Have you or someone you love been diagnosed with Meniere's disease? Learn more about this condition and how it is classified and supported within Traditional Chinese Medicine.
What is Meniere’s?
In the simplest of descriptions Meniere’s disease is an inner ear disorder that results in the sense of spinning / imbalance or vertigo and hearing loss. In most cases Meniere’s only affects one ear.
Meniere’s can take place at any life stage however it is more prevalent between early and middle adulthood affecting approximately one in every six hundred people aged between 30 and 50 years.
What are the symptoms of Meniere’s disease?
A persistent ringing, buzzing, roaring or whistling sound in the ear known as tinnitus.
Severe dizziness known as vertigo. This is a spinning sensation that is spontaneous and can occur without warning or trigger and last from a few minutes to several hours. Where vertigo is severe it Is often accompanied by nausea.
Intermittent hearing loss, particularly early on.
Sensation of pressure, congestion, or blockage in the ear.
Sufferers of Meniere’s Disease may find that between episodes their symptoms can ease or in some cases disappear.
Meniere’s from a Western Medicine Perspective -
The Western medicine diagnosis of Meniere’s disease, which is a build-up of fluid in the compartments of the inner ear, called the labyrinth is reached after a thorough exam and medical history. There are many other conditions that need to be eliminated to settle on a diagnosis of Meniere’s Disease.
Exploring the potential of Meniere’s Disease is certainly a good idea after the following symptoms are experienced:
Two or more episodes of vertigo lasting a minimum of 20 mins and no longer than 24 hrs.
Hearing loss and have had this confirmed by a hearing test.
Tinnitus or sensation of fullness / blockage in the ear.
As mentioned above it is important to have other causes for these symptoms excluded. This may require scans such as CT scans and MRIs to ensure that these are ruled out.
The Stages of Meniere’s Disease:
Meniere's Australia describes Meniere’s disease as generally seen to progress through three distinct stages of symptoms. We will explore those below:
Stage one-
Often the first sign of Meniere’s is the experience of imbalance and dizziness otherwise known as vertigo. The vertigo can also be accompanied by nausea and severe vomiting. Vertigo attacks can last for hours, at their worst even days. It is common for the vertigo to usually in clusters.
Stage two-
This is the time of more of a ‘classical’ presentation of Meniere's disease. The symptoms at this point include:
Continuing attacks of vertigo
Increasing and continuous tinnitus
Sensation of pressure or fullness in the ear
Fluctuating hearing ability that does not return to normal
Stage three-
The third stage of Meniere’s is also referred to as “burnt out Meniere's.” At this point hearing loss can be severe and without fluctuation in hearing levels. Tinnitus may still be present however the patient is so used to it that it can be considered less of an interruption to their day-to-day life. The severe vertigo attacks have in most cases settled and eventually they cease altogether. In line with the vertigo easing the vomiting attacks and nausea are also rare. At the point that the ear has lost 50% of its balancing function, the patient will have a persistent feeling of unsteadiness.
During stage three some patients experience a condition called Turmarkins crisis also known as ‘drop attacks.’ When this takes place the patients balance is lost for a duration of several seconds resulting in a fall. A ‘drop attack’ is sudden and takes place without warning.
Meniere’s Disease from a Traditional Chinese Medicine Perspective:
When approaching Meniere’s from a Chinese medicine perspective, we recognise many of the same symptoms as outlined in the Western Medicine approach, however we consider them as originating from a combination of:
external contraction of one of the six environmental excesses
internal damage by the seven affects
poor diet and lifestyle choices.
We also tend to organise Meniere's disease in the following categories:
xuan yun – dizziness
xuan mao - veiling dizziness
tou xuan - head dizziness
tou feng xuan - head wind dizziness e xin - nausea
To paint a clearer picture here are a few scenarios we may encounter when supporting a patient with symptoms of Meniere’s Disease:
A patient who is Yang in nature that is exposed to emotional stress, resulting in frustration and anger. This patient is also consuming spicy, acrid, hot, and fatty foods or drinking alcohol. The combination of all of these factors can result in their Liver Yang becoming excessive. In an extreme case this pattern may create Wind and transform into Fire.
We see the intrinsic link between our emotions and our physical symptoms played out constantly in TCM. One common example is a patient who has Liver damage or deficiency that occurs in patients with unrealised desires or anger. This also had the potential to transform into Fire. When you combine that with aging, other disease or imbalance, over work, excessive exercise, the use of drugs, or excessive sexual activity, the resulting Yin deficiency may lead to Yang excess with subsequent Wind and Fire. Ascending Wind and Fire can harass the clear orifices above and result in dizziness.
When the presents with chronic disease or fatigue then their Qi and Blood has likely become damaged. Simple blood loss can also result in Qi and Blood deficiency. Along with this if the patient has a tendency towards overthinking, worry and anxiety the Spleen will also be impacted. The experience of dizziness is a likely response to all of the above.
