Dr. Andrea La Torre
Specialist in Otolaryngology
Tinnitus, vertigo, hearing loss, Meniere's: your doctors could help you, if they wanted
Tinnitus (noise in the ear), hearing loss, recurrent dizziness (vertigo) or subjective loss of balance, ear pressure or blocked ear (fullness), hyperacusis (reduced tolerance to noise) and motion sickness. All these disorders can be caused by a treatable and reversible dysfunction in the inner ear, created by the increase in inner ear fluids (hydrops), exerting excessive pressure or stimulation of cochlear cells or vestibular receptors.
Therefore, the underlying cause is not always (or not only) permanent damage that, anyway, can never be proved. Only when the patient is affected by each of these symptoms, we can use the definition of Meniere's Disease or Meniere's Syndrome. But hydrops and Meniere's Disease are not synonyms.
The main goal of the international version of my website is to spread knowledge about hydrops and its treatment, and to assist colleagues in other countries to help their patients. But I can even offer my direct assistance by video consultation via WhatsApp or other apps. I speak fluently Italian, English, French, Spanish, and Russian (and many other languages at lesser level), so I can easily offer consultations in one of them, hoping it's enough.
Language is not a problem for me but, if you are reading this English page, it could be a limit for you. In the Italian full website there is a lot of information, including many videos, while this page in English offers only an abstract and a concise version of the full content. You can anyway access the full Italian website, and get an automated translated version in English with Google Translate with a simple click on a button.
Links open the full website related section
It's always the inner ear!
From the anatomical perspective, the ear can be subdivided into three parts, the outer ear, the middle ear and the inner ear. All three sectors are involved in the auditory function, but only the inner ear (cochlea) or the acoustic nerve connecting the ear to the brain can cause sensorineural hearing loss or tinnitus. And only in the inner ear (labyrinth) there are vestibular receptors able to cause vertigo, dizziness, or subjective balance disorders.
Look my video (with audio in Italian but with subtitles also in English), to better understand how the ear works.
Cells, nerves, and fluids
Have you seen the video? Let's look inside the inner ear. What do we have in the inner ear? Only cells (hair cells in the cochlea and cells of the vestibular receptors in the vestibular part of the inner ear), nerve fibers (auditory nerve and vestibular nerve), and fluids (perilymph and endolymph). But knowing the biology of the inner ear cells (that are modified neurons) and nerves, we can be sure that damage to cells or nerves would be always permanent and untreatable. Neurons and cochlear cells cannot regenerate after damage, and they cannot be repaired. Therefore, we can be sure that recurrent or fluctuating symptoms can NEVER arise from a cellular or neural damage, but only from a dysfunction created by the fluids (hydrops). This is the case of recurrent vertigo, fluctuating tinnitus or fluctuating hearing loss. But a persistent hydrops can also be the underlying cause of a non-fluctuating tinnitus or cause a permanent (but reversible with the proper treatment) sensorineural hearing loss.
Inner ear and Hydrops
Inner ear Hydrops means a condition of increased fluid volume in the inner ear. This is the well-known pathologic situation giving the Meniere's Disease and proven and studied for many years, although the primary causes leading to the development of the hydrops remain unclear.
This increased pressure can affect cochlear cells and vestibular receptors, thus creating different combinations of hearing loss, tinnitus, vertigo, balance disorders, subjective fullness. Hydrops is much more frequent than what is believed, and it's underestimated, thinking about it only when every symptom is shown (in a typical Meniere's Disease). The increased inner ear fluid can lead to one single symptom (e.g., only tinnitus without hearing loss or vertigo, or only vertigo or dizziness without any cochlear symptom, etc…), different combinations of different symptoms, or even remain asymptomatic. Hydrops is the only treatable condition in the inner ear, considering that cellular or nerve damage could never be repaired.
In A a section of a normal cochlea In B, cochlea with hydrops
Hydrops and ADH
The exact mechanisms regulating the amount of liquid necessary for the performance of cochlear function (hearing) and vestibular function (balance) are not yet fully understood. But what we know is enough to be able to propose a treatment against the misregulation of the inner ear fluids (hydrops). We know that an important role is played by the interaction between the antidiuretic hormone (ADH, also known as vasopressin) and specific hormonal receptors and specific water channels (aquaporins) have been identified in the inner ear already 25 years ago. The release of the stimulating hormone, mainly activated by any kind of stress (not just psychological) and the lack of free water, and its interaction with the inner ear, are the main target of my treatment.
The relationship between ADH, and the inner ear and the hydrops is reported by many scientific papers for years. ADH is the main point of attack of the treatment I have conceived against the hydrops, but it seems to be totally ignored by otolaryngologists and audiologists worldwide. As I know, nobody else has developed a treatment based on ADH – inner ear relationship. Here is a short list (scroll it) of scientific articles about ADH (vasopressin), Meniere's Disease Hydrops and Ear. But there are many more.
And what is really weird is that there is a drug, TOLVAPTAN (brand name SAMSCA, produced by Otsuka Pharmaceutical, Japan), that could be very useful being a selective antagonist of the V2 ADH-receptors. But practically, it's not available for outpatients, it is expensive and cannot be prescribed for these ear disorders.
I have even tried to contact Otsuka, to understand why nobody used it for Meniere's Disease or Endolymphatic Hydrops, despite many studies. However, they seem not even know anything about. So, I've tried to contact at least 50 main University centers in Europe, USA, and Japan, to do something together and “push” new researches, but it appears that nobody cares about this topic.
