliminating episodes of vertigo because the vestibular asymmetry varies widely during attacks; the central nervous system cannot Hydrochlorothiazide dosage menieres adapt because the vestibular system is not in a steady state. •Balance training and vestibular rehabilitation exercises can be helpful in patients who have sustained peripheral vestibular injury and experience resultant imbalance. Vestibular therapy Vestibular therapy consists of Hydrochlorothiazide dosage menieres a series of head and eye movements and balance tasks that are performed repetitively for the purpose of enhancing Hydrochlorothiazide dosage menieres central adaptation to vestibular loss. Specific exercises have Hydrochlorothiazide dosage menieres been shown to be more beneficial than general Hydrochlorothiazide dosage menieres physical exercise in one double-blind placebo-controlled trial [39, Class I]. Other investigators have documented improvement in function and quantitative balance measures in patients undergoing vestibular exercises, as compared with the pretreatment measures [40*, 41, 42, Class III].References and Recommended ReadingRecently published papers of particular interest have been highlighted as:*Of importance**Of Hydrochlorothiazide dosage menieres major importance1.Pearson BW: Guidelines for reporting treatment results in Meniere's disease. Otolaryngol Head Neck Surg 1985, 93:579-581."> View the PubMed notation for this reference.2.Alford BR: Meniere's disease: criteria Hydrochlorothiazide dosage menieres for diagnosis and evaluation of therapy for reporting. Trans Am Acad Ophthalmol Otolaryngol 1972, 67:1462-1464.3.*Silverstein H, et al.: Dexamethasone inner ear perfusion for the treatment of Meniere's disease: a prospective, randomized, double-blind, crossover trial. Am J Otol 1998, 19:196-201.Although oral corticosteroids are being used increasingly more frequently by some, this Hydrochlorothiazide dosage menieres double-blind study of dexamethasone use in patients with Meniere's disease found no benefit in 10 patients when compared with 10 controls."> View the PubMed notation for this reference.4.*Torok N: Old and new in Meniere's disease. Laryngoscope 1977, 87:1870-1877.A landmark article that critically reviews some of the treatments for Meniere's and notes the high rate of spontaneous remission."> View the PubMed Hydrochlorothiazide dosage menieres notation for this reference.5.Silverstein H: Natural history versus surgery for Meniere's disease. Otolaryngol Head Neck Surg 1989, 100:6-16."> View the PubMed notation for this reference.6.Santos PM: Diuretic and diet effect on Meniere's disease evaluated by the 1985 Committee on Hearing and Equilibrium Hydrochlorothiazide dosage menieres guidelines. Otolaryngol Head Neck Surg 1993, 109:680-689."> View the PubMed notation for this reference.7.Shinkawa Hydrochlorothiazide dosage menieres H: Hydrochlorothiazide dosage menieres Effect of diuretics on endolymphatic hydrops. Acta Otolaryngol 1986, 101:43-52."> View the PubMed notation for this reference.8.Klockhoff I: Meniere's disease and hydrochlorothiazide: a critical analysis of symptoms and therapeutic effects. Acta Otolaryngol 1967, 63:347-365."> View the Hydrochlorothiazide dosage menieres PubMed notation for this reference.9.*Ruckenstein Hydrochlorothiazide dosage menieres MJ: The treatment of Meniere's disease: Torok revisited. Laryngoscope 1991, 101:211-218.One of two double-blind studies that brings into question the effectiveness of diuretics in Meniere's disease."> View the PubMed notation for this reference.10.Van Deelen GW: The use of oral diuretic (Diazide) in the Hydrochlorothiazide dosage menieres treatment of Meniere's disease. Otol Rhinol Laryngol 1986, 48:287-292.11.Klockhoff IM: Diuretic treatment of Meniere's disease. Acta Otolaryngol 1974, 100:262-265.12.Jackson CG, et al.: Medical management of Meniere's disease. Ann Otol Rhinol Laryngol 1981, 90:142-147."> View the PubMed notation for this reference.13.Brookes GB: Oral acetazolamide in Meniere's disease. J Laryngol Otol 1984, 98:1087-1095."> View the PubMed notation for this reference.14.Brookes GB: Otoadmittance Hydrochlorothiazide dosage menieres changes following glycerol dehydration in Meniere's disease. Acta Otolaryngol 1984, 98:30-41."> View the PubMed notation for this reference.15.Moffat Hydrochlorothiazide dosage menieres DA, et al.: Transtympanic electrocochleography during glycerol dehydration. Acta Otolaryngol 1978, Hydrochlorothiazide dosage menieres 85:158-166."> View the PubMed notation for this reference.16.Frew IJC: Betahistine hydrochloride in Meniere's disease. Postgrad Med J Hydrochlorothiazide dosage menieres 1976, 52:501-503."> View the PubMed notation for this reference.17.Wilmot TH: Betahistine Hydrochlorothiazide dosage menieres in Meniere's disease. J Laryngol Otol 1976, 90:833-840."> View the PubMed notation for this reference.18.Meyer ED: Treatment of Meniere's disease with betahistine dimesilate: double-blind crossover study versus placebo. Laryngol Rhinol Otol Stuttg 1985, 64:269-272."> View the PubMed notation for this reference.19.Thornton ARD: A non-invasive, objective test of endolymphatic hydrops. Acta Otolaryngol 1991, 479(suppl):35-43.20.Weintraub J, et al.: The efficacy of conservative medical regimens on the rate of hearing loss in Meniere's syndrome: a retrospective computerized statistical analysis. Laryngoscope 1976, 86:1391-1396."> View the PubMed notation for this reference.21.Bertrand RA: Long-term evaluation of the Hydrochlorothiazide dosage menieres treatment of Meniere's disease with betahistine Hcl. Adv Hydrochlorothiazide dosage menieres Otorhinolaryngol 1982, 28:104-110."> View the PubMed notation for this reference.22.Fraysse B, et al.: Betahistine dihydrochloride versus flunarizine: a double-blind study on recurrent vertigo with or without cochlear syndrome typical of Meniere's disease. Acta Otolaryngol 1991, 490:1-10.23.Beck C: Ten years of experience with intratympanically applied streptomycin (gentamicin) in therapy Hydrochlorothiazide dosage menieres morbus Meniere. Hydrochlorothiazide dosage menieres Arch Otorhinolaryngol 1978, 221:149-152."> View the PubMed notation for this reference.24.Nedelski JM, et al.: Chemical labyrinthectomy: local application of gentamicin for the treatment of unilateral Meniere's disease. Am J Otol 1992, 13:18-22."> View the PubMed notation for this reference.25.Moller C: Vestibular and audiologic functions in gentamicin treated Meniere's disease. Otolaryngol Head Neck Surg 1987, 9:383-391.26.Odkvist LM: Middle ear ototoxic treatment for inner ear disease. Acta Otolaryngol 1989, 457(suppl):83-86.27.Pykko I, et al.: Intratympanic gentamicin in bilateral Meniere's disease. Otolaryngol Head Neck Surg 1994, 110:162-167."> View the PubMed notation for this reference.28.**Thomsen J, et al.: Placebo effect in surgery for Meniere's disease: a double-blind, placebo-controlled study on endolymphatic sac shunt surgery. Arch Otolaryngol 1981, 107:271-277.Perhaps the most controversial, often-referenced article on Meniere's disease. It reported that placebo surgery was as effective as endolymphatic shunt surgery. This article caused performance of this procedure to be curtailed greatly, although many have pointed out flaws in its study design."> View the PubMed notation for this reference.29.Bretlau P, et al.: Placebo effect Hydrochlorothiazide dosage menieres in surgery Hydrochlorothiazide dosage menieres for Meniere's disease: a three year follow-up study of patients in a double-blind placebo-controlled study on endolymphatic shunt surgery. Am J Otol 1984, 5:558-561."> View the PubMed notation for this reference.30.*Pillsbury HC, et Hydrochlorothiazide dosage menieres al.: Endolymphatic sac surgery. The Hydrochlorothiazide dosage menieres Danish Sham Study: an alternative analysis. Otolaryngol Clin North Am 1983, 16:123-127.A rebuttal to the Thomsen paper that suggests, upon reanalysis, that endolymphatic shunt surgery was helpful in the Hydrochlorothiazide dosage menieres patients in the Thomsen study."> View the PubMed notation for this reference.31.Moffat DA: Endolymphatic mastoid shunt surgery in unilateral Meniere's disease . Ear Nose Throat J 1997, 76:642-651."> View the PubMed notation for this reference.32.Glasscock MR III: Current status of surgery for Meniere's disease. Otolarygnol Head Neck Hydrochlorothiazide dosage menieres Surg 1984, 92:67-72.33.**Brookes GB: The role of vestibular nerve section in Meniere's disease. Ear Nose Hydrochlorothiazide dosage menieres Throat J 1997, 76:652-663.A well-written review of the indications for vestibular neurectomy in Meniere's disease."> View the PubMed notation for this reference.34.Kemink JL, et al.: Transmastoid labyrinthectomy: reliable surgical management of vertigo. Otolaryngol Head Neck Surg 1989, 101:5-10."> View the PubMed notation for this reference.35.Wareing MJ: The role of labyrinthectomy and cochlear implantation in Meniere's disease. Ear Nose Throat J 1997, 76:664-672."> View the PubMed notation Hydrochlorothiazide dosage menieres for this reference.36.Graham MD: Transmastoid labyrinthectomy: further experience with the indications, complications and early Hydrochlorothiazide dosage menieres post-operative results. J Laryngol Otol 1981, 95:1205-1211."> View the PubMed notation for this reference.37.Gray RF: Cochlear results: a comparison of live-voice and videotaped tests. Laryngoscope 1995, 105:1001-1004."> View the PubMed notation for this reference.38.Eddington DK, et al.: Auditory prostheses research with multiple channel intracochlear stimulation in man. Ann Otol Rhinol Laryngol 1978, 53(suppl):1-39.39.Krebs DE: Double-blind, placebo-controlled trial of rehabilitation for bilateral vestibular hypofunctions: preliminary report. Otolaryngol Head Neck Surg 1993, 109:735-741."> View the PubMed notation for Hydrochlorothiazide dosage menieres this reference.40.*Cass SP: Functional outcome of vestibular rehabilitation in patients with abnormal sensory-organization testing. Am J Otol 1996, Hydrochlorothiazide dosage menieres 17:581-594.A study indicating that patients with demonstrable imbalance from Hydrochlorothiazide dosage menieres a vestibular disorder improve with habituation exercises and physical therapy."> View the PubMed notation for this reference.41.Cohen H: Vestibular rehabilitation improves daily life Hydrochlorothiazide dosage menieres function. Am J Occup Ther 1994, 48:919-925."> View the PubMed notation for this reference.42.Horak FB, et al.: Effects of vestibular rehabilitation on dizziness and imbalance. Otolaryngol Head Hydrochlorothiazide dosage menieres Neck Surg 1992, 106:175-180."> View the PubMed notation for this reference. Meniere's Page - Compilation of Hydrochlorothiazide dosage menieres Treatments Compilation of Treatments for Ménière's disease This compilation is Hydrochlorothiazide dosage menieres based on the published literature and includes treatments which may not be provided by the physicians at Washington University. Where available, a brief explanation is given for the basis of each treatment There are an extremely large Hydrochlorothiazide dosage menieres number of treatments presently being used to treat Meniere's disease. This is perhaps a reflection of the fact that no single treatment is effective in all patients. Dietary Manipulations Low salt (low Hydrochlorothiazide dosage menieres sodium) diet Water Hydrochlorothiazide dosage menieres intake Caffeine restriction Chocolate restriction Alcohol restriction General dietary considerations Diuretics (Water pills) Dyazide; Maxzide; Maxzide-25 HCTZ, Esidrix Lasix Diamox Anti-emetic, Anti-nausea and Anti-vertigo drugs Antivert, Meclizine Serc / betahistine Phenergan, Promethazine Dramamine, Vomex Stemetil, Compazine Scopolamine Vistaril Gravol Torecan Anti-anxiety drugs Valium, Diazepam Ativan, Lorezipam Xanax, alprazolam Thorazine, Chlorpromazine Steroids Prednisone Cortisone Dexamethasone Anti-histamines Hismanal Claritin Allegra Calcium channel blockers Stugeron / Cinnarzine Vasoactive drugs Niacin Osmotic Agents Glycerol Urea Isosorbide Ototoxic Antibiotics Gentamicin Streptomycin Nutritional supplements Ginko biloba Ginger Lipoflavinoids Miscellaneous Sodium bicarbonate infusion Acupuncture Chiropractic manipulations Surgical Procedures Anesthetics Endolymphatic shunt Endolymphatic sac decompression Tympanostomy tube / eardrum Endolymphatic sac - partial ablation Sacculotomy, Cochleosacculotomy Vestibular nerve section Labyrinthectomy Dietary manipulations - Low salt (low sodium) diet There is no doubt that restriction of dietary salt does help large numbers of Meniere's patients. However, this is a good example of a treatment which does not yet have a solid scientific explanation for how it works. Many years ago it was believed that endolymphatic hydrops