Kidney essence deficiency can be a result of any of the following: Poor constitution, aging, ongoing disease, drug use, and excessive sexual activity. Kidney essence deficiency engenders the marrow which gathers in the brain. If Kidney essence deficiency fails to fill the brain with marrow, then dizziness may occur.
Another common presentation is the patient who may be over-eating fried or sweet foods and/or drinking excess alcohol. In this case we see that dampness is formed internally and this dampness could further transform into phlegm. The emotions of excessive worry and anxiety can also damage the Spleen which if deficient may fail to transform fluids in the body. The resulting phlegm dampness or phlegm turbidity can obstruct the centre, block the clear orifices, and cause dizziness. If phlegm turbidity becomes depressed and creates heat or transforms into fire, phlegm and fire may ascend to assail the clear orifices. This can cause even more serious dizziness.
As with the TCM approach to and dis-ease or imbalance the patient must be considered as a whole and all factors environmental, dietary, and internal must be addressed in order to successfully overcome the imbalances and restore optimal health.
As you will have noted in our mock scenarios, Meniere’s Disease is often influenced by factors such as stress, poor diet and overeating and drug or alcohol consumption therefore it is essential that along with acupuncture, herbal medicine and other TCM therapies our patient’s ongoing support includes the appropriate lifestyle advice.
Traditional Chinese Medicine Treatment Protocols:
Following are a few potential acupuncture treatment protocols that Scott may use for Meniere's disease based on TCM pattern discrimination.
1. LIVER YANG RISING PATTERN.
-according to (Flaws & Sionneau 2005, pp.359-361).
MAIN SYMPTOMS:
Dizziness
Tinnitus with a loud noise
Possible diminished hearing
Head distension and pain
Easy to anger
Over exertion worsens the symptoms
Insomnia and profuse dreams
A bitter taste in the mouth
A flushed red facial complexion
A red tongue with yellow coat
A wiry, fine, rapid pulse
TREATMENT PRINCIPLES:
Calm the liver and subdue yang, tonify and nourish the liver and kidneys.
2. QI & BLOOD DEFICIENCY PATTERN.
-according to (Flaws & Sionneau 2005, pp.361-362).
MAIN SYMPTOMS:
Dizziness and vertigo made worse by movement and over exertion causing recurrent attacks
A marked sombre white facial complexion during attacks
A sombre white or sallow yellow facial complexion between attacks
Heart palpitations
Insomnia
Lassitude of the spirit and a desire to sleep
Slight but continuous tinnitus
Decreased hearing
Disinclination to speak
Devitalised eating and drinking
Cold hands and feet
A fat, pale tongue with teeth-marks on its edges
A fine, weak pulse.
TREATMENT PRINCIPLES:
Supplement and tonify the qi and blood, reinforce the spleen and harmonise the stomach.
3. KIDNEY ESSENCE DEFICIENCY PATTERN.
-according to (Flaws & Sionneau 2005, pp.362-363).
MAIN SYMPTOMS:
Dizziness
Continuous tinnitus which increases during attacks
Marked decrease in hearing during attacks
Devitalised essence spirit
Impaired memory
Insomnia
Profuse dreams
Lower back and knee soreness and limpness
In men, premature ejaculation
If yin vacuity is predominant, there is vexatious heat in the five hearts, a red tongue, and a fine, rapid pulse
If kidney yang deficient is predominant, there is lack of warmth in the four limbs, aversion to cold, decreased sexual desire, a pale tongue, and a deep, fine, force less pulse
TREATMENT PRINCIPLES:
Tonify the kidneys and support the essence. If tending to yin deficiency, also enrich yin. If tending to yang deficiency, also invigorate yang.
4. PHLEGM TURBIDITY OBSTRUCTING THE CENTER PATTERN.
-according to (Flaws & Sionneau 2005, pp.363-364).
MAIN SYMPTOMS:
Dizziness
Vertigo
Tinnitus with a low sound
Decreased hearing
Profuse phlegm
Heavy headedness
Chest oppression
Nausea and vomiting
Devitalized eating and drinking
Heart palpitations
Slimy white tongue fur
A soggy, moderate (i.e., slightly slow) pulse.
TREATMENT PRINCIPLES:
Transform phlegm and eliminate dampness, harmonise the stomach and stop vomiting.
These acupuncture protocols are of great assistance in the support of patients with Meniere's disease. With every individual there will be variable unique to their experience and as such these patterns are simply an example and would alter from person to person in a clinical setting.
Meniere’s disease can have a profound impact of the quality of life for a patient. It is a debilitating condition at times so if you or someone you know suffers from the symptoms of Meniere’s and would like to explore how Traditional Chinese Medicine can become part of their symptom management please do not hesitate to get in touch. You can contact us via our website or by calling (03)59061494.