Each day we see new patients affected by one or more disorders from a inner ear dysfunction (tinnitus, sensorineural deafness, vertigo or other balance disorders, or with a previous diagnosis, but still searching a treatment, of typical Meniere's disease). In most of our patients hydrops can be directly suspected already collecting the clinical history of patient's troubles which are often described as fluctuating and not constant. This changeable situation can not be only due to a permanent damage, that could only produce, obviously, a permanent symptom. But even in case of a permanent symptom like i.e. a tinnitus heard always at the same loudness level, we can not diagnose a permanent damage or exclude a reversibility with the right treatment.
Success or failure of the special treatment we have conceived, which is the result of many years of intensive interdisciplinary clinical research, is mainly linked to the particular and present functional status of the ear of every single patient, wich can't be evaluated without carrying out special diagnostic tests other than the traditional ones. The peculiar psychological status of every single patient must be as well taken in account because psychological stress is often a main factor for the development of an ear hydrops and for the frequency of recurrent crisis.
The production of tinnitus or sensorineural deafness, giddiness / dizziness or disorders of balance can be basically the expression of one or more among three different pathological mechanisms: fluids excess in the inner ear (hydrops); permanent damages of the cochlear cells ; troubles with the acoustic or vestibular nerves.
Only in the first case of three (the hydrops) a treatment can be effective but, fortunately, this is the actual situation for at least 70% of patients. This situation is widely underestimated because, without performing a complete functional evaluation of the whole labyrinth and listening carefully to patient's complaints, the ENT specialist cannot always recognize the hydrops, so that the most frequent diagnosis the patients generally still receive is that there must be an "hypothetical" (but not actually shown) permanent damage of cells or nerves. The "logical" consequence is that the best suggestion the patient often receives is... "there's nothing we can do!"
Dealing with a "typical" Meniere's disease, the right treatment can always reduce the frequency and the lenght of the recurrent rotatory vertigo crises, as well as stop (in most of cases) the evolution of the hearing loss (it can be rather often reduced, partially or completely) and remove the feeling of fullness and pressure in the ear (a typical symptom of hydrops). There's no need, and until now we never had it for more than a thousand of Meniere's disease patients we have treated, at the level reached by therapeutical means and knowledge, to cut the vestibular nerve or to destroy the labirynth with ototoxyc drugs, even if those are nowadays the most proposed ways to prevent new crises. The rate of success with Meniere's disease tinnitus with the sole treatment against the hydrops, is generally high, but less predictable, because it depends of the residual functional status of the cochlear cells, which could be (but it's not the rule) partially but permanently damaged after many years of recurrent crises.
Our functional evaluation always includes special tests, like the assessment of activity of the cochlear cells and nerves (OtoAcoustic Emissions, OAE) and the evaluation of the bioelectrical transmission thru the acoustic nerve and the auditory pathways (Evoked Potentials, ABR, BSER).
At the end of the diagnostic stage we decide with the patient affected by an hearing (tinnitus or/and hearing loss) or balance disorder (giddiness, instability) if and how his/her problem can be treated and above all, IF there's the need for a treatment considering that many patients only need to be reassured, because the symptoms are indeed very rare or not annoying at all.
Indeed, even when the diagnostic test do not show directly the presence of hydrops, or even if there's a strong clinical suspicion of an unrecoverable permanent damage, we could often reach significant improvements. The inner ear actual and present status, could indeed be better whatever is shown by the tests. In case of tinnitus or deafness, in example, cochlear cells can be intact, even if they're not "sufficiently working" because of the hydrops, and this could lead to a false "absence of response" at the specific functional tests.
One main goal of the treatment, in that case, is also to reach a diagnosis. Even if initial success is only partial or temporary we have shown, in any case, the reversibility of the dysfunction, that means that there was at least a component due to the excess of fluids and not coming from a permanent damage.
In case of failure, it could be possible, to deal with each problem (when the dysfunction is not, indeed, totally reversible) by means of other methods (like, for example, the TRT - Tinnitus Retraining Therapy or the vestibular rehabilitation, that must be taken in account when a balance disorder is caused by a permanent damage of the labirynthic receptors, indeed more rarely then what is generally diagnosed). But in that case after the failure of the treatment, that must be taken in account for not-fluctuating hearing losses or tinnitus not reversible after the treatment itself, we refer the patient to other centers.