was caused by an excess Hydrochlorothiazide dosage menieres of sodium in the endolymph, which was thought to be alleviated by a reduction of salt intake. More recent studies have show that endolymph sodium is typically near normal both in animals with induced endolymphatic hydrops and in a limited number of patients from which endolymph was sampled. In addition, Hydrochlorothiazide dosage menieres a low-salt diet is known to have extremely little influence on the plasma sodium concentration, because the body has exquisite regulation systems in the kidney that maintain plasma levels within a narrow range. On the other hand, reducing salt intake has more complex and Hydrochlorothiazide dosage menieres far-reaching effects Hydrochlorothiazide dosage menieres than that of simply changing plasma or Hydrochlorothiazide dosage menieres endolymph sodium level. In order to maintain a constant composition of blood plasma, the kidneys adjust their capacity for ion transport activity according to the amount of salt intake. These adjustments are achieved by a number of hormones, including aldosterone, which control the amount of ion transport performed by the kidney. There is now some evidence that changes in hormones such as Hydrochlorothiazide dosage menieres aldosterone may also affect ion transport processes in the ear, in some way altering the way endolymph is regulated. Help with maintaining a low-salt diet is available. Dietary manipulation - Water Intake Many physicians give little or no guidance with regard to how much water should be consumed. General rules for a Hydrochlorothiazide dosage menieres healthy diet apply, including eating small, regular meals and keeping water intake up. If the goal of the diuretics and Hydrochlorothiazide dosage menieres low salt diet is to increase sodium loss from the body, then a normal level of water consumption (8 glasses per day) would help achieve this aim. Some physicians apparently advise their patients to limit water intake, presumably to aid in the dehydrating effect of the diuretic. To my knowledge, there are no data supporting either point of view. Dietary manipulation - Caffeine restriction Often recommended, but no known data published Hydrochlorothiazide dosage menieres to support a direct association with Meniere's Dietary manipulation - Chocolate restriction Often recommended, but no known data published to support a direct association with Meniere's Dietary manipulation - Alcohol restriction Often recommended, but no known data published to support a direct Hydrochlorothiazide dosage menieres association with Meniere's Dietary manipulations - Other Some patients report that by limiting sugar, MSG (monosodium glutamate) caffeine and/or alcohol their attacks occur less frequently. There is no compelling scientific rationale for why this should be. Therefore, each individual needs to make their own decision of what is appropriate. It is important to be as objective as possible in this assessment. If dietary restriction does not alleviate the symptoms then do not adopt an increasingly restrictive diet. It may be that your form of the disease may not be alleviated Hydrochlorothiazide dosage menieres by diet alone. It is unrealistic to expect that even the strictest dietary management will prevent Ménière's disease in all patients. The best approach is to keep a diary in which symptoms are rated as onjectively as possible. This can best guide the otologist in the management of their condition. Also, it is important to avoid making "spurious" associations between events and symptoms. For example, an attack following a specific food does not necessarily mean that this food produced the attack. Perhaps the attack could have occurred anyway, even without that type of food. The key is to be objective and to monitor your Hydrochlorothiazide dosage menieres symptoms over a prolonged period. If any strategy reduces the frequency of the attacks it is logical to maintain that strategy. However, If you maintain a controlled, healthy diet and attacks persist, you should not feel "guilty" that perhaps your diet was not Hydrochlorothiazide dosage menieres "strict enough". Some patients will not respond simply to dietary managment an no amount of restrictions will help. The key is to Hydrochlorothiazide dosage menieres try to be objective in your assessment. Diuretics - General By increasing urine production, treatment with diuretics contibutes to a "negative sodium balance", which means that more sodium is lost from the body than is eaten in the diet. This contributes to the effects of a low-sodium diet and results in hormone level changes Hydrochlorothiazide dosage menieres associated with sodium conservation by the body. Diuretic - Brand Names: Dyazide; Maxzide Generic name : Triamterene and Hydrochlorothiazide Drug Class : Antihypertensive; Potassium Sparing Diuretic Dyazide is a Hydrochlorothiazide dosage menieres combination of hydrochlorothiazide (diuretic and antihypertensive) and triamterine. Triamterine is a potassium-sparing diuretic, which means that it increases excretion of sodium and chloride in the urine, while conserving potassium. Diuretic - Brand Names: HCTZ, Esidrix, Oretic, HydroDiuril, Microzide Generic Name: Hydrochlorothiazide dosage menieres Hydrochlorothiazide (HCTZ) Drug class : Thiazide Diuretic; Antihypertensive HCTZ is one of the diuretic components of Dyazide. Diuretic - Brand Name: Lasix Generic Name: Furosemide Furosemide is loop diuretic, a specific Hydrochlorothiazide dosage menieres class of diuretics that inhibits reabsorption of sodium and chloride ions not only in the proximal and distal tubules, but also in Henle's loop, thereby increasing the volume of urine excreted. It is also known that stria vascularis in the cochlea (the tissue that secretes endolymph) is highly sensitive to furosemide, although it is not known whether this helps in the action of this diuretic. Diuretic - Brand Name : Diamox Generic Name: acetazolamide Drug Class : Carbonic Anhydrase Inhibitor, Anticonvulsant, Antiglaucoma Acetazolamide is sometimes prescribed and because of its documented effectiveness in treating glaucoma of the Hydrochlorothiazide dosage menieres eye (with which endolymphatic hydrops is sometimes compared). However, regulation of endolymph in the inner ear occurs by completely different mechanisms to those in the eye, so that acetazolamide is unlikely to Hydrochlorothiazide dosage menieres have any direct effect on hydrops in the ear. Acetazolamide also acts as a diuretic and may, by increasing sodium excretion, be beneficial. The action of acetazolamide is different in that it inhibits the Hydrochlorothiazide dosage menieres enzyme carbonic anhydrase, which influences carbon dioxide, and bicarbonate Hydrochlorothiazide dosage menieres homeostasis, and may affect pH regulation in some tissues. One study (Brookes Hydrochlorothiazide dosage menieres and Booth, Hydrochlorothiazide dosage menieres 1984) reported poor results and a high incidence of side effects with this diuretic. Anti-emetic, Anti-nausea and Anti-vertigo drugs - General While most of these drugs are generally aimed at treating the effects of vertigo in Meniere's disease they may also play a role Hydrochlorothiazide dosage menieres in controlling the disease itself by reducing stress and anxiety. Anti-nausea - Brand Names : Antivert, Bonine, D-Vert, Dramamine II, Meclicot, Medivert Generic Name: Meclizine Hydrochlorothiazide dosage menieres Hydrochloride Drug Class : Antiemetic; H1 Receptor Blocker (antihistamine) Meclizine is used to treat the nausea and vomiting associated with motion sickness and Hydrochlorothiazide dosage menieres vertigo. It is believed to work by decreasing the sensitivity of the body's central nervous system Hydrochlorothiazide dosage menieres balance centers. It helps manage motion sickness and Hydrochlorothiazide dosage menieres affects the chemoreceptor trigger zone to control vomiting. Anti-nausea - Brand Name : Serc Generic name : betahistine Drug Class : an H1 binding histamine: In Europe, Betahistine is tending to Hydrochlorothiazide dosage menieres replace meclizine as the Hydrochlorothiazide dosage menieres preferred anti-vertiginous drug. Betahistine is also reported to increase cochlear blood flow, which may in some way also contibute to the improvement seen in patients. Betahistine has not been approved by the FDA and is not available in the USA. Anti-nausea - Brand Name : Phenergan Generic Name: Promethazine Hydrochloride Drug class : Tranquilizer, Antiemetic, H1 Receptor Blocker, Phenothiazine Promethazine controls nausea, Hydrochlorothiazide dosage menieres vomiting and motion-sickness. An H1-blocking antihistamine with sedative and anti-emetic properties. Anti-nausea - Brand Hydrochlorothiazide dosage menieres Names : Dramamine, Vomex Generic Name : Dimenhydrinate Drug class Hydrochlorothiazide dosage menieres : Antiemetic, H1 Receptor Blocker Dimenhydrinate is an antihistamine Hydrochlorothiazide dosage menieres used to treat motion sickness, nausea and vomiting. It works by blocking histamine from binding to its receptor, preventing histamine from Hydrochlorothiazide dosage menieres exerting its effects. Anti-nausea - Brand Names : Compazine, Stemetil Generic Name: Prochlorperazine Maleate (Phenothiazine) Drug class : Hydrochlorothiazide dosage menieres Tranquilizer; Antiemetic; Antipsychotic Prochlorperazine belongs to a class of agents called phenothiazines. It is used for the management of psychotic disorders, anxiety and to control emesis (nausea and vomiting). It works by blocking Hydrochlorothiazide dosage menieres the dopamine receptors in different parts of the brain. Anti-nausea - Brand Name : Transderm-Scop Scopolamine [Transdermal] Drug class: Anticholinergic Agent, Antiemetic Transdermal Hydrochlorothiazide dosage menieres scopolamine is a naturally occurring belladonna alkaloid with anticholinergic properties. It is used to prevent nausea and vomiting associated with motion sickness in adults. It does this by altering stimulation to the central nervous system. Anti-nausea - Brand Names : Vistaril Generic Name: Hydroxyzine Pamoate Drug class :Antihistamine, Tranquilizer, Antiemetic, H1 Receptor Blocker Hydroxyzine pamoate is an antihistamine used to treat a variety of allergic conditions. It is even used preoperatively Hydrochlorothiazide dosage menieres to help induce sleep. It works by blocking the Hydrochlorothiazide dosage menieres action Hydrochlorothiazide dosage menieres of histamine, an important nflammatory mediator in Hydrochlorothiazide dosage menieres the body, from binding to its receptor and exerting its effects. Anti-nausea - Brand Hydrochlorothiazide dosage menieres Names : Gravol No information available Anti-nausea - Brand Names : Torecan Generic Name : Thiethylperazine Maleate Drug class : Antiemetic, Phenothiazine Thiethylperazine maleate belongs to a class of antiemetic agents called phenothiazines. It is used to treat severe nausea and vomiting in certain patients. Thiethylperazine works by triggering brain chemoreceptors to alter the message to the vomit center in the brain. Anti-anxiety drugs - General There is no doubt that stress is an important factor in triggering Meniere's attacks. It is well documented that stress changes some Hydrochlorothiazide dosage menieres hormone levels (especially of the corticosteroids). Therefore treating the stress may itself lead to an improvement in the patient. So-called "life-stress situations" which commonly precede attacks include personal antagonism and conflicts, sexual conflicts death of a close relative, social, educational or financial problems and finally, fear of future attacks. The greater the fear of attacks, the more frequent and severe they become and vice versa (the "viscious cycle"). The use of anti-anxiety drugs is aimed at breaking this cycle. Anti-anxiety Brand names : Valium, Di Tran, Diazepam Intensol Generic Name: Diazepam (Benzodiazepine) Drug class : Anticonvulsant, Antianxiety, Skeletal Muscle Relaxant Diazepam is a benzodiazepine, a type of central nervous system (CNS) depressant (medicine that slows down the nervous system). It is used to treat several disorders including panic disorder, muscle spasms, anxiety, and alcohol withdrawal. It is also Hydrochlorothiazide dosage menieres used in combination with other anti-seizure medications to treat seizure disorders. Anti-anxiety Brand names : Ativan, Lorazepam Intensol Generic Name Hydrochlorothiazide dosage menieres : Lorazepam Drug Hydrochlorothiazide dosage menieres class : Benzodiazepine, Antianxiety Lorazepam is a benzodiazepine, a type of Hydrochlorothiazide dosage menieres central nervous system (CNS) depressant (medicine that slows down the nervous system). It Hydrochlorothiazide dosage menieres is used to treat anxiety, anxiety associated