The Trial and Error Treatment -- MEDICA - World Forum for Medicine

The Trial and Error Treatment

Photo: Eye Testing

Many tests are necessary to
diagnose Menière's Disease;
© Dizziness Unit Munich

„People still argue about what Menière’s Disease really is“, says Martin Khan, doctor at the ENT clinic of the Charité in Berlin. Scientists are still not even a hundred percent sure about what causes the illness. Most specialists have agreed upon an ‘endolymphatic hydrops’ that is to blame for the symptoms vertigo, hearing loss and tinnitus though: fluid accumulates in the inner ear until the membrane that separates endo- and perilymph disrupts due to the pressure and the fluids subsequently mingle. Such is the theory - proven is nothing.

Uncertainty prevails not only about the cause of Morbus Menière - also the diagnosis is difficult that is based upon observing symptoms and eliminating other illnesses after many tests. „Many people walk through life with a wrong diagnosis“, Khan is convinced and there exists no official number of people suffering from the illness. About 0.1 percent of all Germans is a popular estimation that refers to figures for Great Britain.

Last but not least - also regarding the treatment of Menière’s Disease there exists no consensus: the manifold medicamentous, surgical and alternative treatment methods start with a salt-free diet and end with cutting the vestibular nerve.

Doctors treat differently

The treatment of a patient depends consequently very much upon which doctor the person seeks advice from. The ENT clinic of the Charité, for example, counts on the active substance gentamicin whereas the Dizziness Unit located in the University Hospital Munich prefers betahistine and treats patients only exceptionally with gentamicin.

Gentamicin is an antibiotic that acts toxic on the inner ear subsequently destroying the sensory cells. In cases of Menière’s Disease in which the sense of hearing is already permanently damaged gentamicin is helpful. Khan, however, uses the substance earlier: „Formerly, the amount of gentamicin given to a patient was too high. That is the reason why many patients fell ill. Nowadays, we only apply a ‚single shot‘. That usually works very, very well.“

Betahistine stimulates the blood circulation in the inner ear and the story with this substance is exactly the opposite: It does not harm the inner ear but controversy prevails whether it has an easing effect on the symptoms at all. But Michael Strupp is convinced that this is due to too little amounts of betahistine.

The professor of the Dizziness Unit in Munich recently concerned himself with the dosage of betahistine in a study. The results: When betahistine is given over a long period of time and with a higher dosage as so far practiced the substance can remedy the vertigo symptoms almost completely. According to Strupp it is also well-tolerated by the patients.

However, Christoph von Ilberg reports that he keeps hearing from his patients that they suffered from strong side effects after having taken betahistine. The professor is head of a clinic in which a special procedure against Menière‘s Disease is offered: the Labyrinth Anesthesia. Von Ilberg promises an 85 to 90 percent improvement of the vertigo symptoms virtually without negative side effects – on his webpage. Studies that can back this unerringly do not exist, though.

Labyrinth Anesthesia is especially controversial

According to von Ilberg he treated 250 patients in his clinic since its opening exclusively with the Labyrinth Anesthesia, a procedure of which the professor himself admits: “It is not possible to explain why this method is effective. I simply know it from my experience.” Exactly for this reason other doctors criticise his method: one should only apply what is logically explainable, such is their credo.

When carrying out a Labyrinth Anesthesia, the nervous system is locally anesthetised via a small cut in the ear, staying numb for about two hours. Afterwards, the dizziness theoretically is to return. Von Ilberg says it does not: “At the moment we have an efficiency factor of 87 percent where the method works primarily.” Von Ilberg believes that through a short-term blocking of the nervous system a normalisation of the pressure balance can be achieved - a re-start in the inner ear, so to speak.

The alleged success rates that are promoted on von Ilberg's website is considered by Strupp to be a „placebo effect“ and he adds: “I don’t think this method is any good at all. A local anesthesia has no influence on the assumed causes of the illness – the accumulated fluid in the ear.“ Khan has no less doubts: “From the mechanism of action I cannot imagine how this should help.”

However, some of von Ilbergs patients repeatedly keep returning, sometimes after years, sometimes already after a few months. How many, von Ilberg does not know exactly. „Maybe around 50 percent“, he finally estimates tentatively. This is certainly rewarding for von Ilberg: He only treats private patients since the statutory health insurance does not cover the costs and wants 2,000 to 2,500 Euros - for one treatment.

Anke Barth