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Ménière's Disease

Tumarkins

Dear Dr Bartels,

Thank you so much for seeing me on Tuesday.  This new development of Tumarkins was very upsetting to me.  Thank you for helping me understand my condition and relaying your experience and prognosis.  You were very patient and answered all my questions.  Thank you so much for working me in your busy schedule.  See you in three months.

M.B.

Having a Doctor that Listens...

Dear Tampa Bay Hearing & Balance Center,

A couple of reasons for my letter...

First, Dr Bartels hello and a million thanks 20 years later!!! In 1988 you performed what you formerly referred to as a Radical Mastoidectomy w/ Temporal Flap.  Your surgery ended a lifetime of messy ear infections and mind-numbing earaches.  On a side note, I still get a kick out of telling people my ear is sewn closed.  I'll never forget how you treated me and my parents who went to great lengths to find me the best care for my chronic ear trouble.

While I have enjoyed 20 years without any trouble in that ear, I have struggled with symptoms in the remaining ear.  Local ENT's have offered psychiatric referrals, anti-depressants or simply dismissed me as being "dramatic".

Finally, after a lot of years (nineteen to be exact), I contacted your office and explained that I was a patient in 1988 and would like to see you ASAP.  It was explained to me that you didn't have any immediate openings but that there was another doctor within the practice.  My initial response was "NO THANK YOU!!" Fortunately for me, the person on the phone took the time to talk with me about Dr Danner and how particular you were when recruiting for a doctor to join your practice.  Knowing I had visited most of the ENT's in my area, I decided to see Dr Danner.

I came to your center in July and had an extensive and thorough history taken; hearing and balance tests, ect. Then it was time to meet with Dr Danner.  As my appointment came to an end I started to think "What if he tells me I am imagining these symptoms" or "There's nothing to explain this."  It was precisely that moment that he said, "You have a textbook case of Ménière's Disease."  I will never forget what it felt like to know I had found the right person to help me - close attention was paid to my description of the symptoms, someone finally believed me and took the time to explain everything in a way that made sense to me.

So, my second reason for writing you is to thank you for bringing Dr Danner into your practice!!!

The Tampa Bay Hearing & Balance Center, you and Dr Danner are the epitome of what all healthcare should be.  Although I know that for Ménière's sufferers; there really isn't any cure and with my case I am somewhat limited with treatment options having only one hearing ear - having a doctor that that listens, answers questions and appears to be genuinely interested is huge!  Dr Danner has done an exceptional job explaining and making clear the options that are there for me.

I may never be able to adequately express my gratitude or tell you how much it means to be under the care of The Tampa Bay Hearing & Balance center.  I would be honored if you would share my letter, as you have so many that I've read in your waiting room.  Dr Bartels, you and Dr Danner are truly doing God's work and with the bed-side manner and compassion of angels.

Forever grateful to you both,

R.G.

Free of Ménière's Disease

Dear Dr Bartels,

Please accept my heartfelt gratitude for helping me to be free of Ménière's Disease, which made me miserable for so many years.  Most of my time was spent in bed due to vertigo and its side effects.

I feel God sent me to you and you worked a miracle.  Everyone said there was no cure for this.  Now I am able to go to Church and do the many things I was unable to do and to enjoy life more at 84 years of age.

I wish I could do more to thank you. I will always remember you in my prayers that you have good health, happiness, and success.

Sincerely,

R.J.

Factors Affecting Postural Instability in Ménière's Disease

The following is a summary of published literature on a specific ear related topic. The reference to the original publication is found at the end of this summary.

In Ménière's disease (MD), several factors can create postural instability. In a recent study, 54 definite MD patients were compared to 66 controls. Several tasks were tested: two-legged stance tasks were performed in 4 conditions: eyes open with and without foam rubber and eyes closed with and without foam rubber (also called sensory organization testing). Six variables in the manner of attempting these tasks were evaluated. For Ménière's disease patients, statistical analyses were performed to explore the relationship between the 6 variables and the following independent variables: gender, age, the presence of abnormal caloric (abnormal in about half of Ménière's disease patients) and/or cervical vestibular evoked myogenic potential (cVEMP) responses (neck muscle response to a click sound placed in the ear, also abnormal in about half of Ménière's disease patients), the time elapsed since the last vertigo attack, and duration of the Ménière's disease.

Since MD patients might have diminished postural stability because of other factors, such as age and the degree of balance organ dysfunction at the time of testing, the purpose of this study was to assess the influence of various factors that can affect postural stability in MD patients, comparing MD patients with normal persons.

To assess postural control, the research used a foam cushion posturography analysis system originally established by their team for improving diagnostic accuracy of peripheral vestibular disorders in accordance with the guidelines from the Standards for Reporting of Diagnostic Accuracy.

Results: The presence of MD was significantly associated with abnormalities of all 6 of the variables. The presence of abnormal ear responses to warm and cool irrigations of the ear and cVEMP responses also correlated strongly with difficulty standing eyes closed, feet close together and the rate of leaning in that condition. The shorter time interval from last vertigo attack to measurement, the more likely patients with Ménière's disease were to have trouble standing on a foam cushion with eyes closed.

These results indicate that MD patients with abnormal caloric and/or cVEMP responses have a greater dependence on visual and somato-sensory inputs (joint position sensors in the back, hips, knees, and ankles) to maintain an upright posture than those subjects with normal caloric and cVEMP responses.

Conclusion. Ménière's disease patients show poor postural performance, which is affected by the existence of their peripheral vestibular function and the shorter time interval from last vertigo attack to measurement.

Comment: While Ménière's disease patients complain more about the abruptly disruptive spells of vertigo that they suffer, they also have chronic balance problems of variable severity that fluctuates in its distracting features with the frequency and severity of the Ménière's disease episodes.

Read the original article: [1]


References

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