with depression, or insomnia. Anti-anxiety Brand names : Xanax, Alprazolam Intensol Generic Name : Alprazolam Drug class : Benzodiazepine, Antianxiety Alprazolam is a benzodiazepine, a type of central nervous system (CNS) depressant (medicine that slows down the nervous system). It is used to treat anxiety, anxiety associated with depression and panic disorders. Anti-anxiety Brand name : Thorazine Generic Name: Chlorpromazine Hydrochloride (Phenothiazine) Drug class : Antipsychotic, Tranquilizer; Antiemetic Chlorpromazine belongs to a class of antipsychotic drugs called phenothiazines. It is used to treat schizophrenia as well as for the control of anxiety or agitation in certain patients, severe nausea and vomiting and severe hiccups. Chlorpromazine works in the brain and at all levels of the central nervous system to exert sedative and anti-nausea activity. Steroids - General Some physicians prescribe steroids which are synthetic glucocorticoids (normally sysnthesised by the adrenal glands). The benefit seen by some patients has been attributed to suppression of an autoimmune response, and has been used to support the concept that Meniere's disease may arise Hydrochlorothiazide dosage menieres from some form of autoimmunity. However, glucocorticoids have a vast array of effects on the body, affecting carbohydrate and protein metabolism, lipid metabolism, electrolyte balance, inflammatory responses and Hydrochlorothiazide dosage menieres immune responses. In addition, glucocorticoid receptors has been demonstrated in tissues of the inner ear (Rarey et al., 1993) raising the possibility that these steroids may have a direct effect on fluid homeostasis Hydrochlorothiazide dosage menieres in the ear. It is therefore impossible at the present time to know exactly which of the effects of these steroids is important in relieving the symptoms of Meniere's disease. Steroid - Prednisone Brand Names : Deltasone, Meticorten, Orasone Generic Name: Prednisone Drug class : Glucocorticoid Prednisone is a glucocorticoid steroid used to Hydrochlorothiazide dosage menieres treat a variety of inflammatory conditions, including asthma, Hydrochlorothiazide dosage menieres allergic reactions and autoimmune diseases (such Hydrochlorothiazide dosage menieres as Hydrochlorothiazide dosage menieres lupus). It works by altering how the Hydrochlorothiazide dosage menieres immune system responds to certain stimuli. It may also act directly on fluid homeostasis in the inner ear by Hydrochlorothiazide dosage menieres interacting with glucocorticoid receptors in the ear. Steroid - Cortisone Generic Name: Cortisone Acetate Drug class : Glucocorticoid Cortisone acetate is a glucocorticoid used to treat a variety of inflammatory conditions, including the management of adrenocortical insufficiency (when the body lacks glucocorticoids). Cortisone may act to supplement the body's natural glucocorticoid stores or alter how the immune system responds to certain stimuli Steroid - Dexamethasone Brand Names: Adrenocot, Dalalone, Decadron, Decaject, Dekasol, Dexacorten,Dexasone,Dexim, Dexone, Hexadrol, Medidex, Primethasone; Solurex Generic Name : Dexamethasone Sodium Phosphate or dexamethasone acetate Drug class : Glucocorticoid Dexamethasone belongs to a class of anti-inflammatory agents called corticosteroids. It is used to treat various inflammatory conditions. It works by altering the way the immune system responds to certain stimuli. Dexamethasone is sometimes given locally to the cochlea (by injection through the eardrum into the middle ear space) in conjunction with intravenous administration. This allows higher drug levels to be achieved in the cochlea. Although initial results look promising, this approach needs to be replicated in other centers. At present some physicians regard the efficacy of intratympanic steriods as an effective long term treatment for Meniere's unproven. Anti-histamine - Brand Name : Hismanal Generic Name: Astemizole Drug class : Non-Sedating Antihistamine; H1 Receptor Blocker Hismanal is no longer regarded as a good choice of therapy. There have been rare cases of severe cardiovascular events when astemizole was taken in high doses or in combination with some specific other drugs. The manufacturer discontinued making the product in June 1999. Patients should contact their doctors to discuss alternative treatment. Anti-histamine - Brand Name: Claritin Generic Name: Loratadine Drug class: Non-Sedating Antihistamine; H1 Receptor Blocker There are no studies in which the efficacy of this drug Hydrochlorothiazide dosage menieres has been assessed in Meniere's patients Anti-histamine - Brand Name : Allegra Generic Name: Fexofenadine Hydrochloride Drug class : Non-Sedating Antihistamine, H1 Receptor Blocker There are no studies in which the efficacy of this drug has been assessed in Meniere's patients Calcium Hydrochlorothiazide dosage menieres channel blocker - Stugeron / Hydrochlorothiazide dosage menieres Cinnarzine Cinnarzine is a calcium channel blocker which is not presently available in the USA. Exactly how it influences Meniere's symptoms Hydrochlorothiazide dosage menieres and/or function of the Hydrochlorothiazide dosage menieres ear is not known. Studies in animals with endolymphatic Hydrochlorothiazide dosage menieres hydrops have shown the endolymph calcium level to be elevated. Limited measurements of endolymph sampled from Meniere's patients also shows Hydrochlorothiazide dosage menieres a high calcium level. This raises the possibility that a calcium disturbance may contibute to the symptoms of Ménière's disease. Some physicians, especially in Hydrochlorothiazide dosage menieres those Hydrochlorothiazide dosage menieres in Europe, have been using calcium channel blockers to treat Ménière's disease, including, Flunarizine, Nimodipine and Cinnarzine. Cinnarzine appears to Hydrochlorothiazide dosage menieres induce fewer side-effects. Vasoactive drug - Niacin Some Hydrochlorothiazide dosage menieres physicians prescribe niacin for Meniere's patients. In a search of the MEDLINE database for papers in the last 5 years which mentioned Meniere's and niacin, there were no citations. In a recent Hydrochlorothiazide dosage menieres symposium on Meniere's disease the use of niacin as a treatment was never mentioned. We conclude that niacin therapy is not widely used to treat Meniere's. Niacin (nicotinic acid) lowers the level of lipids circulating in the blood. LDL-cholesterol is reduced and HDL-cholesterol is increased. Niacin therapy may be appropriate in patients showing abnormal blood lipids, but probably Hydrochlorothiazide dosage menieres has no direct effect on the Meniere's disease itself.. Osmotic Agent - Glycerol Glycerol is given to patients with Ménière's disease as part of some diagnostic tests. The effect is very short-term (hours) and glycerol is not used as a long-term therapy. In addition, glycerol Hydrochlorothiazide dosage menieres somestimes has the side effect of producing nausea and headache. Osmotic Agent - Urea Urea is given to patients with Ménière's disease as part of some diagnostic tests. Its effects are very short-term (hours) and urea not used as a long-term therapy. Some groups are researching giving urea at the first sign of an attack, to reduce the attack Hydrochlorothiazide dosage menieres severity. However, urea is not well accepted by patients due to the taste and the side effects, which can include nausea and headache. Osmotic Agent - Isosorbide Isosorbide is used as an osmotic agent, which produces diuresis (production of urine). Clinically, Hydrochlorothiazide dosage menieres isosorbide is better accepted than urea and glycerol as it tastes better and does not have the side effects. It has been reported that over an 8 week period, isosorbide treatment improved hearing in 38% of the patients in one study (Kakigi et al, 1995) but no reduction in vertigo was reported. Ototoxic Antibiotics - General In Meniere's disease, antibiotics are not used for their conventional, bacteriocidal purpose. Instead, the ability of specific antibiotics to selectively damage the sensory hair cells of the vestibular system is used. This can also be described as a chemical labyrinthectomy, which represents a non-surgical, method to reduce Hydrochlorothiazide dosage menieres the sensitivity of the vestibular system. By impairing or destroying these cells, the brain is no longer sent "incorrect" information that the head is rotating. The techniques rely on the fact that for antibiotics such as gentamicin, the sensory cells of the vestibular system are more sensitive to damage than are the cells of the cochlea. This gives the opportunity, at the right dose, for vestibular function to be Hydrochlorothiazide dosage menieres reduced without damaging hearing. The antibiotic is usually injected into the middle ear space through the eardrum, and enters the inner ear through the round and oval windows. This method can be effective, but in practice it is difficult to achieve vestibular ablation without causing some damage to hearing. A number of groups are presently researching the best regimen of antibiotic applications. Olsen et al. (1995) reported that best results were obtained with 2-4 applications to the middle ear, with Hydrochlorothiazide dosage menieres a greater liklihood of hearing loss if more treatments were given. One common approach is to "titrate" the number of treatments to Hydrochlorothiazide dosage menieres the patients symptoms, using just enough to alleviate vertigo without necessarily destroying all vestibular function. Ototoxic Antibiotic - Gentamicin Gentamicin is most widely used for the selective ablation of the vestibular system of one ear. It is administered by injecting it through the eardum into the middle ear space. From there it diffuses into the fluids of Hydrochlorothiazide dosage menieres the inner ear. Usually, repeated injections are performed over a period of weeks, which allows hearing function to be Hydrochlorothiazide dosage menieres monitored to minimize the chances of further hearing loss. Ototoxic Antibiotic - Streptomycin In cases of bilateral disease some physicians administer streptomycin intramuscularly at a dose which is titrated to suppress labyrinthine function. One of the problems associated with bilateral ablation of the labyrinths is a condition called oscillopsia. This is perceived as an oscillation of the visual field, which can be as disturbing to the patient as vertigo. The goal with streptomycin administration is to reduce the sensitivity of the labyriths without totally ablating them. One study has reported that permanent dysequilibrium may be observed in 47% of cases treated with this streptomycin titration method. Nutritional Hydrochlorothiazide dosage menieres supplements - Ginko biloba While the use of Ginko biloba has been advocated by some to help Meniere's Hydrochlorothiazide dosage menieres patients, there is no scientific evidence demonstrating any effect on symptoms or on the ear. It probably will not do any Hydrochlorothiazide dosage menieres harm, but is more likely to be a waste of money. Nutritional supplements - Ginger Some find that use of ginger helps reduce nausea. Nutritional supplements - Lipoflavinoids Some dietary supplements are being marketed containing flavinoids which are claimed to have a beneficial theraputic effect in Ménière's patients. The scientific data supporting such claims is extemely weak and the medical community would generally not accept the fact that Ménière's disease arises from a dietary deficiency. If this type of supplement appeals to you, it will Hydrochlorothiazide dosage menieres probably not do any harm, except maybe to your wallet. Miscellaneous - Sodium bicarbonate Hydrochlorothiazide dosage menieres infusion Some Japanese physicians administer intravenous sodium bicarbonate as a treatment for an acute vestibular Meniere's attack. This therapy is not presently used in the USA Miscellaneous - Acupuncture Since stress is a precipitating factor in Meniere's disease, there are many approaches by Hydrochlorothiazide dosage menieres which symptoms can be reduced by stress reduction. Acupuncture probably falls in this category. Miscellaneous - Chiropractic Hydrochlorothiazide dosage menieres manipulations Since stress is a precipitating factor in Meniere's Hydrochlorothiazide dosage menieres disease, there are many approaches by which symptoms Hydrochlorothiazide dosage menieres can be reduced by stress reduction. Chiropractic manipulations probably fall in this category. Surgical Procedures - Anesthetics It has been suggested that the improvement seen Hydrochlorothiazide dosage menieres in patients following ear surgery may in part be due to the Hydrochlorothiazide dosage menieres general anesthesia used. Furthermore, some patients benefit from anesthesia