DEAR DR. DONOHUE: Our 45-year-old daughter has recently been diagnosed with Meniere’s disease. For five months, she suffered from bad headache, swishing sounds in her ear and a loss of balance. The doctor tells us there is no cure. She is on a salt-free, caffeine-free diet. She also has lost her voice. Is there anything that can be done to relieve these symptoms? Is there a cure? — M.M.

ANSWER: Meniere’s is a triad of symptoms that comes in spells: vertigo, tinnitus and hearing loss. Vertigo is dizziness, often described as a whirling, spinning sensation that lasts for 20 or more minutes. Tinnitus is noises in the ear — ringing, clanging or buzzing sounds. It, too, comes in episodes, along with vertigo and hearing loss. As time passes, the intervals between attacks lessen, and these symptoms become more or less permanent.

All of this comes from an accumulation of fluid in the inner ear. Getting rid of the fluid gets rid of the symptoms.

A greatly reduced salt intake is quite effective, as is a reduction in or complete abstention from alcohol and caffeine. Diuretics (water pills) get rid of the fluid. For control of dizziness, a medicine like Antivert is useful.

Incapacitating symptoms call for more drastic measures. One is injection of the inner ear with the antibiotic gentamicin. It takes care of the harmful stimulation of the inner ear due to the fluid buildup. Vertigo can be controlled by severing the part of the hearing nerve that brings signals to the brain that produce dizziness. A little gadget called the Meniette device sends pressure waves to the inner ear to drive fluid out. It requires that a tube be placed in the eardrum. I haven’t mentioned all possible treatments. Your granddaughter ought to consult an ear, nose and throat doctor or a neurologist.

Headaches aren’t part of the syndrome. Migraine headaches can sometimes create dizziness and vertigo, and, therefore, be mistaken as Meniere’s. Such headaches need migraine medicines. I cannot explain her voice changes — something that has to be investigated.

DEAR DR. DONOHUE: In 1997 I had knee replacement. As a child I believe I had rheumatic fever, since I have a slight heart murmur. My doctor had me take antibiotics prior to dental work. Now some doctors and dentists say the rules have changed; I no longer need to take antibiotics before dental procedures. Others say I should. I’m not looking to take pills, but I want to be safe. Should I continue to take antibiotics? — M.P.

ANSWER: People with certain heart problems, such as damaged heart valves from rheumatic fever, were told to take antibiotics for dental procedures that could release mouth bacteria into the blood. Those bacteria were believed to have a chance of landing on the damaged heart valves and initiating a serious infection called endocarditis.

Experts have relaxed those requirements. Only high-risk heart conditions require antibiotic protection. High-risk conditions are artificial heart valves, a past history of endocarditis and a variety of congenital heart problems. Your slight murmur does not require this treatment.

The rules for artificial joints have changed many times. Current advice is to take antibiotics when having procedures where bacteria might get into the blood. Dental procedures where bleeding is likely are an example.

DEAR DR. DONOHUE: My son, 48, lives in Florida. When he visits family in Maryland and Virginia, his feet develop an awful smell. His shoes have to be left outside. This doesn’t happen anywhere else he goes or when he is at home.

Do you have an answer why this happens? — A.K.

ANSWER: I don’t. It doesn’t sound like a medical problem to me. What kind of materials are his shoes made from? Maybe that’s the cause.

I am leaving this question for reader input. If anyone has a clue about or experience with this situation, please write so we can make A.K.’s son a welcomed guest.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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