In other words, the treatment can be effective for fluctuating tinnitus or hearing losses (deafness), recurrent vertigo crises or balance disorders, ear fullness, but a complete success can not be promised to everyone if we are dealing with permanent hearing loss or tinnitus. Indeed we try...and sometimes we reach an unexpected success. But it wouldn't be honest to say that "EVERY HEARING LOSS or TINNITUS can be cured". And before searching a contact for a date and to let you grow your illusion, it's very important, if your tinnitus or hearing loss is REALLY permanent without any change of loudness or loss, to understand well that. Even if it's true that every patient has the right to try to be treated, we can't say that every patient will have a sure benefit. Because our treatment cures the inner ear fluids excess. Real permanente damage (that we can suppose but it can't be certified) CAN'T BE YET TREATED. It's clear?
The main goal of the therapy we have conceived to deal with hydrops is mainly the regulation of the antidiuretic hormone release. It doesn't have any side effect.
But, how is this treatment pratically performed? It is based on three different therapeutical approaches:
- Fluids (water) overload, that must be associated to a special diet (not just the low-salt diet traditionally suggested for Meniere's disease) conceived by us, and successfully used since 1998 to prevent Meniere's disease recurrent crises. Why that? Because water is the main and the only available (nowadays) antidiuretic hormone antagonist!
- A single intravenous treatment (only if the diet alone it's not enough!) with an osmotic diuretic and steroids (without any risk for side effects or complicance). Steroids, if they are associated with a water overload, do not cause a water retention but, on the opposite, they have a diuretic effect, because they regulate the release of the antidiuretic hormone!!. Nowadays we have changed the original treatment proposing a dissociated two-phases treatment because sometimes diet alone or diet and steroids can be enough.
- Treatment of stress and psychological factors (that's often, but not always, needed because stress is an important sustaining condition) with drugs active on the brain. The special treatment we propose in that case is characterized by low or none side effects and a therapeutic ability even directly (sometimes even avoiding the diet ) on tinnitus and vertigo and even on hearing. This is because stress can lead to an increased production of the antidiuretic hormon and by means of it to an increased hydrop in the inner ear.
How this treatment basically works?
1. IF we suppose that in the inner ear there is an excess of fluids
2. AND we know that fluids of the inner ear are under the regulation of the antidiuretic hormone (ADH) and the hydrops can be the result of a normal stimulation on a hypersensitive inner ear (due to different causes we can't know)
3. Even if we can't (yet) change the way the inner ear answers to ADH stimulation but we can control the release of the antidiuretic hormone to reduce the excess of fluids in the ear
Drugs with a specific activity against the ADH are not yet available for inner ear disorders. Tolvaptan is the name of an anti-ADH drug but it has not been studied enough for this purpose.
The main and more effective way to control the ADH is to guarantee a constant water intake. But this can work only if we add to the water intake a special diet to control the quality of food intake, that can't be limited to salt restrictions. Overload of water intake without food intake modifications and restrictions is generally uneffective and potentially dangerous.
Our special diet is often sufficient, alone, to prevent the recurrent crises of a initial Meniere's disease and to avoid a worsening of the dysfunction.
But if we want to reduce the hydrops already developed and "blocked" inside the inner ear, then we often need an additional help. So we try to reduce the excess of fluids already present with an acute intensive treatment with an osmotic diuretic (that works at its best only if associated to an overload of water intake) and steroids, for their ability to regulate the ADH release but only if they are associated with water intake.
The treatment has indeed no risks or danger, but there are some counter indications (absolute or relative) that must be evaluated before we can propose the treatment, particularly to aged patients. Unfortunately the treatment is not actually an option for children but only for adult patients.
All the diagnostic evaluation is performed in the same day, and there's no need generally for a second date.
In any case our treatment is a short-period therapy that aims to show results (if a success can be achieved) in few weeks. A possible recurrence after time, even in case of success, must be taken in account because we don't erase the disease from the ear, but every eventual recurrence can be treated in an easy way having learned the treatment without the need to come back again to the doctor every time. In our experience, in most of patients a short period tratment can protect the ear for a long time. The mein advantage of the treatment is that it's self-made without the nedd of many dates with the doctor. The specialist aid to the treatment after the first needed visit can be through phone or mail, so that patients can be treated even if living in other cities in Italy or abroad.