without surgery. Gates (1999) reported that in the 30% Hydrochlorothiazide dosage menieres of Meniere's patients who did not repond Hydrochlorothiazide dosage menieres to low-salt diet, diuretics and stress reduction, 60% of these patients gained relief from vertigo by one injection of the anesthetic, Innovar. This has been attributed to a long-lasting depression of the vestibular system by some anesthetics. Surgical Procedures - Endolymphatic shunt Endolymphatic sac surgery is still relatively controversial. Based on a published study, many physicians regard endolymphatic sac surgery as a "placebo" surgery (i.e. the patient gets the same outcome whether or not the sac is acutally shunted) and will no longer perform it. One physician has described the procedure as "at best non-specific Hydrochlorothiazide dosage menieres and at worst of no value". Others regard surgery of the sac to as a valuable "intermediate step" between non-surgical therapies Hydrochlorothiazide dosage menieres and the more invasive procedure of vestibular nerve section. If you are looking for "intermediate steps" you may want to consider having a tympanostomy tube inserted before committing to shunt surgery, as the numbers of patients gaining benefit appears to be similar for the two procedures. Endolymph-subarachnoid shunt. This involves Hydrochlorothiazide dosage menieres placing a tube between the endolymphatic sac and the cranium Endolymph-mastoid shunt This involves placing a tube between the endolymphatic sac and the mastoid cavity of the middle ear. This procedure is generally used to avoid potential problems of opening the cranium in the endolymph-subarachnoid shunt. Surgical Procedures - Endolymphatic sac decompression This surgery involves drilling away the bone overlying the endolymphatic sac to make a larger "cavity" for the sac to occupy. Surgical Procedures - Insertion of a tympanostomy tube through the eardrum This is a relatively minor procedure which is widely used in Hydrochlorothiazide dosage menieres children and adults for the relief of middle-ear infections. Hydrochlorothiazide dosage menieres The purpose of the tube is to Hydrochlorothiazide dosage menieres maintain a tiny hole through the eardrum. Although the medical community has been skeptical that this treatment would have any bearing on Meniere's disease, many physicians are finding that they are very effective Hydrochlorothiazide dosage menieres with success rates as good as endolymphatic shunt surgery. The published studies indicate a high proportion of Ménière's patients get relief from vertigo by this procedure. Furthermore, a recent study in animals has provided scientific support that the Hydrochlorothiazide dosage menieres procedure is effective, finding that hydrops developed to a lesser degree when the eardrum was perforated. However, some physicians remain unconvinced and there is Hydrochlorothiazide dosage menieres as much controversy on this issue, as there is with endolymphtic shunts. It should be emphasized that the apparent "fullness in the ear" described by Meniere's patients does not arise from abnormal pressure in the middle ear space so the reason for the tube is not to release a middle ear pressure. In our present research Hydrochlorothiazide dosage menieres we are finding there are a number of mechanisms by which perforation of the tympanic membrane could affect the cochlear fluids. For those considering surgical options, this may be something to try before Hydrochlorothiazide dosage menieres other, more invasive, surgeries are considered. Surgical Procedures - Endolymphatic sac : partial ablation It has now been shown that outcomes equal Hydrochlorothiazide dosage menieres or better than other sac Hydrochlorothiazide dosage menieres procedures can be obtained by partially ablating (destroying) the distal region of the endolymphatic sac. (Gibson 1999) Surgical Procedures - Sacculotomy, Cochleosacculotomy These are also relatively minor surgical procedures which involve perforation of the saccule through the stapes footplate (sacculotomy) or through the round window, via the basilar membrane (cochleosacculotomy). While the Hydrochlorothiazide dosage menieres procedures showed some benefit in reducing vertigo, there is considerably greater risk to hearing Hydrochlorothiazide dosage menieres by Hydrochlorothiazide dosage menieres these procedures than by other surgical procedures. As a result, these procedures are not widely used. Surgical Procedures - Vestibular Hydrochlorothiazide dosage menieres nerve section This is a highly invasive surgery which can dramatically cure severe cases of disabling vertigo. The goal of the surgery is to cut the nerve from the vestibular apparatus, while Hydrochlorothiazide dosage menieres leaving the auditory nerve intact, thereby preserving hearing. During the recovery period, the brain Hydrochlorothiazide dosage menieres adapts to manage without vestibular input from the operated side, so that normal activity can be resumed. There are some concerns that after this procedure, patients may not be totally asymptomatic (Mattox 1999) Although the vertigo attacks may be cured Hydrochlorothiazide dosage menieres , it is fairly common for chronic disequilibrium or imbalance to persist after the procedure. Surgical Procedures - Labyrinthectomy Surgical ablation of Hydrochlorothiazide dosage menieres either Hydrochlorothiazide dosage menieres a portion or the entire labyrinth can be performed by a Hydrochlorothiazide dosage menieres trans-canal or post-auricular approach. These procedures are normally only performed when there is no useful hearing in the affected ear, since collateral damage Hydrochlorothiazide dosage menieres to the cochlea may produce significant hearing loss. Page generated by: Alec N. Salt, Ph.D., Cochlear Fluids Research Laboratory, Washington University, St. Louis Meniere's Disease Information Center -- Treatment Last Modified Thursday, July 21, Hydrochlorothiazide dosage menieres 2005 Start Here What is Meniere's Disease? · What is the cause? · Hydrochlorothiazide dosage menieres What is the cure? · What can I do about it? Symptoms · Cause · Diagnosis · Treatment · Prognosis · Find Doctors · Research · Disability · Serc Home · What's Hydrochlorothiazide dosage menieres New · Search · Site Map · Book · Famous Patients · Glossary · Misc. · Calendar About Us · Disclaimer · Hydrochlorothiazide dosage menieres Mission · Copyright · Hydrochlorothiazide dosage menieres Non-Profit · Privacy · Email · Report Errors · Media Inquiries Nearly every general information question is answered on this website. Be sure to use our search page and site map. If your question isn't answered here, visit MenieresTalk.com. Meniere's Disease Treatment Copyright © 1997-2005 Meniere's Hydrochlorothiazide dosage menieres Disease Information Center. All rights are reserved. All copying, including (but not limited to) websites, bulletin boards, forums, and blogs, is prohibited. Linking is permitted and Hydrochlorothiazide dosage menieres encouraged. Click here for more copyright information. There is no known and no known cure for Meniere's Disease (but Meniere's Disease is not fatal). All treatments are "symptomatic" -- since there is no cure, the goal is to treat the Hydrochlorothiazide dosage menieres symptoms. Excess endolymphatic fluid. Unless Hydrochlorothiazide dosage menieres otherwise indicated, the treatments described below appear to be Hydrochlorothiazide dosage menieres founded on the theory that Meniere's Disease symptoms result from excess endolymphatic fluid in the inner ear ("idiopathic endolymphatic hydrops.") While this is the prevailing theory, it is not the definitive theory. More on the cause of Meniere's Disease. Strategies for obtaining a treatment plan. Sometimes patients are confounded in their quest for treatment because there is no qualified doctor in their town. The solution to this problem is simple: go out of town. Visit Hydrochlorothiazide dosage menieres our doctors page for strategies on Hydrochlorothiazide dosage menieres obtaining a Hydrochlorothiazide dosage menieres treatment plan from an out-of-town specialist who coordinates treatment with your local doctor. What works. No one treatment works for Hydrochlorothiazide dosage menieres everyone, yet every treatment seems to work for someone. We each seem to respond differently to various treatments. Some patients are nearly symptom-free just by observing a low-sodium diet (see below). Other patients seem unresponsive to any treatment -- even invasive surgery. The bottom line: each patient tries to find the treatment (or treatments) that works best for each one. Our lay and inexpert speculation: perhaps there are ten (or more or fewer) currently unknown diseases Hydrochlorothiazide dosage menieres that each have the same symptoms as what we now call "Meniere's Disease," and we each Hydrochlorothiazide dosage menieres have one (or perhaps Hydrochlorothiazide dosage menieres two or three) of the ten (or more Hydrochlorothiazide dosage menieres or fewer) of the currently unknown diseases. *IF* this is true, then ten patients could be diagnosed with "Meniere's Disease," yet each one could have a different disease, and each one could respond differently to various treatments. Clinical trials. The U.S. government has a website for information Hydrochlorothiazide dosage menieres on clinical trials. These clinical trials Hydrochlorothiazide dosage menieres are usually conducted by the NIH (National Institutes of Health). In the usual clinical trials, there are two groups, the test group and the control group. The test group is treated in some way. The control group is "pretend-treated," usually with a placebo ("fake") drug. Studies may last one year, more or less. The results of both groups are compared to see whether patients in the test group improved significantly compared to the control group. You might or might not like to participate in Hydrochlorothiazide dosage menieres a study. Remember, one group will always be given placebo ("fake") treatment. However, control groups are necessary in research and patients in the control group make very useful contributions to medical science. If you are interested in participating in a clinical trial, talk to your doctor. What is a clinical trial? U.S. National Hydrochlorothiazide dosage menieres Institutes of Health. Dietary and lifestyle. The purposes of dietary and Hydrochlorothiazide dosage menieres lifestyle modification therapies are to reduce all symptoms by reducing conditions that may initiate or exacerbate trigger symptoms. Triggers. While the cause of Meniere's Disease is unknown, there are known "triggers" that can bring on or increase symptoms in *some* patients. Most patients find it helpful to identify and avoid -- or treat -- triggers, when possible. Triggers known to affect many (but not all) patients. Allergies, including food allergies. Allergies, including food allergies, are believed by many to have a Hydrochlorothiazide dosage menieres role in triggering Meniere's Disease symptoms in *some* patients. Treatment of allergies may or may not help reduce Meniere's symptoms or frequency of occurrences, depending upon the patient. Dr. Jennifer Derebery, House Ear Institute, Los Angeles, studies Hydrochlorothiazide dosage menieres the relationship of allergies to Meniere's Disease. Some patients seek allergy testing Hydrochlorothiazide dosage menieres in order to see whether avoidance of allergenic reactions may help to Hydrochlorothiazide dosage menieres reduce the frequency and/or Hydrochlorothiazide dosage menieres intensity of Hydrochlorothiazide dosage menieres Meniere's Disease episodes. Anecdotally, this strategy seems to help some patients, but not all patients. Click here to search PubMed for Meniere's Disease and allergy research by Dr. Jennifer Derebery. Menstruation. Some women Hydrochlorothiazide dosage menieres patients experience Meniere's symptoms in conjunction with menstruation. Washington University. Dr. Gwen Morse and Dr. John House have authored a paper Hydrochlorothiazide dosage menieres describing evidence of a relationship between the menstrual cycle and Meniere's Disease responses in some women. "Results from this study provide evidence that a unique relationship does exist between the menstrual cycle and Meniere's disease responses for some women. Knowledge gained from this study is beneficial in identifying the importance of appropriate clinical assessment methods of menstruate women with Meniere's disease. Recommendations include further research with larger samples and testing of different symptom management strategies for women of different perimenstrual symptom patterns." Pregnancy. Some women patients anecdotally report that their symptoms are exacerbated during pregnancy. Some women patients report that