MIDDLE EAR MUSCLE DYSFUNCTION AS THE CAUSE OF MENIERE’S DISEASE

Thank you for posting this, I think this is a VERY important paper. My hydrops started on the heels of some sustained and intense stress, and I've also thought that stress (muscular contractions in the face) has been a contributor. But the question is, how do you treat it? Work on relaxing the muscles as much as possible I suppose? I have a splint for TMJ but it is not changing my symptoms. Thanks again for posting.

 

Interesting theory -- makes sense and fits fairly well with my perception of the disease. Along with the antivirals, betahistine, immunosuppressants and vitamins, perhaps we could add the medications for restless leg syndrome and see if they help to reduce the little muscle spasms. Kidding --- mostly.

 

James, keep us posted on what your doc says. The more I think about this theory, I believe it has merit (noting also that we could all have different causes, I mean it has merit for what I think happened to me). And leave it to an Australian researcher to turn the proposed etiology of Meniere's on it's head!

 

After reading this paper, I thought maybe stress/anxiety has been causing muscle spasms that have increased episodes. In the past month I've had 20 disabling rotational vertigo attacks. I don't know whether lorazepam has any affect on muscles, but it is designed to help with anxiety. It's been prescribed for me, but I don't take it because I don't want to be dependent on it, and didn't like the dull fuzzy feeling when I first tried it.

However, in light of a hypothetical stress-muscle spasm connection, I decided to take a preventive .5mg lorazepam in the morning and again in the afternoon (as prescribed) to see if it would deter vertigo. Just a few hours after the morning dose I had a strong spinning attack that required valium, zofran and a few horizontal hours to resolve. I didn't take any more "preventive" lorazepam in the afternoon, not wanting to load up on benzos. Later in the evening I had a second severe attack which required more valium + zofran. What a day.

The result of my little experiment is that lorazepam doesn't seem to work as a preventive medication for me. I can't say whether this has any bearing on middle ear muscle spasms, but thought I'd share my trial.

 

It's good to have my experiment validated, James.

 

Very interesting! Thank you very much for posting. This really chimes with me!

I don't have "menieres", but some kind of variant (I've had diagnoses of "Secondary Hydrops" and "Migraine Associated Vertigo"). I've had the whole gamut of audiovestibular and vestibular symptoms except low frequency loss. I have mild HF loss but it doesn't appear to be progressive. I have never had hearing 'interrupted'.

My condition has improved significantly over the years and I usually only suffer from tinnitus now.

My whole journey was kicked off by me stupidly trying to wash out some wax from my ear with a very mild pressure shower water (yes, I know!). It was uncomfortable at the time, for an instant, so I stopped. About 20 mins later, walking along the street I started to feel dizzy. You have to wonder if I injured my ear and potentially this very set of muscles.

This was followed by 5 weeks of imbalance and then I apparently fully recovered as if nothing had happened. I did not get tinnitus at any point.

However, and unfortunately I had a couple of very short episodes of dizziness brought on by stress, then 5 months later I was hit by a train and became dizzy with all sorts of terrible debilitating symptoms for over 3 years.

Fast forward and I've only got HF tinnitus (regularly pulsative), but I'm certain there is a pressure issue involved because if I squeeze my jaw I can momentarily increase the tinnitus. I used to be able to increase the tinnitus by bending over, but this has subsided.

What I find strange is why the body doesn't learn to release the pressure with feedback from the ear?

Or perhaps because of hearing loss (in some way), the pressure is kept to maintain optimal acuity in the prevailing circumstances?

 

I think this exactly what I have! what is the treatment?

 

I'd like to bump this thread as well.

This lines up with me exactly. I developed right ear cochlear hydrops following a period of stress. I've since discovered that I have TMJ misalignment. I also have somatic tinnitus that changes with the movement of my jaw and neck.

I have been looking for a good explanation for quite some time on how muscle spasms can cause SSNHL. I imagine SBUTTS are related to this.

