The Ménière's Years (Part 9)
Vertigo and the Brain
According to AAO-HNS guidelines (American Academy of Otolaryngology - Head and Neck Surgery) —
Ménière’s disease is a clinical condition defined by spontaneous vertigo attacks, each lasting 20 minutes to 12 hours, with documented low- to mid- frequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. Clinical Practice Guideline: Ménière’s Disease | AAO-HNS Bulletin
Other references include this information as necessary for a diagnosis of Ménière’s Disease:
Two or more vertigo episodes lasting 20 minutes to 12 hours
Hearing loss confirmed by audiometry (usually in low frequencies)
Tinnitus or ear fullness in the affected ear(s)
No other explanation for the symptoms
I’ve heard the same explanation from many different specialists in addition to research in various medical journals.
[There are some people who believe Ménière’s disease is ‘over diagnosed.’ I will address those concerns in a future ‘Ménière’s Years’ newsletter.]
Vertigo and Brain Questions
I became interested in the long-term effects of vertigo on the brain after suffering a TIA (Transient Ischemic Attack) last year. I wrote about possible connections between Ménière’s and stroke in the last newsletter, so you can read more about that there.
My question to specialists, along with studying advanced medical research myself, is what long-term effects vertigo has on a person’s brain. The ‘early’ and ‘intermediate’ stages of Ménière’s often include sudden, unpredictable vertigo attacks. Many doctors and scientific organizations report that episodes of vertigo can become more severe in the intermediate stage. Even though ‘late stage’ Ménière’s may have less vertigo attacks and be replaced with more severe balance and hearing issues, how did years of vertigo affect the brains of Ménière’s sufferers?
[FYI — Some specialists divide stages of Ménière’s into the ‘aura’ stage, ‘early’ stage, ‘attack’ stage, ‘in-between’ attack stage, and ‘late stage.]
If you’ve experienced Ménière’s for many years (even decades), you’ve probably seen many doctors and specialists. Some I’ve seen used the term ‘Ménière’s Ladder’ when discussing the progress of Ménière’s. Their treatment often begins with lifestyle changes to ‘manage’ the disease along with ‘rescue’ medication for severe vertigo attacks. Moving up the ‘ladder’ leads to diuretics and invasive treatments like ITS (Intratympanic Steroid Injections) and surgeries on the inner ear.
Controlling the number and severity of vertigo attacks seems to be one goal of the ‘Ménière’s Ladder,’ but many patients suffer years of vertigo. So, what are the long-term effects of vertigo on the brain?
The Brain
The human brain has an amazing ‘adaptive’ ability. By that I mean it can suffer a variety of illnesses or injuries and use a variety of ways to adapt. The brain can adapt to Ménière’s vertigo by depending more on vision and proprioception (use of body awareness) for balance.
When I was going through the early diagnosis process of determining what was causing my dizziness, loss of balance, and vertigo, I asked an veteran doctor of audiology why I felt dizzy when I leaned forward, backward, to the left, or to the right. He explained how my brain was receiving ‘mixed signals’ from my ears and eyes and was responding to the information it was receiving by sending signals to various parts of my body about how to respond to the information it was receiving. More than one doctor told me my brain was working extremely hard to keep me balanced — much harder than someone who did not suffer from Ménière’s. Doctors told me that was one of the causes of my mental and physical fatigue. They also told me about ‘brain fog.’
“Brain fog” is a term for a range of symptoms that cause cognitive impairment. This affects your ability to think clearly, focus, concentrate, remember and pay attention. Like its name, these symptoms cloud your mind and make it difficult to perform routine tasks like holding a conversation, listening to instructions or remembering the steps of something you’re doing.” Cleveland Clinic
Most Ménière’s patients I’ve known through the years (personally and through forums) have complained about how the disease has affected their quality of life (QOL). The areas they’ve mentioned included everything from chronic vertigo, hearing loss, imbalance and increased risk of falling, brain fog, short-term memory, anxiety and panic attacks, depression, frustration, loss of sleep, tiredness, muscle weakness, shorter attention span, increased migraine headaches, along with problems from photo-phobia, sounds, and weather changes. Another problem mentioned by many is that friends, family, and co-workers often don’t understand what the patient is going through, with some even believing the Ménière’s patient is faking the symptoms.
What are we to make of all that? Can a person’s brain deal with years of those kinds of challenges?
Neuroplasticity
“Neuroplasticity, also known as neural plasticity or brain plasticity, is a process that involves adaptive structural and functional changes to the brain. A good definition is ‘the ability of the nervous system to change its activity in response to intrinsic or extrinsic stimuli by reorganizing its structure, functions, or connections.” National Library of Medicine
Even though many studies suggest that long-term vertigo may affect the vestibular cortex, the ‘neuroplasticity’ of the brain can help Ménière’s sufferers deal (to varying degrees) from years of vertigo attacks. Vestibular rehabilitation therapy (VRT), lifestyle changes, and medications can also help — though there is no known cure for Ménière’s.
Your specialists (e.g. ENT, Neurologist) can help you better understand how to reduce the number of vertigo attacks you have through the ‘Ménière’s Years.’ That could be an important benefit as you age.
[You might find this article in Science Direct interesting to read about both adaptive and maladaptive neuroplasticity.]
“… rejoicing in hope, patient in tribulation, continuing steadfastly in prayer.” Romans 12:12
Here’s to hope!
How Do I Subscribe To A ‘Section’ On Substack?
If you're a new subscriber to a publication on Substack, you'll receive all sections by default.
If you're already a subscriber and the writer has created a new section or sections, you'll need to subscribe to them in order to receive a new email newsletter or see a post in your app Inbox.