their symptoms of Meniere's Disease first appeared either Hydrochlorothiazide dosage menieres during pregnancy or soon after delivery. Visual stimuli. Some patients anecdotally report that certain visual events, especially parallel vertical lines, will Hydrochlorothiazide dosage menieres trigger dizziness and other symptoms. Here Hydrochlorothiazide dosage menieres are some examples: Streets and highways lined with trees or telephone poles. Supermarket aisles. Some motion pictures. Changes in barometric pressure. Some patients anecdotally report that Hydrochlorothiazide dosage menieres changes in barometric pressure can trigger symptoms. Some patients so affected track weather patterns very closely in an attempt to anticipate increases in symptoms. Other triggers. There are literally a million possible triggers, because each patient is different and may be affected by certain factors specific to each, which may or may not include any of the triggers described above. Salt (sodium) avoidance. Physicians frequently prescribe a low-salt diet to reduce the amount of sodium in the body. Sodium in the body increases fluid retention. Common table salt is, of course, sodium chloride, and is normally the primary source of sodium in the body. On the theory that Meniere's Hydrochlorothiazide dosage menieres Disease symptoms may result from excess endolymphatic fluid in the inner ear, physicians often counsel a reduction in over all fluid in the body, with the hope that endolymphatic fluid will be reduced in the process. To reduce sodium, and therefore bodily Hydrochlorothiazide dosage menieres fluids, physicians often prescribe diuretics (see below) and counsel a low-salt diet. Hydrochlorothiazide dosage menieres Results vary. Some patients anecdotally report a strong correlation between salt ingestion and onset or worsening of symptoms. Other patients anecdotally report no correlation between salt and symptoms at all. What's a low-salt (low-sodium diet)? Descriptions vary. Some say the less the better. Some degree of sodium intake is necessary to stay healthy. Many patients attempt to keep their sodium intake under 1,000 mg. per day. A Hydrochlorothiazide dosage menieres few say that they succeed. Ask your doctor how much sodium is right for you. Saltwatcher.com. Online resource with low-sodium information Hydrochlorothiazide dosage menieres and recipes; also has food products for sale online. Low Sodium Cooking. Great site! Quote: "A can of chili may contain 2400 mg [of salt] all by itself; homemade chili may contain less than 100 mg." Need we say more? Salt Free Life. Terrific low-cost membership website! You don't have to do low salt to love the recipes, reviews, and cooking tips. Non-members get Hydrochlorothiazide dosage menieres a free recipe every month. Members may access an archive of Hydrochlorothiazide dosage menieres over 240 recipes with new recipes posted every month. Now your family will love and share the low- and no-salt meals that you have to have. You can have dinner guests again without guilt! (No, we do NOT get paid to say this!) Dr. Salt's Salt Page (Washington University). Alec Salt, Ph.D., is Hydrochlorothiazide dosage menieres the author of this page on, ironically, salt; it is addressed specifically to Meniere's Disease patients. VEDA offers a low-salt cookbook. Amazon Books discount book store on the Web. Click here to search for low-salt books. (We do *not* get a commission.) Alcohol avoidance. Some patients report that alcohol intake is devastating. Others report no effect whatsoever from imbibing. Caffeine avoidance. Many patients report that caffeine intake is devastating. Some patients report that caffeine has no effect whatsoever on their Meniere's Disease symptoms. Nicotine avoidance. Physicians nearly always prescribe cessation of smoking, Hydrochlorothiazide dosage menieres and many Hydrochlorothiazide dosage menieres Meniere's Disease patients -- who can -- quit out of necessity. Stress Hydrochlorothiazide dosage menieres avoidance. Stress is suspected to have a role in Meniere's Disease, although stress is not well suited Hydrochlorothiazide dosage menieres for objective measurement Hydrochlorothiazide dosage menieres and is not well documented. Link: Washington Hydrochlorothiazide dosage menieres University. Click here to search PubMed for Meniere's Disease and stress. Complementary and Alternative Medicine (CAM) In general. Cautions. Dr. Stephen Barrett's Quackwatch. Quackwatch search on Hydrochlorothiazide dosage menieres "Meniere's." Dr. Barry Beyerstein's seven reasons Why Bogus Therapies Often Seem to Work. Logical fallacies. In general. Datanation.com. University of North Carolina. Post hoc, ergo propter hoc (after this, therefore because Hydrochlorothiazide dosage menieres of this). Datanation.com. If a patient improves after treatment "x" (say, grapefruit juice), a Hydrochlorothiazide dosage menieres patient may think that the grapefruit juice improved the patient's Meniere's Disease. However, Hydrochlorothiazide dosage menieres the mere fact that improvement followed a treatment is not evidence Hydrochlorothiazide dosage menieres that the improvement was Hydrochlorothiazide dosage menieres *caused* by the treatment. (Correlation is not causation.) Clinical trials. The best medical studies (trials) based on science are those that are randomized, double-blind, placebo-controlled, and that are subsequently peer-reviewed and published in a professional journal, and after that are replicated by independent researchers. What is a clinical trial? U.S. National Institutes of Hydrochlorothiazide dosage menieres Health. Resources U.S. National Institutes of Health, National Center for Complementary and Alternative Medicine. U.S. National Institutes of Health, Office of Dietary Supplements. Mayo Clinic, Complementary and Alternative Medicine Center. George Washington University, Center for Integrative Medicine. University of Maryland, Center for Integrative Medicine. Cochrane Collaboration. Aetna Intelihealth. Herbs/Vitamins/Minerals/Supplements. Cautions. There is no medical evidence to support the effectiveness of herbs, vitamins, or minerals in the treatment of Meniere's Disease. (See for yourself at PubMed.) It is always prudent to thoroughly research the effects and drug interactions of any medication that you contemplate taking, whether prescription, over-the-counter Hydrochlorothiazide dosage menieres (OTC), herbal, vitamin, mineral, supplemental, or whatever. Talk to your pharmacist and to your physician. Ginkgo biloba. Some patients believe that Hydrochlorothiazide dosage menieres "ginkgo" acts as a vasodilator that improves blood flow to the head, improving their symptoms. Other patients report no effect at all. Moreover, ginkgo has its detractors, who believe that it is a dangerous anti-coagulant, especially when teamed up Hydrochlorothiazide dosage menieres with certain other drugs, such as aspirin. The moral: do your Hydrochlorothiazide dosage menieres homework; study up before taking any substance, and be sure to discuss with Hydrochlorothiazide dosage menieres your Hydrochlorothiazide dosage menieres physician. Ginkgo and aspirin (student health service, Illinois State University). "Ginkgo Biloba - A Word of Hope and A Word of Caution," by Dr. Stephen Nagler. Ginkgo biloba information from ivillagehealth.com. Click here to search PubMed for Meniere's Disease and ginkgo biloba. Vinpocetine. Some patients believe that vinpocetine improves their symptoms. Click here to search PubMed for Meniere's Disease and vinpocetine. Niacin (vitamin B-3; nicotinic acid; nicotinamide). Some patients believe that niacin improves the blood flow to the head (frequently producing a temporary, characteristic facial "flush"), which improves their symptoms. Other patients report no effect at all. Niacin in chronic (continuing) overdoses can cause liver damage. Talk to your physician. Product information for Niacor brand niacin. Click here to search PubMed for Meniere's Disease and niacin. Bioflavonoids. Some patients believe Hydrochlorothiazide dosage menieres that bioflavonoids improve their symptoms. Click here to search PubMed for Meniere's Disease and bioflavonoids. Lipoflavonoids. Some patients believe that lipoflavonoids improve their symptoms. Click here to search PubMed Hydrochlorothiazide dosage menieres for Meniere's Disease and lipoflavonoids. Ginger Hydrochlorothiazide dosage menieres root. Ginger root tea is often described by patients as helpful in fending off nausea. Acupuncture. Cautions. Click here to search PubMed for Meniere's Disease and acupuncture. Acupuncture.com on Meniere's Disease. Homeopathy. Cautions. Homeowatch. "Homeopathy: the ultimate fake." Quackwatch. Click here to search PubMed for Meniere's Disease and homeopathy. Vertigoheel (cocculus compositum). Study Published in AMA Professional Journal Implies Efficacy of Vertigoheel and Betahistine Hydrochloride (Serc). The bottom line: "Results: Both homeopathic [Vertigoheel] and conventional [betahistine hydrochloride (often referred to by the brand name "Serc")] treatments showed a clinically relevant reduction in the mean frequency, duration, and intensity of the vertigo attacks. The Hydrochlorothiazide dosage menieres therapeutic equivalence of the homeopathic remedy [Vertigoheel] and betahistine [hydrochloride ("Serc")] was established statistically." Note: this isn't saying much, since the efficacy of SERC in itself is controversial. See our page on Serc. Click here to search PubMed for Meniere's Disease and Vertigoheel. Vertigoheel, though a "homeopathic" medicine, has been approved by the U.S. FDA for treatment by prescription only, and is listed in the PDR (Physicians' Desk Reference.) We received this email on October 15, 2002: "I receive so many phone calls from people with Meniere's who have been looking for Vertigoheel to help treat their Hydrochlorothiazide dosage menieres symptoms and who have had a lot of trouble finding Hydrochlorothiazide dosage menieres the product -- anywhere -- that I thought I would write and Hydrochlorothiazide dosage menieres let you know that I sell Cocculus Compositum (exact formula as Hydrochlorothiazide dosage menieres Vertigoheel but you don't need a prescription) for $18.06 (20% off) and usually ship the next day by priority mail. [Note that the manufacturer of this product is Heel, the company that also manufactures Vertigoheel. -- Editor.] My Hydrochlorothiazide dosage menieres website is Vitamin-Resource at http://www.vitamin-resource.com, and there is a direct link to the Cocculus Compositum tablets [here]. Hope this will be Hydrochlorothiazide dosage menieres helpful to some of your members. Best wishes, Joanne Lindon, Vitamin-Resource" We receive no compensation Hydrochlorothiazide dosage menieres for posting this Hydrochlorothiazide dosage menieres information. Chiropractic. Cautions. "Don't let chiropractors fool you." Quackwatch. Chirobase. Chiroweb. Click here to search PubMed for Meniere's Disease and Chiropractic. Osteopathy. Cautions. Dubious aspects of osteopathy. Quackwatch. Click here to search PubMed for Meniere's Disease and Osteopathy. Symptomatic relief after Hydrochlorothiazide dosage menieres treatment of temporomandibular disorder (TMD) Hydrochlorothiazide dosage menieres and cervical spine disorders (CSD) in patients with Meniere's disease: a three-year follow-up. Abstract at PubMed. According to the abstract, results showed that a coordinated treatment of TMD and CSD in patients with Meniere's disease is an effective therapy for symptoms of this disease. The results suggested that Meniere's disease has a clear association with TMD and CSD and that these three ailments appeared to be caused by the same stress, nervousness, and muscular tension. Devices. Meniett device. This is a portable pressure pulse generator originally developed by the Swedish company Pascal Medical AB and now Hydrochlorothiazide dosage menieres marketed in the U.S. by Medtronic Xomed. Click here to search PubMed for Meniere's Disease and Meniett device. Enttex P-100 device. The P-100 debuted June 2005. It is described as a manual type of pressure pulse delivery device, positioned as a lower-cost alternative to the "expensive device" (obviously, a thinly-veiled reference to the Meniett device). There is not yet a great deal of information available about the P-100. 