I am most curious to know how this theory bodes with the theories/evidence(?) that a herpetic virus can induce these exact issues as well. As I mentioned, I do have TMJD, but my hydrops have responded well to antivirals / lysine / JOH. We also know that stress is often a trigger for herpetic viruses to come out of latency. I'm curious to hear any thoughts on the potential overlap or connection between what I see as two of the strongest leading theories behind most inner-ear inflammation and Meniere's disease.

 

I thought that paper was superb also. However, a few days after reading it I started to think of a few "holes" perhaps. It is a very clear explanation on the hearing loss aspect however, what about the hour by hour, day by day variability of hearing? Maybe I need to read it again, but right now I can't think of how it explains sudden dizziness or vertigo that then goes away. If the muscle is in a spasm, you would think it would be stationary. Like a leg cramp - it's tight but when it stops, the muscle relaxes and comes back to normal. What about Tinnitus?

 

Always good to hear from you, Donamo, and thanks for weighing in! I'll do my best to compile what I recall as the best answers to your questions:

Per the paper: "The simultaneous involvement of balance and hearing disorders during a Meniere’s attack – typically explosive in onset and sometimes abrupt in termination – point to a single physical factor rather than a biochemical imbalance. Pressure is put forward as the likely physical factor. House [3] provides an important clue. In the midst of an attack, accompanied by intense vomiting, patients sometimes report hearing a snap, at which point their symptoms are suddenly gone, perhaps for months. This quick resolution again supports some sort of direct physical effect, and the idea that an attack is brought on by dysfunction of the middle ear muscles is consistent with this observation. The explanation is that the inner ear muscle feedback loop is suddenly upset and is gradually restored – just like with most muscle cramps – after which pressure returns to normal and the symptoms disappear."
Also of note: "As an indication of the important role that pressure plays in normal cochlear function, there are long-standing observations of what can happen if hydraulic pressure within the inner ear is lost, such as through a labyrinthine fistula. Sometimes encountered as an unwanted outcome of surgery for otosclerosis, leakage of fluid from the otic capsule produces sudden vertigo, tinnitus, and severe sensorineural hearing loss — the same distinctive symptoms as seen in MD." ​

Per the paper: "When a muscle spasm begins, there will be a sudden rise of pressure, and the typical MD symptoms will start. It is important to note that, in the early stages, the hearing loss in MD has the same typical pattern of low-frequency hearing loss (upsloping audiogram) as occurs with the acoustic reflex (loss of sensitivity below about 1 kHz: p.142 of [20];p.20 of [8]; [18]) and with sudden hearing loss [40,44]." This description suggests to me that the spasms are, in fact, not constant. Thus, symptoms are not 'stationary'. I do not know why the frequency, intensity, or behavior of the spasms fluctuate, but it appears that they do -- just as many of our symptoms.​

Per the paper: "It is sufficient for our purposes to simply note that one of the effects of raising pressure in the ear canal is subjective tinnitus [37], and the simplest and clearest explanation must be that the increased pressure has, like tensor tympani contraction, forced the stapes into the otic capsule and increased fluid pressure. It has been noted [69] that tinnitus can result from voluntary contraction of the middle ear muscles."
As also stated: "In the long term, sustained elevated pressure will damage hair cells."
My interpretation is that prolonged inflammation or pressure on the inner ear structures and nerves is what leads to tinnitus, either directly or via caused hearing loss.​

The paper does mention that some who undergo treatment for potential causes of middle ear muscle dysfunction do not find relief in their MD symptoms. This may be because it is still very well possible that a herpetic virus is/can be causing the inflammation and pressure changes of the inner ear. Nevertheless, I am curious to narrow down the exact mechanisms by which such inner ear pressure can be created, so we all know exactly what is causing our symptoms.

 

I did say "Maybe I need to read it again"

This could also be the result of the build up of too much fluid in the inner ear (by inflammation or chemical unbalance) being suddenly released through that valve. That's what it always felt like to me.

I had a weird thing happen to me the other day, but I will put it in another thread to not distract from this excellent thread.

 

Hehe I know, was just eager to share since much of the paper happened to cover your good questions, and a great opportunity to lay out the info here.

Quite possibly -- do we know which valve exactly that would be, and where the fluid would go? I suppose it's hard to say, I wonder if anyone has a firmer grasp on what happens here in the inner ear.