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International Physician Update
| OTOLARYNGOLOGY - HEAD & NECK SURGERY |
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Treating Meniere's Disease
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| Special goggles worn by patient Harold Daniels help Lloyd Minor, left, and John Carey detect subtle eye movements that may signal recurrence of Meniere's. |
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Harold Daniels was being hit by attacks of dizziness and nausea so bad that he would lie in bed for hours vomiting. “I was in a fog, exhausted, wanting to sleep,” says the 56-year- old software entrepreneur from Potomac, Maryland. “I would get up and say I’m going to whip this thing. Then it would hit me again, like Muhammed Ali.”
Daniels’ curse was Meniere’s disease. The buildup of fluid in the inner ear that defines the miserable condition had ruptured the membranes of his inner ear, causing a perpetual ringing, hearing loss and intolerable vertigo.
Daniels got on the Internet and discovered several treatments. But most came with a worry. Surgery on the impaired inner-ear membranes could correct the condition, but posed a 5 percent risk of destroying remaining hearing. A drug called Gentamicin injected directly into the middle ear once a day for five days, or multiple times a day over two or three days, could control vertigo as effectively as surgery, but also posed the risk of further hearing loss.
Then Daniels discovered a third option. Lloyd Minor, M.D., and John Carey, M.D., at Hopkins also used Gentamicin. But these otolaryngologists were getting rid of the vertigo with just a single dose. And they had cut the risk of additional hearing loss to a minuscule 2 percent.
To come up with the new approach, Minor and Carey had studied how Gentamicin reacted on chinchillas. They found that the drug became sequestered within the impaired sensory cells in the animals’ middle ear. Weeks later, it went off like a time bomb and disabled the cells. Clinicians who tended to inject the drug were unaware of this delayed effect. Knowing how much to give had been a stab in the dark.
“Our research validated giving just a single injection,” Minor says. “We’re able to control the vertigo, and we haven’t had anyone lose hearing.” The regimen has proven effective in 90 percent of cases.
Daniels has not had a recurrence of vertigo or lost more hearing: “Dr. Minor walks on water. He’s given me back the quality of my life.”
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