32nd Annual International Conference of the Neurootological and Equilibriometric Society (NES) 2005. According to this website, the following paper was presented at the conference: Franz, B., Melbourne, Australia, P-100 for Treatment of Meniere's Disease, A Clinical Study. (Enter the site, click on "scientific program" on the left, then click on "preliminary program" on the bottom, then download "Preliminary Scientific Program.) Alternatively, click here. We Hydrochlorothiazide dosage menieres have not seen either the study or an abstract. Click here Hydrochlorothiazide dosage menieres to search PubMed for Meniere's Disease and the P-100 device. A search at PubMed on June 28, 2005, did not locate any articles on this device. Tinnitus retraining therapy (TRT). A treatment for tinnitus (resulting from Meniere's Disease or otherwise), which involves a conditioning to the presence of the tinnitus rather than actually eliminating the tinnitus. The technique uses a masking device that resembles a Hydrochlorothiazide dosage menieres hearing aid. University of Maryland at Hydrochlorothiazide dosage menieres Baltimore Tinnitus and Hyperacusis Center. Anyone interested in Hydrochlorothiazide dosage menieres obtaining information Hydrochlorothiazide dosage menieres should call 410-328-1279. Tinnitus & Hyperacusis Center at Emory University (U.S.); Pawel J. Jastreboff, Ph.D. Dr. Jastreboff is considered by many to be the foremost U.S. (and perhaps world) researcher Hydrochlorothiazide dosage menieres into TRT. Southeastern Comprehensive Tinnitus Clinic Tinnitus Relief Center at Mercy Medical Center, Baltimore (U.S.) New York Times article on tinnitus published August 21, 2001. Electrical Hydrochlorothiazide dosage menieres stimulation. A treatment for tinnitus (resulting from Meniere's Disease or otherwise), which involves treating the outside of the ear with a Hydrochlorothiazide dosage menieres small electric current. Atlanta Ear Clinic, Ronald L. Steenerson, M.D. This site has a Hydrochlorothiazide dosage menieres page on the treatment of tinnitus, including a description of electrical stimulation (note that this page is headed "Treatment of Annoying Tinnitus at the Georgia Tinnitus Clinic"; it is unclear to us how the "Georgia Tinnitus Clinic" relates to the "Atlanta Ear Clinic"). The Possibility of Tinnitus Suppression by Electrical Stimulation. Article co-authored by Dr. Steenerson (above), abstracted at PubMed. Rehabilitation. Vestibular rehabilitation therapy (VRT). Vestibular rehabilitation strategies in Meniere's Disease. Click here to search PubMed for Meniere's Disease and vestibular rehabilitation. Wobblers Anonymous. Founded by a patient with Hydrochlorothiazide dosage menieres antibiotic-induced bilateral vestibular hypofunction. Bilateral Hydrochlorothiazide dosage menieres loss of vestibular function. Dr. Timothy Hain. More from Dr. Timothy Hain. Medical. It is always prudent to thoroughly research the effects Hydrochlorothiazide dosage menieres and drug interactions Hydrochlorothiazide dosage menieres of Hydrochlorothiazide dosage menieres any medication that you contemplate taking. Talk to your pharmacist and to your physician. Overview. Drug Treatment of Vertigo, Dr. Timothy C. Hain. Diuretics. Diuretics are often prescribed to treat Meniere's Disease, often in conjunction with a low-salt diet (see above), apparently for the purpose of reducing body fluids in general and endolymph in particular. This treatment presumes that the Hydrochlorothiazide dosage menieres patient suffers from (idiopathic) Hydrochlorothiazide dosage menieres endolymphatic hydrops (excess endolymphatic fluid). Notes from the University of Kansas (KU) Medical Center; scroll down to "treatment." Maxzide; Dyazide (generic: triamterene/hydrochlorothiazide (HCTZ)). Diamox (generic: acetazolamide). Antiviral drugs. We are hearing anecdotal reports from patients who are (perhaps by their own demand) being treated with antiviral drugs such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) -- with mixed results. This apparently responds to a few studies finding a tenuous Hydrochlorothiazide dosage menieres (in our view) connection between the herpes simplex virus (HSV) and Meniere's Disease. However, we are not convinced that HSV is a culprit. No study states for a fact that HSV can cause Meniere's Disease. There are practically no reported studies on treating Meniere's Disease with an antiviral drug. Click here to search PubMed for Meniere's Disease and antiviral drugs. Vestibular Hydrochlorothiazide dosage menieres sedatives. These drugs are intended to sedate the vestibular system to reduces the effects of vertigo (the spinning sensation). Not surprisingly, these "vestibular sedatives" can have a side effect of drowsiness. Yet, some patients complain that the vestibular sedatives make them drowsy. Such is the nature of medicine: one trades off the benefit of the treatment in exchange for acceptance of the side effects. In this case, one makes a choice as to whether one would prefer vertigo or drowsiness. However, what many patients fail to understand is that they can work with their doctors to adjust the dosage of the vestibular sedatives to reach the point at Hydrochlorothiazide dosage menieres which the patient is willing to Hydrochlorothiazide dosage menieres accept the trade-off: the point at which the vertigo is sufficiently controlled and at which the patient is willing to accept that particular degree of drowsiness as a side effect. One's doctor may either adjust the strength of the prescription or simply advise the patient to break or cut the pills. Valium (generic: diazepam). The purpose of Valium in treating Meniere's Disease is to prevent or reduce vertigo by sedating the vestibular system. Antivert, Meclizine (generic: meclizine hydrochloride). Antivert (Meclizine) is an antihistamine that is also a vestibular sedative. Hydrochlorothiazide dosage menieres The purpose of Antivert in treating Meniere's Disease is to prevent or reduce vertigo and hence the resultant nausea by sedating the vestibular system. Information on meclizine hydrochloride is available at MedLinePlus (NIH). Meclizine hydrochloride 25 mg. tablets may be purchased over-the-counter in the U.S. and elsewhere under various brand name and private label products sold for car, air, and seasickness, including Dramamine Hydrochlorothiazide dosage menieres II and Dramamine Less Drowsy Formula, Bonamine, and Bonine (but not regular Dramamine, which is 50 mg. dimenhydrinate). Names and formulations vary and are subject to change; be sure Hydrochlorothiazide dosage menieres to read the ingredients and potency listed on the package. Also available in generic form, over the counter (but sometimes "behind the counter," meaning one asks the pharmacist for it but a prescription is not required). Generic meclizine hydrochloride can be bought by mail Hydrochlorothiazide dosage menieres without prescription at Amazon.com and elsewhere. Phenergan (promethazine hydrochloride). Phenergan is an antihistamine and vestibular sedative, the purpose of which in treating Meniere's Disease is to sedate the vestibular system. Those who are currently experiencing nausea and vomiting and are unable to "keep down" the oral form may well find that rectal suppositories of this drug are Hydrochlorothiazide dosage menieres much more effective. Anti-nausea drugs. Unlike some diseases and conditions, and some drugs, Meniere's Disease does not cause nausea. Meniere's Disease causes vertigo (the spinning sensation), a consequence of which may be Hydrochlorothiazide dosage menieres nausea. A consequence of the nausea may be vomiting -- sometimes severe, even projectile, vomiting. Ideally, one would control one's nausea by controlling one's vertigo. However, when Hydrochlorothiazide dosage menieres attempts at controlling one's vertigo are ineffective, then one will still want to try to control the consequential nausea. One of the problems with taking medicine to control nausea is that if one is already vomiting, one will have difficulty in keeping down and absorbing oral meds. Scopolamine transdermal patch. This patch was off the U.S. market for some time, but it's back. Scopolamine is sometimes prescribed as an antiemetic, antinausea drug to treat the nausea of Meniere's Disease brought on by vertigo. Phenergan (promethazine hydrochloride). An antihistamine and vestibular sedative, the purpose of which in treating Meniere's Disease is to sedate the vestibular system. Those who are currently experiencing nausea and vomiting and are unable to "keep down" the Hydrochlorothiazide dosage menieres oral form may well find that rectal suppositories Hydrochlorothiazide dosage menieres of this drug are much more effective. Ginger root. Although ginger root is not a "drug," we mention it here because so many people find that ginger root, or ginger root tea, is effective in reducing nausea. Immunosuppressant (immuno-suppressant) drugs: prednisone, methotrexate, Enbrel, Remicade, etc. Treatment of immune-mediated (induced) conditions. (Also called immune-mediated, autoimmune-mediated, and auto-immune-mediated conditions.) Some researchers believe that some or all cases of Meniere's Disease result from, or Hydrochlorothiazide dosage menieres are aggravated by, an autoimmune condition in which the immune system is overactive and erroneously attacks certain normal cells as if they were a threat. Immune-mediated conditions Hydrochlorothiazide dosage menieres are difficult to diagnose. With Meniere's Disease, a doctor who suspects an immune-mediated Hydrochlorothiazide dosage menieres condition may prescribe a round of prednisone. If the patient's symptoms are reduced by the prednisone, then longer-term immunosuppressant treatment may be recommended. There is a fine line between immune-mediated Meniere's Disease and Autoimmune Hydrochlorothiazide dosage menieres Inner Ear Disease (AIED). See: Autoimmune Hydrochlorothiazide dosage menieres Inner Ear Disease (AIED). Information from Baylor College of Medicine. Abstract: Allergic and Hydrochlorothiazide dosage menieres immunologic aspects of Meniere's disease (via Pub Med). Prednisone is a generic name for several branded drugs; it is a steroid, the purpose of which in treating Meniere's Disease is to suppress the Hydrochlorothiazide dosage menieres immune system and/or to reduce inner ear inflammation. You should be extremely careful in following the prescribed instructions for taking Hydrochlorothiazide dosage menieres this powerful drug, especially any instructions regarding a tapered withdrawal. Prednisone is often prescribed for Meniere's Disease, sometimes in combination with, or preceding, treatment with methotrextate (MTX) or other powerful immunosuppressant drugs. Chronic (long-term) administration of prednisone would have extremely serious side effects that should be discussed with your doctor. MedicineNet on prednisone. Coping Hydrochlorothiazide dosage menieres With Prednisone (and Other Cortisone-Related Medicines); It May Work Miracles, but How Do You Handle the Side Effects? by Eugenia Zukerman and Julie R. Ingelfinger, M.D. Methotrexate. This immunosuppressant drug has been used to treat suspected immune-mediated cochleovestibular disorders. Note that methotrexate should be administered carefully and is reported to have caused deaths. See the article at RXMED. Still, methotrexate is widely prescribed for autoimmune diseases, especially rheumatoid Hydrochlorothiazide dosage menieres arthritis. Sometimes otologists will prescribe a therapy of methotrexate to be administered by Hydrochlorothiazide dosage menieres a rheumatologist who has more experience with immunosuppressant Hydrochlorothiazide dosage menieres drugs. Emerging immunosuppressant drugs. There are emerging immunosuppressant drugs, Hydrochlorothiazide dosage menieres such as Enbrel and Hydrochlorothiazide dosage menieres Remicade, that are finding their way into treatment of suspected immune-mediated Meniere's Disease. Talk to your doctor. Serc (betahistine hydrochloride). This drug which is widely prescribed for Meniere's Disease outside of the U.S. Contrary to false information available elsewhere, this drug under the brand name Serc may be imported under strict conditions into the U.S., and the generic equivalent (betahistine hydrochloride) is legally available Hydrochlorothiazide dosage menieres by prescription from compounding pharmacists in the U.S. See our comprehensive page on Serc (Betahistine Hydrochloride) for more information, Histamine. Since betahistine hydrochloride, a histamine analog, may help some Meniere's Disease patients, one would logically wonder about the efficacy of histamine in treating Meniere's Disease. Click here to search PubMed for Meniere's Disease and histamine. Click here to search PubMed for Meniere's Disease and histamine phosphate. Lidocaine (also see licodaine under surgical, below). The purpose of using lidocaine in Hydrochlorothiazide dosage menieres the treatment of Meniere's Disease is to treat the symptom of tinnitus. There has been an early report that indicates Hydrochlorothiazide dosage menieres that lidocaine drops in the nose may help to reduce tinnitus in some patients. This therapy is in its infancy all over again. The potential of the "cains" for relieving tinnitus was first observed long ago. FDA on lidocaine and tinnitus. Retrospective case review on the administration of lidocaine to treat tinnitus by Dr. John J. Shea, Jr., and presented at the American Otological Society Annual Meeting in Orlando, Florida, May 13, 2000. This paper Hydrochlorothiazide dosage menieres is not reported in PubMed. Novocain (procaine hydrochloride) was long ago found to have some tinnitus-relieving properties. Xylocaine (lidocaine hydrochloride) is in current vogue. Click here to search Hydrochlorothiazide dosage menieres PubMed Hydrochlorothiazide dosage menieres for lidocaine and tinnitus. Surgical. The principal purpose of most surgery is to relieve severe vertigo. Overview. Compilation of Treatments for Meniere's Disease, Washington University. Merely talking about surgery. According to this "erratum" note in a medical journal, many patients who are scheduled Hydrochlorothiazide dosage menieres for surgery experience remission before the surgery is actually performed. The authors suggest scheduling surgery two months in advance, possibly not in earnest, to see whether simply scheduling the surgery will produce remission. Pressure equalization (PE) tubes, tympanostomy tubes, myringotomy tubes, ventilation tubes, and grommets. The middle ear is "ventilated" by virtue of a structure Hydrochlorothiazide dosage menieres called the Eustachian tube. This tube connects the middle ear to the pharynx (throat). It is like a valve that opens and closes. When it opens, air Hydrochlorothiazide dosage menieres pressure in the middle ear is equalized with the outside air pressure. The Eustacian tube typically opens during yawning and swallowing. The the function of the Eustacian tube, and the state of Hydrochlorothiazide dosage menieres pressure in the middle ear, can be tested by means of a tympanogram.. If the Eustachian tube is Hydrochlorothiazide dosage menieres becomes dysfunctional by congestion, infection or otherwise, pressure in the middle ear can occur to the point of pain. Congestion and infection Hydrochlorothiazide dosage menieres may be treated by decongestants, antihistamines, and antibiotics (if the infection is suspected to be bacterial in nature). For chronic (continuing) cases, doctors sometimes create an alternate opening to middle ear from the outer ear by creating an opening in the eardrum and by inserting a tube called a "pressure equalization (PE) tube" or a "ventilation tube" or, sometimes (especially Hydrochlorothiazide dosage menieres in Australia), a "grommet." When a PE tube Hydrochlorothiazide dosage menieres is in place, there is a continuous opening in the eardrum, and air pressure in the middle ear is continuously "equalized" with the air pressure outside of the middle ear. Infants suffering from middle ear infections (otitis media) often have PE tubes inserted. The symptom of fullness that is experienced with Meniere's Disease feels just like pressure in the middle ear -- but it is *not* pressure in the middle ear. Meniere's Disease has nothing to do with the Eustachian tube, and the typical Meniere's Disease patient has a fully functioning Eustachian tube. If so, adding a PE tube wouldn't accomplish anything. Nonetheless, doctors sometimes insert PE tubes into patients who have fully functional Eustachian tubes, Hydrochlorothiazide dosage menieres and the Hydrochlorothiazide dosage menieres patients sometimes report improvement with their symptoms, possibly (or probably) due to a placebo effect. Click here to read Dr. Timothy Hain's comments on PE tubes. Click here to search PubMed for Meniere's Disease and Hydrochlorothiazide dosage menieres pressure equalization (PE) tubes (also called ventilation Hydrochlorothiazide dosage menieres tubes and grommets). Transtympanic (intratympanic) instillation and perfusion of drugs. Transtympanic (intratympanic) (through the tympanic membrane (ear drum)) instillation (insertion) and perfusion ("seeping" through the round window separating the middle ear from the inner ear) of various drugs, including dexamethasone (DMZ) (Decadron), streptomycin, and gentamicin). Note: The October 2004 Hydrochlorothiazide dosage menieres issue (Vol. 27, pp. 955-1113) of "Otolaryngologic Clinics of North America" is devoted to "Intratympanics (sic) Treatment of Inner Ear Disease." The titles of the 10 substantive articles inside appear relevant and interesting to Meniere's Disease patients. Click here to view the contents. Viewing the full text is trickier. There is a 30 day trial, there is access to individual articles, and there is access to purchasing a full issue. Hydrochlorothiazide dosage menieres A more practical means of access is to visit a hospital or Hydrochlorothiazide dosage menieres medical school library. (See our research page.) Drugs used in transtympanic instillation and perfusion. Nonototoxic drugs. Some corticosteroid drugs Hydrochlorothiazide dosage menieres are used, perhaps among other purposes, Hydrochlorothiazide dosage menieres to (1) reduce inflammation and (2) to suppress the immune system. Dexamethasone (DMZ) (Decadron). The apparent purpose of transtympanic instillation and perfusion of DMZ is to Hydrochlorothiazide dosage menieres reduce inflammation and to suppress the immune system very directly, perhaps together with or followed by additional DMZ Hydrochlorothiazide dosage menieres administered intravenously and/or orally. Apparently, this therapy presumes that inflammation and/or an autoimmune (overactive immune) condition is causing or contributing to the symptoms. DMZ is apparently not believed to be ototoxic. Some physicians believe Hydrochlorothiazide dosage menieres that this procedure has great potential Hydrochlorothiazide dosage menieres for relieving vertigo while preserving, and in some cases, even improving hearing. Others disagree. As always, see your physician for medical advice. Click here to search PubMed for Meniere's Disease Hydrochlorothiazide dosage menieres and Dexamethasone (DMZ) (decadron). Labyrinth anesthesia (lidocaine). From time to time, researchers will instill lidocaine (sometimes together with the drug Kinetin) into the middle ear (for subsequent perfusion into the inner ear) Hydrochlorothiazide dosage menieres in hopes of improving Meniere's Disease symptoms. Just how this might work has not been satisfactorily explained (at least, not to us).Note that Hydrochlorothiazide dosage menieres this is a topic distinct from the use of Hydrochlorothiazide dosage menieres lidocaine in treating tinnitus (from Meniere's Disease or otherwise), above. Dr. Timothy Hain reports that it is "hard to understand" why lidocaine might work to Hydrochlorothiazide dosage menieres produce a remission, although he notes: "Kinetin is a plant growth factor, pesticide, and an ingredient in Hydrochlorothiazide dosage menieres skin preparations. Perhaps Kinetin has a positive effect on Meniere's disease." We think that Dr. Hain was speculating on a possible factor for the outcome described in the article, rather than rendering a judgment on the use of Kinetin. Click here Hydrochlorothiazide dosage menieres to search PubMed for Meniere's Disease and labyrinth anesthesia or kinetin. Click here to search PubMed for Meniere's Disease and lidocaine or novacain. Ototoxic drugs ("ear poisons"). The purpose of transtympanic instillation and perfusion of ototoxic drugs ("ear poisons") is to chemically ablate (destroy) part or all of the inner ear. Streptomycin ("strep"). This famous antibiotic is very ototoxic, which is one reason why it is no longer used as an antibiotic, except in rare cases when there is no other treatment. Not only is streptomycin Hydrochlorothiazide dosage menieres toxic to Hydrochlorothiazide dosage menieres the vestibule (balance function), but it is also toxic to the cochlea (hearing function). Streptomycin may be used to chemically ablate the balance function, but it will also destroy Hydrochlorothiazide dosage menieres whatever may be left of the hearing function, thus resulting in a "chemical labyrinthectomy" (in effect, destruction of the entire labyrinth). An alternative would be a "surgical" labyrinthectomy, in which the organs of the labyrinth are surgically removed. A high dose of gentamicin (see below) could be used instead of streptomycin. Streptomycin may be administered intravenously to accomplish the same Hydrochlorothiazide dosage menieres result, but the destruction that results from this procedure Hydrochlorothiazide dosage menieres applies to both ears instead of one ear. This methodology is usually used, if at all, only when the patient Hydrochlorothiazide dosage menieres is bilateral (Meniere's Disease symptoms in both ears) and has already lost all, or nearly all, hearing in both Hydrochlorothiazide dosage menieres ears. Click here to search PubMed for Meniere's Hydrochlorothiazide dosage menieres Disease and streptomycin. Gentamicin ("gent"). Like streptomycin (above), gentamicin is an antibiotic, and it is also ototoxic, although less ototoxic than streptomycin. There are three possible reasons for transtympanic instillation of gentamicin. 1. To destroy the "dark cells" that produce endolymph, with the objective of reducing the production of endolymph, thus reducing the "hydrops." If this is the reason, the hope is that the tiny hairs in the vestibule (which affect the balance function) and the tiny hairs in the cochlea (which affect the hearing function) will be undamaged, or at least not damaged very much. This is usually a very low dose (in terms of volume and strength) of gentamicin. There may be one or more injections, and the length of time (interval) between multiple injections may vary. 2. To damage the tiny hairs in the vestibule with the objective of impairing the transmission of faulty vestibular (balance) data to the brain. If this is the reason, the hope is that the tiny hairs in the cochlea will be Hydrochlorothiazide dosage menieres undamaged, or at least not damaged much, because damage to the tiny hairs in the cochlea causes hearing loss. Hydrochlorothiazide dosage menieres There may be one or more injections, and the length of time between multiple injections may vary. This is usually a somewhat higher dose of gentamicin that is given for purpose 1 above, but still a Hydrochlorothiazide dosage menieres low enough dose to attempt to preserve whatever hearing may remain. 3. To ablate (destroy) the labyrinth totally, using a high dose of gentamicin, with the objective of totally destroying the tiny hairs in the vestibule to block all transmission of vestibular (balance) data to the brain, and accepting the concurrent destruction of the tiny hairs in the cochlea, Hydrochlorothiazide dosage menieres which will cause deafness. This high dose of gentamicin is usually (but not always) performed when there is little or no Hydrochlorothiazide dosage menieres functional hearing left. This is called a "chemical labyrinthectomy," because the effect is to totally destroy all Hydrochlorothiazide dosage menieres functions of the labyrinth, both vestibular and cochlear. Streptomycin (see above) could be used for this purpose instead of gentamicin. An alternative would be a "surgical" labyrinthectomy, in which the organs of the labyrinth are surgically removed. There are different "protocols" for each of the methodologies above, depending on the patient and on the doctor. The strength of the gentamicin and the interval between the instillations Hydrochlorothiazide dosage menieres may vary. University of Pittsburgh Medical Hydrochlorothiazide dosage menieres Center. Click here to search PubMed for Meniere's Disease and gentamicin/gentamycin. Methodology. Simple. In the Hydrochlorothiazide dosage menieres simplest of methods, an office procedure, one lays on one's side, with the ear to be treated toward the sky and the other ear against the bed or Hydrochlorothiazide dosage menieres whatever surface one is lying upon. A surgeon swabs the ear drum with a local anesthetic, then pokes a needle through the ear drum and instills (injects with a syringe) a drug toward the round window. The patient lies still for some period of time, and with luck the drug will pool Hydrochlorothiazide dosage menieres in the round window and perfuse through the round window to the inner ear. [Editor's note: this methodology comes from anecdotal reports from patients.] Laser. With this method, performed in an office, surgical suite, or Hydrochlorothiazide dosage menieres hospital, one lays on one's side, with the ear to be treated toward the sky and the other ear against the bed or whatever surface one is lying upon. The patient is either placed under general anesthesia Hydrochlorothiazide dosage menieres or the ear drum is swabbed with a local anesthesia. The surgeon then uses a laser to burn a hole through the ear