Meniere's Disease and the Meniett
Presenter: Dr. George A. Gates, M.D. Professor and Director, Virginia
Merrill Bloedel Hearing Research Center, University of Washington,
Dr. Gates devoted the second half of his presentation to a discussion
of Meniere's Disease and a new treatment option called the Meniett.
Meniere's Disease is caused by too much fluid in the inner fluid
space of the inner ear, and is characterized by vertigo, ringing, and
hearing loss. Treatment typically includes a low sodium diet and
diuretics; for 70% of Meniere's patients, that is all that's required.
For the other 30%, no medication has been found to be effective, so
these folks have no treatment option other than surgery.
It has been known for some time that pressure change can make the ear
feel better. Pressure chambers are sometimes used to treat Meniere's in
Sweden, but that option is rarely available in the US. So scientists
began looking for a different way to get pressure to the ear, and they
came up with a device called the Meniett. It requires the insertion of a
tube through the eardrum (like that typically used to treat chronic ear
infections in kids) as a conduit to administer pressure change.
The Meniett is in clinical study at the University of Washington
Medical Center under Dr. Gates. The study is seeking to validate the
long-term effectiveness of the Meniett in a randomized,
placebo-controlled, double-blind clinical trial in people with classic,
active Meniere's disease. People participating in the study are those
diagnosed with unilateral (one ear) Meniere's disease and experiencing
tinnitus and aural pressure in the same ear. They also have vertigo
lasting for at least 20 minutes and at least 2 attacks during the past 2
months, and fluctuating hearing loss. They are between 21-70 years of
age with general good health. Current medical therapy has failed to
control their vertigo.
The Meniett generates pressure pulses at a rate of six Hz. These
pulses are generated for one second, followed by four seconds without
pulses. To use the Meniett, a patient inserts a probe into his ear and
turns the device on for five minutes. The probe delivers the pressure
pulses to the inner ear through the tube. Treatment is required three
times a day.
Scientists aren't certain why this treatment works. They speculate
that it's either because it causes the inner ear fluid to move, or
because it somehow signals the inner ear to "behave". Whatever
the exact mechanism, it alters the endolymphatic control mechanism. It
takes days or weeks to have an effect, and symptoms return quickly if
treatment stops. The results have been very good on patients for whom
low sodium diet and diuretics fail to work; over 90% of such patients
typically report relief using the Meniett. Some candidates also
experience a bit of hearing improvement.
Dr. Gates explained the "treatment ladder" for Meniere's,
in the order in which they are typically tried:
- Low sodium diet and diuretics
- Pressure chamber
- Local overpressure
- Endolymphatic sac surgery
- Gentamicin injections
- Inner ear destruction
The cost of the Meniett is $3500. Most insurance companies have no
clue about this treatment, but Dr. Gates hopes they will cover it when
their study is completed this year. He pointed out that it's a lot
cheaper than surgery. He also predicted that it will become the standard
Q: Does the Meniett work for people who have vertigo from other
Q: I can hold my nose and swallow and put presser on the middle ear
that way. How is the Meniett different from that?
A: You can't pulse the pressure at the rate of 6 Hz.
Q: You said that the trial is for people with unilateral Meniere's.
What about people with bilateral Meniere's?
A: We're excluding them from this trial, because it's a different form
of Meniere's. We want to prove the Meniett for one ear first.
Q: What about the micro wick being studied in Florida? How does this
A: This is a treatment of gentamicin injection and it destroys hearing.
It won't be needed if the Meniett works.
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