Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The diagnosis of Meniere's disease is primarily made from the history and physical examination. Tinnitus or ear fullness (aural fullness) need to be present to make the diagnosis An audiogram is helpful to show a hearing loss, and to rule-out other abnormalities. It is often helpful, if it can be done safely, to have an audiogram during or immediately following an attack of vertigo. This may show the characteristic low frequency hearing loss. As the disease progresses hearing loss usually worsens.
Other tests such as the auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways,
computer tomography (CT scan) or, magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing or balance nerve. These tumors are rare, but they can cause symptoms similar to Meniere's disease. A full neurological evaluation is performed to exclude other causes of vertigo.
How can Meniere's disease be treated?
Medications: A diuretic (water pill) such as triamterene (Dyazide, Maxzide) combined with a low salt diet, is the primary treatment of Meniere's disease. Anti-vertigo medications such as
meclizine (Antivert, Bonine, Meni-D, Antrizine) or
diazepam (Valium) may provide temporary relief during the attacks of vertigo. Anti-nausea medications
[for example, promethazine (Phenergan)] sometimes also
are prescribed. Both anti-vertigo and anti-nausea medications may cause drowsiness.
Surgery: If vertigo attacks are not controlled medically and are disabling, one of the following surgical procedures may be recommended depending on the individual patient's situation:
endolymphatic shunt (A surgical procedure in which a shunt (tube) is
placed in the endolymphatic sac that drains excess fluid from the ear.)
labyrinthectomy (surgical removal of the labyrinth of the ear) and eighth nerve section.
Although there is no real cure for Meniere's disease, the attacks of vertigo can be controlled in nearly all cases. If you have vertigo without warning, you should not drive, because failure to control the vehicle may be hazardous to yourself and to others. Safety may require you to forego ladders, scaffolds, and swimming.
Meniere's Disease At A Glance
Meniere's disease is a disorder of the flow of fluids of the inner ear.
Symptoms of Meniere's disease include ringing, ear fullness, hearing loss, and poor equilibrium.
Diagnosis of Meniere's disease is usually based on history and exam, though other tests can be used.
Treatments for Meniere's disease include diet and life style changes, medications, and surgery.
Tinnitus is a ringing or swishing that seems to originate in the ear or head. Most of the time it is not a serious problem (it is however, a nuisance to those that suffer from the condition). Causes of tinnitus include loud noise exposure (firearms, loud music), medications, and other diseases (Meniere's disease). Treatment options are limited for tinnitus. Tinnitus can be prevented by wearing hearing protection when exposed to loud noises.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Vertigo is a feeling of spinning movement, and at times accompanied by nausea and vomiting occur. Vertigo is most often associated with an inner ear problem. The treatment for vertigo can be lifestyle changes and medication if necessary.
Balance is a state of body equilibrium or stability. We often take for granted how dependent we are on a healthy balance system. When the system breaks down, however, patients will describe symptoms such as dizziness, vertigo, lightheadedness, or motion sickness.
Noise-induced hearing loss may be an acoustic trauma (temporary hearing loss), or permanent due to an acute acoustic trauma. Experts agree that continual exposure to more then 85 dBs (decibels) is dangerous to the ears. Ear plugs and ear muffs can help prevent noise-induced hearing loss as well as decreasing exposure to loud noises.
Hearing loss (deafness) may be present at birth or it may manifest later in life. Deafness may be genetic or due to damage from noise. Treatment of deafness depends upon its cause.
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