drum. (Note that the laser is not used to "treat" Meniere's Disease; the laser is merely a tool to place a hole in the eardrum.) A drug is then instilled (injected with a syringe) toward the round window. The patient lies still for some period of time, and with luck the drug will pool in the round window and perfuse through the round window to the inner ear. The patient lies for a couple of hours or so in a recovery room in the position described above. The hole heals rather quickly, Hydrochlorothiazide dosage menieres and so this method might involve daily administration of the drug over a short time. Gelfoam (absorbable gelatin sponge) With this method, performed in an office, surgical suite, or hospital, one lays on one's side, with the ear to be treated toward the sky and the other ear against the bed or whatever surface one is lying upon. A surgeon uses a laser to burn a hole in the ear drum. The surgeon then operates through the hole to place a piece of Gelfoam in the bony niche that surrounds the round window. The drug is instilled into through the opening in the ear drum and is soaked Hydrochlorothiazide dosage menieres up by the Gelfoam. The theory is that this method provides a greater likelihood that the drug will actually be delivered to the round window and perfused more effectively under more consistent circumstances. Abstract of Article by Dr. Silverstein, Ear Research Foundation, Sarasota, Fla., US, concerning a procedure using Gelfoam. Journal of Otolaryngology-Head and Neck Surgery, May 1999. Abstract of article by Dr. Arriaga, Allegheny General Hospital, Pittsburgh, Pa., US. concerning a procedure using Gelfoam. Laryngoscope, Nov. 1998. Abstract of Article by Dr. Silverstein, Ear Research Foundation, Sarasota, Fla., US, concerning a procedure using Gelfoam. Ear, Nose, and Throat Journal, Aug. 1996. Variation: Self-Administration In one variation of the procedure, reported anecdotally by a patient, a ventilation tube (in some areas, called a "grommet") is placed into the ear drum. This creates Hydrochlorothiazide dosage menieres an opening of some duration. Under this variation, some physicians will have the patient self-administer the drug using a dropper, perhaps over time. Silverstein MicroWick With this method, a ventilation tube (sometimes called pressure equalization (PE) tube, or, in some areas, "grommet") is placed into the eardrum. This creates an opening of some duration. One end of the MicroWick is inserted through the tube into the bony niche in the middle ear that surrounds the round window. The Hydrochlorothiazide dosage menieres other Hydrochlorothiazide dosage menieres end of the MicroWick extends through the tube into the outer ear. The patient may self-administer the drug over time. Silverstein MicroWick page at the Florida Ear and Sinus Center, Sarasota, Fla., US. Great explanation of the Silverstein MicroWick, with a great illustration! RealVideo "movie" of the procedure used to place the MicroWick into a patient's ear! Abstract of an article by Dr. Silverstein, Ear Research Foundation, Sarasota, Fla., US, concerning the use of a new device, the MicroWick, to deliver medication to the inner ear. Ear, Nose, and Hydrochlorothiazide dosage menieres Throat Journal, Aug. 1999 Very nice Hydrochlorothiazide dosage menieres illustrations of the Micro-Wick and of pressure equalization (PE) tubes at the Micromedics website. Round Window Microcatheter (also: Round Window Micro-Catheter). The Round Window Microcatheter is a portable pump used to deliver a consistent, controlled, quantity of low-potency gentamicin through the ear drum to the round window membrane separating the middle ear from the inner ear, with the intention that the gentamicin perfuse through the round window membrane to the inner ear. The intention is that a controlled delivery Hydrochlorothiazide dosage menieres of low-potency gentamicin over weeks would permit the destruction of cells in the inner ear in order to reduce vertigo, yet at the same Hydrochlorothiazide dosage menieres time not be so destructive as to further impair hearing. We first read about the round window microcatheter in this 1997 U.S. Navy press release, which describes its use by Navy doctors at the Naval Medical Center in San Diego. At the time, the device Hydrochlorothiazide dosage menieres was manufactured and marketed by a company called "IntraEar, Inc." In 2001, Durect, Inc., acquired IntraEar, Inc., and the round Hydrochlorothiazide dosage menieres window microcatheter As of May 2004, there have been seven published studies on this device found through PubMed. However, in May 2004 we could no longer find current information on the round window microcatheter, and there was no mention of it at the Durect website. Click here to search PubMed for Meniere's Disease and round window microcatheter. Endolymphatic sac surgery. A somewhat pricey book (2/98) by I.K. Arenberg (inventor of the Arenberg shunt), "Treatment Options for Meniere's Disease -- Endolymphatic Sac Surgery: Do It or Don't Do It and Why," should be of interest to many Menierians. This surgery is somewhat controversial; some doubt the efficacy and duration of efficacy even under the best of circumstances. Others believe that, given the right surgeon and the right patient, this surgery may be helpful over a long period of time. Endolymphatic sac decompression (ESD). This term may be used Hydrochlorothiazide dosage menieres in two ways: Endolymphatic sac enhancement (ESE) -- enlargement of the bony cavity that surrounds the endolymphatic sac by Hydrochlorothiazide dosage menieres drilling away bone. Washington University, St. Louis, Mo., U.S.A. Associates in Otolaryngology, Head & Neck & Facial Plastic Surgery. Michigan Ear Institute. One-time drainage of fluid from the endolymphatic sac to reduce pressure and excess endolymph. Because the effects of the ESD may not be long-lasting, an endolymphatic sac shunt (ESS) (described below) may be inserted to provide continuous drainage. Ear Surgery Information Center. University of Minnesota. Michigan Ear Institute. Endolymphatic sac shunt (ESS) surgery. Introduction of a tiny device (valve or tube), or surgical plastic (Silastic), into the endolymphatic sac to continuously shunt (drain) excess endolymph, thereby reducing dilatation, a procedure pioneered by Dr. I. Kaufman Arenberg, who developed the Arenberg Shunt. This surgery is somewhat controversial. Some critics say that it is a "sham" surgery because, they say, the results are no better than a placebo. Other critics say that the surgery is short-lived because scar tissue covers the device within Hydrochlorothiazide dosage menieres two years or so. Supporters contend that the surgery is helpful for some patients. Click here to view a photo of endolymphatic sac shunt surgery (Otolaryngology Houston). Click here to search Hydrochlorothiazide dosage menieres PubMed for Meniere's Disease and shunt (endolymphatic shunt surgery). Click here to search PubMed for Meniere's Disease and Shunt Sham (whether shunt Hydrochlorothiazide dosage menieres surgery is any better than sham surgery). Surgical labyrinthectomy (laby). Surgical removal of the labyrinth (balance organ of the inner ear) of Hydrochlorothiazide dosage menieres one ear. Usually performed only on patients who are already deaf in the affected Hydrochlorothiazide dosage menieres ear, because this procedure removes both the balance and hearing mechanism in the ear. The remaining unaffected ear "learns" to provide all balance functions. Click here to search PubMed for Meniere's Disease and labyrinthectomy. Vestibular nerve section (VNS) or vestibular neurectomy (VN). Although the VNS is described by some patients (and doctors) as the "gold standard" for treating the symptom of vertigo in Meniere's Disease patients, VNS is not 100% successful, for a variety of reasons. The nerve at issue is the Hydrochlorothiazide dosage menieres vestibulocochlear (8th cranial) nerve. This nerve can be thought of as a road with a fork at each end. Hydrochlorothiazide dosage menieres At the inner ear end, hearing nerve fibers coming from the cochlea form one branch of the fork, and balance nerve fibers coming from the vestibule form another branch of the fork. They join in what becomes the vestibulocochlear nerve that runs from the inner ear to the brain. Before the nerve reaches the brain, however, the nerve Hydrochlorothiazide dosage menieres branches off into the vestibular branch Hydrochlorothiazide dosage menieres and the auditory branch. Each branch attaches to the brain at a different site. In VNS surgery, the surgeon severs (sections) the vestibular branch near where it meets the brain, thus interrupting the vertigo signals from the vestibule before they can reach the brain and cause dizziness. An attempt is made to leave the auditory branch untouched, therefore preserving whatever hearing Hydrochlorothiazide dosage menieres remains at that point in time. Of course, since VNS is merely a treatment for the symptom of vertigo, and since Meniere's Disease is incurable Hydrochlorothiazide dosage menieres and progressive, hearing loss, tinnitus, and fullness continue to progress in every case. This is very invasive skull base surgery (many would say brain (intracranial) surgery). There are many different techniques for locating and severing the vestibular nerve. Each technique has its advantages and disadvantages; talk to your doctor. Potential problems with VNS. Human anatomy varies quite a bit from person to person, as is learned by medical students in their human anatomy and cadaver dissection classes. In some patients, *some* vestibular fibers run with the auditory branch. Thus, they remain in service even after the vestibular branch is severed. It is possible that the vestibular branch does not get completely severed. It is possible that one has or develops Meniere's Disease in the other ear. Occasionally, surgeons theorize that after surgery the severed ends Hydrochlorothiazide dosage menieres of the vestibular branch have regenerated and "rejoined" or "reconnected," although we are greatly Hydrochlorothiazide dosage menieres skeptical of this explanation. There there is the unknown "aw shit" factor. Sometimes, it just doesn't work out as expected and no one really knows why for sure. Then there are other risks with VNS surgery. The surgeon cuts the Hydrochlorothiazide dosage menieres wrong nerve (it happens). Sometimes the facial (7th cranial) nerve is mistaken for the vestibular Hydrochlorothiazide dosage menieres branch of the vestibulocochlear (8th cranial) nerve. This is a Hydrochlorothiazide dosage menieres devastating problem. The facial nerve is bruised during surgery (it Hydrochlorothiazide dosage menieres runs close to the vestibulocochlear nerve). A cerebral-spinal fluid (CSF) leak develops. Infection is always a risk with surgery and with hospitalization. Complications from anesthesia. Remaining hearing is compromised, despite the theoretical preservation of remaining hearing (subject to the unrelenting progression of Meniere's Disease). Failure of vestibular nerve section. Dr. Timothy Hain. Dr. Hain cites a paper by Eisenman, et al, to the effect that there was evidence that there is retained vestibular function in about half the patients who have a nerve section. Failure of vestibular nerve section. American Hearing Research Foundation. Click here to search PubMed for Meniere's Disease and vestibular neurectomy (VN)/vestibular nerve section (VNS). Retrolabyrinthine/retrosigmoid vestibular neurectomy (RRVN). This is one surgical technique out of several for performing a VNS. Microvascular Decompression (MVD). Some doctors believe that the symptoms of Hydrochlorothiazide dosage menieres Meniere's Disease may result from pressure of blood vessels upon the vestibulocochlear (8th cranial) nerve; if so, they believe, relieving the pressure of the blood vessels on the vestibulocochlear nerve may relieve Hydrochlorothiazide dosage menieres the symptoms of Meniere's Disease. This involves separating the depressing vessel from the nerve in what is called microvascular decompression. Some doctors view microvascular compression syndrome (MCS) as a separate disease. Microvascular compression syndrome, Dr. Timothy Hydrochlorothiazide dosage menieres Hain. Microvascular decompression (MVD), Illustrated, Neurosurgery.org. Click here to search PubMed for Meniere's Disease and microvascular decompression (MVD). Copyright © 1997-2005 Meniere's Disease Information Center. All rights are reserved. All copying, including (but not limited to) websites, bulletin boards, forums, and blogs, is prohibited. Linking is permitted and encouraged. Click here for more copyright information.
buy generic lasix 40mg online

Hydrochlorothiazide dosage menieres pharmacy

main Hydrochlorothiazide dosage menieres