Tinnitus and Hydrops
In most cases, tinnitus comes from hydrops and can be treated, despite the frequent diagnosis of permanent damage, given by many specialists, without any proof of this alleged damage. Real tinnitus, which is not real sound or noise, produced by an actual sound source, but only a bioelectric signal, arriving at the acoustic area of the brain, originates from dysfunction of the inner ear and the auditory apparatus. And it is often reversible and treatable, when the cause is the hydrops. Every tinnitus, fluctuating or not, is potentially a consequence of inner ear hydrops, that is a treatable condition of the inner ear. And that is always true if tinnitus is fluctuating, but frequently true even in case of stationary, not fluctuating tinnitus, providing an adequate, real, anti-hydrops therapy. But certainly this outcome cannot be achieved with the many “false therapies” offered today. Even the so-called “pulsatile tinnitus”, that actually is not a “tinnitus” at all, but the perception of the own heartbeat, can be treated.
Recurrent Vertigo, Dizziness and Inner Ear Hydrops
The annoying feeling of subjective imbalance (dizziness) and all the recurrent attacks of vertigo are always due to hydrops and can always be treated, with no exception. All recurrent vertigo syndromes and subjective dizziness, the perception of imbalance, which generally remain without any diagnosis and without real therapies, always come from the labyrinth (inner ear). And they always come from the hydro-mechanical action of labyrinthine fluids (hydrops), and not from permanent irreversible damage, that at most can create a single major acute crisis (labyrinthitis) followed by a real loss of balance lasting weeks or more. Recurrent vertigo crises and dizziness are therefore always due to hydrops and can always be ntreted without the need for destructive procedures. Even the so-called “paroxysmal positional vertigo (VPPB)”, traditionally linked to cupololithiasis and wandering otoliths in the labyrinth, actually is a disorder coming from hydrops.
Hearing loss, Ear Fullness, and Hydrops
Sensorineural hearing loss is the term used for every hearing loss originated from an inner ear dysfunction. Usually patients are told there's no other solution except to buy expensive hearing aids and that a cure is not available, being impossible to recover permanent hair cells damage (and that last part is true!). But many cases if not the most part of inner ear hearing losses are actually due in part or in whole to hydrops and are therefore reversible and treatable.
The sensation of closed ear or pressure in the ear (so-called “ear fullness”) is instead a purely mechanical phenomenon, which could be associated with hearing loss or with normal hearing. It is usually the direct expression of the pressure exerted by the excess of fluids, although it is too often misdiagnosed as a middle ear effusion.
The treatment against hydrops. How does it work, and what can it do?
The treatment I have developed against hydrops comes from the synergistic association of various pharmacological and non-pharmacological components. It is effective in reducing the excess of fluid in the inner ear, mainly (but not only) by creating a specific antagonism against the action of anti-diuretic hormone (ADH), their primary regulator.
ADH is not, apparently, the direct cause of the problem. Hormonal levels, at least out of an acute attack of vertigo, seem to be in the range. The development and the maintenance of hydrops is probably related to a hypersensitivity of the ear to the hormonal stimulus and its fluctuations, or a defect in resorption of the excess of fluids produced under the effect of ADH. But, not knowing the cause of this presumed hypersensitivity, the only target we have is the production of the hormone and its interaction with the ear.
The non-pharmacological components in my treatment are represented by a considerable water load (i.e., plenty of water to drink every day) because water is the main natural inhibitor of anti-diuretic hormone; short cycles of strict special diet following the provided rules; a pressure treatment to create a back pressure in the inner ear, and, only in selected cases and with the same purpose, sessions of hyperbaric therapy.
Drugs used for the treatment are only medications well known and used at doses practically without side effects. They are drugs active on the neurotransmitters, often but not always needed, and practically without side effects, with the aim of creating a protective umbrella between stress and the production of the hormone ADH; corticosteroids (short time), and an osmotic diuretic, the mannitol, administered I.V., with a particular method.
Every component of my treatments acts in a specific key point of the mechanism creating and preserving the hydrops in the inner ear (look at the image). But not every component of the treatment is needed for every patient.
As you can see, there is nothing really new or weird in my treatment. What works against the hydrops is the combination of many treatments with different points of action. A therapy with steroids or a diet are ineffective without increasing the water intake. Drugs active on neurotrasmitters and stress regulation are seldom combined by others with other treatments, like water intake, and so on. But I have also changed almost every single component from the traditional way they are used by others.
The therapy, that I began to develop in 1998, but since then, frequently updated and improved, effective against the hydrops, cannot do anything against any permanent damage already present in the inner ear. But permanent damage can never be confirmed for anybody! This hypothesis must be considered, anyway, only when treating a stationary hearing loss or a steady, constant, non-fluctuating tinnitus or for the constant part of them, if the symptoms, albeit never disappearing, can change. But recurrent or fluctuating tinnitus or hearing loss, as well as any type of subjective or objective vertigo or dizziness, and the ear fullness, are always due to the hydrops. They can always improve with this treatment, if properly performed, as I have seen in many thousands of patients I have treated.
The therapy can “cure”, i.e., help the patient recover partially or totally from his or her disorders, but it can not, however, permanently “heal” the ear because recurrence, after a certain unpredictable period, is still possible. But often the patient is free from symptoms for a long time and any recurrence can be managed easily and quickly, knowing how the treatment has to be performed. And the disability coming from the symptoms is drastically different when the patient knows already that there is, despite what everybody told him before, a proper treatment.
The first goal of this therapy is anyway to improve the current situation of the patient. And there is no disease that can be cured permanently like can happen after for surgical treatments, except for childhood infective diseases leaving a permanent immune defense.
This is not, anyway, a life-lasting treatment. Out of the acute phases the patient can stay without any treatment at all because sometime the benefit of the proper treatment lasts years. And there's no need for any therapy just for sporadic and mild symptoms if they even occur.