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During a full-blown Ménière's episode, the patient can basically do nothing, so the question does not even occur. But what about mild events in a patient with a Ménière's diagnosis?

I am asking about a situation where the patient feels some symptoms (some dizziness, a change in hearing loss) but can still do most activities. Should the patient rest during such a period, and if yes, how much rest is good?

I could imagine a few different scenarios:

  • All activity during such an episode is damaging, or preventing healing of existing damage, and should be avoided even if it does not cause discomfort
  • The body "knows" when the activity is damaging, and discomfort is a good way to judge how much to do
  • There is no lasting damage or episode prolonging due to activity. The patient can decide how much discomfort he is willing to endure without fearing any side effects.
  • There is no lasting damage through activity, and complete rest can be detrimental, e.g. by making the patient more sensitive/susceptible to future events.

Which scenario comes closest to the truth? How can a patient decide on his activity level? What signs are there that there is too much or too little activity?

Also, if activities should be reduced: is there a difference between types of activities? Is an activity which relies on listening or balance worse than an activity which does not rely on them (e.g. listening to a lecture vs. taking a walk vs. sitting in a chair and reading)? Also, is an activity which is known to be irritating to either hearing (e.g. being around persistent noise) or balance (e.g. being driven in a car on a mountain road with many turns) worse than other kinds of activity? Are physical and mental activities similarly good/bad during such episodes, or is there a difference?

  • I can't give you a real professionally-backed opinion, but my mother has it, and I might but we've never confirmed it (in my case it seems to be chronic unexplained migraines often manifesting as vertigo / nausea). From her experiences and what I've observed, no activities have any effect on the disease itself, but the disease can make activities themselves dangerous. For example, an activity that requires balance would be unwise during a minor attack, not because you can damage your sense of balance further, but because you can hurt yourself. So I think that... – Jason C Apr 27 '17 at 20:37
  • .. it really varies and basically comes down to the patient's own conscious judgment and comfort. My mother, for example, refused to drive a vehicle during mild attacks or when she felt one coming on, just as a policy, sort of like how a responsible person might give somebody their car keys before drinking. It's more of a "be safe and comfortable" kind of thing. Comfort, too, e.g. some folks may get irritated by certain noises, so obviously they should try to avoid them. Others may not, and so no need. It varies greatly. – Jason C Apr 27 '17 at 20:39
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The short answer: I haven't come across anything that states that patients with a mild Meniere's episode should rest on principle even if they're feeling well enough to perform activities. So, I think it would be up to the patient's own judgement about what they are comfortable doing.

The longer answer: Meniere's disease is a disease of the inner ear, and is associated with distortions of the delicate membranes found in the inner ear. The underlying cause is not fully understood - various theories include that Meniere's disease is caused by a blockage at the endolymphatic sac, genetics, a virus, or a problem with blood vessels, but nobody knows for sure. If a person has definitively been diagnosed with Meniere's disease by a physician, then the treatment focuses on reducing symptoms. Treatments include lifestyle chances (limiting salt intake to 2-3 g per day, avoiding caffeine/alcohol/nicotine/MSG which are harmful substances that can worsen symptoms based on their effects in the inner ear, etc.). Treatments also include certain medicines (prescribed by a physician, e.g. anti-nausea medications like prochlorperazine.) There's also vestibular rehabilitation therapy which tries to help people with their balance, and hearing aids for hearing problems. Finally, there are some surgical procedures that might help in certain really severe cases of Meniere's that don't respond to any other treatments. In all my reading about Meniere's, I was not able to find any studies that suggested that patients should force themselves to rest during a mild Meniere's episode during which they would be capable of performing various activities. At the end of the day "listening to your body" is really a good piece of advice: if the patient feels safe and comfortable performing certain activities during a mild episode, it is probably alright; if they start to feel worse, they can stop what they are doing or take it more slowly. Of course, the best person to answer this question would be the patient's personal physician, since the physician will know the patient's full medical history and will therefore be able to give a more individualized answer. Source: I'm a medical student, and I referenced the article on Meniere's disease in UpToDate, a medical encyclopedia.

  • 2
    Nice answer. Using UpToDate is fine if you're a clinician looking for help. But it relies on references itself. If UpToDate were just a bunch of docs/residents/med students giving their opinions, it would be useless. So, when answering a question like this, you should at least pull one reference from UTD to post so that someone can verify what you're saying even if it's only to read the abstract. – anongoodnurse Mar 7 '18 at 4:17

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