Pappas Ear Clinic Birmingham AL – Surgical Intervention for Meniere’s Disease

Meniere’s Disease is a disease involving a common set of symptoms including dizziness or vertigo, a feeling of fullness in the ear, tinnitus or “ringing in the ear”, and a progressive loss of low frequency hearing (usually in one ear). I was diagnosed with Meniere’s Disease in 2001, although the only symptoms I exhibited at that time were the fullness and hearing loss in my right ear. I was having little or no dizziness. The physician then advised a low salt diet and to avoid caffeine.

Over the next several years, despite the hearing loss, I was bothered little by the Meniere’s. However, in February of 2005, I began to have intense episodes of dizziness. When sitting watching television or reading, I would feel as if the room was moving around me. This would sometimes be accompanied by nausea. The attacks of Meniere’s became frequent, and began to affect my lifestyle. I was afraid to participate in outdoor activities like cycling or boating, for fear I would have an attack or it would worsen the symptoms. I began to stay at home more and more.

I saw my local ENT, and he advised me to take Antivert for the dizziness, continue with the low salt diet, and come back to see him if it did not improve. For a few weeks, the attacks seemed to have gone away, but then they returned with a revenge, and I returned to the ENT’s office again. This time he recommended that, since it was affecting my lifestyle to such a degree, I should go to the Pappas Ear Clinic in Birmingham. He made the appointment for me, and I went there the following week.

From the conversation in the waiting area, I could tell most of the people were there for treatment of Meniere’s. This surprised me and when I asked the nurse about it, I told her I had thought Meniere’s was rather rare. She stated that they see Meniere’s patients there from all over the world.

The Pappas Ear Clinic features two Dr. Pappas: Junior and Senior. I saw the elder Dr. Pappas. He did a diagnostic test to measure the pressures in my ears, a hearing test, and then did a physical exam. He also interviewed me extensively on my history and the symptoms I had been experiencing. He assured me that from the tests he had conducted, I did indeed have Meniere’s Disease.

He suggested that, because of the effect it was having on my life, that he could do “a little surgical procedure” that would greatly improve my symptoms and give me the relief I needed. He explained that I would go into the hospital as an outpatient, would be given anesthesia, and then he would do a tympanotomy and labyrinthotomy. He said I could go home the same day, barring any complications, and that I would have some fullness in my ear for awhile, some popping sounds, but that my dizziness should resolve right away. I agreed and he scheduled the surgery the following Thursday. He also gave me a mild diuretic to take along with the Antivert, and advised me to continue with low salt dieting.

I fasted before the surgery and after being prepped, I was asked if I wanted to be “put to sleep” or “given a drug that will have you awake but oblivious to what they are doing”. I choose the latter, as I hate being put to sleep, and have such a drowsy feeling for days afterward when I’ve had general anesthesia in the past. I was given the sedative, and taken to the operating room.

I remember hearing Dr. Pappas come into the room, and the anesthesiologist was there, along with several nurses. I was given another medication by IV, and then became very drowsy. During the next hour or so, I drifted in and out of sleep. I could hear noises in my ear and knew someone was doing something to it but it was more like dreaming than reality, and it was painless. After awhile, I was taken back to the recovery room. I was advised that I would need to stay for a few hours until I could sit up and drink well and keep it down. I slept for an hour or so, and the nurse came in to give me some ice chips. The drugs were beginning to wear off, and I had some discomfort, but the nurse gave me a pill and that resolved. I also had some nausea but no vomiting. She also gave me medication for that.

When I was ready to go home, they removed the IV from my arm, and gave me a prescription for pain medication to take home, along with instructions about no cooking, driving, etc. and to return to see Dr. Pappas the next week. When I went into see Dr. Pappas the next week, I was taken back to the examining room and I could hear a patient down the hall yelling in pain. That was very disconcerting and I asked the nurse what was wrong. She said he had the same surgery I had, and they were just putting in the profusion injection into his ear. I realized then I should have asked more questions. She said during the surgery, Dr. Pappas had “thinned” the membrane between the middle and inner ear to allow the medication to be absorbed, and had made a small window in my ear drum, which would close by itself in a few weeks.

Dr. Pappas came in and examined my ear. He then used a long needle to painlessly inject a medication into the ear “to help kill the nerves that cause the vertigo.” I had no discomfort from this and am not sure what was the other patient’s problem. I was then told I had to “lie flat for four hours so the medicine stays put.” My husband was allowed to stay in the room with me, and we both took a little nap in our chairs while we waited. He also did some admiring of Dr. Pappas’ collection of historical memorabilia that lines his walls.

I went back to Dr. Pappas four more times over the next few weeks for these injections, each time lying flat afterward for four hours. My symptoms of vertigo improved immediately, and the fullness in my ear decreased and became more comfortable. I did feel like I wasn’t hearing well from that ear, but figured it was due to swelling/healing. One morning at the end of the third week after surgery, I woke up to find I had no balance. I felt as if the entire world was severely tilted to one side. I had to hold onto the wall or someone else to walk from the bed to the bathroom. This was very disconcerting, as I had not been told anything about this being a possibility. I called Pappas Ear Clinic and spoke with the nurse and she informed me that this was common, and that the more I moved around, the better it would get. I researched it on line, and found that this is not something that is quickly resolving, and can take weeks or months to resolve. The information we obtained said that this is the brain’s attempt to compensate for the lack of information coming from the nerves in that ear, and that it will eventually compensate for it. I wished I had asked more before having the surgery.

I was unable to do any normal activities for two or three days, and then walked with a cane for the next few weeks. Three months later, I still had times when I woke up in the morning to stand, that the world felt off- kilter, but it was brief and resolved fairly quickly. I had taken early retirement before having this surgery, but a longer recuperation time might be a consideration for someone having this surgery. However, if the Meniere’s has been compromising your life to a great extent, it’s still easier to deal with the balance problems rather than the vertigo, because they do get better over time.

It has now been a year since the surgery. I have some hearing loss that never got better in that ear, but it is not severe, and I can manage well without requiring a hearing aid. I have no dizziness or vertigo, no full feelings in the ear. However, I was advised that I would need to continue the low salt diet to help with the possibility of this occurring later in my other ear.

I found Dr. Pappas and his staff to be caring and professional. They were helpful in filing our insurance and in getting us appointments to accommodate our long travel to his office. My advice to someone considering this surgery would be to make a list of questions to ask about the surgery and recuperation, and to arrange help for awhile after surgery.

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