A common inner ear disorder, Meniere’s disease can cause dizzy spells (vertigo), sound in the ear and hearing loss. The inner ear is responsible for hearing and balance. Typically, affecting one ear, the condition can occur at any age, but usually starts between young and middle-aged adulthood. People in their early 40s and 50s are much more likely to experience the condition. Being a chronic condition, there is no specific cure for this ear disorder. However, various treatment modalities can help minimize the intensity of symptoms and its long-term impact on the patient’s life. Key treatment modalities include diet and lifestyle changes, medications, and surgery. Otolaryngologists and other specialists treating this inner ear disorder must document the causes and symptoms correctly in the patient medical records. Opting for medical billing services from an established medical billing company can help simplify the documentation process.
Also called idiopathic endolymphatic hydrops, the exact cause of Meniere’s disease is not known. The condition is expected to be caused by a combination of factors or severe changes in the fluid in tubes of the inner ear (known as endolymph). Other related causes include autoimmune diseases, allergies, head injury, infection to the inner or middle ear, medication side effects, smoking, migraines, stress or anxiety and family history of the disease. The disease can significantly cause a negative impact in your life, causing severe fatigue and stress. Vertigo can cause patients to lose balance, potentially increasing the risk of falls and accidents.
Symptoms of Meniere’s Disease
The signs and symptoms associated with the condition often fluctuate and vary from person to person with some persons experiencing severe attacks over a period of several days and others having an isolated attack every once in a while. The symptoms may start as a minor nuisance and can become disabling, particularly if the attacks of vertigo are severe, frequent, and occur without warning. The signs and symptoms of Meniere’s disease tend to come on as “episodes” or “attacks.”
Symptoms may begin with a feeling of pressure in the ear, followed by a tinnitus (the sensation of ringing, in the affected ear). These episodes will last anywhere from twenty minutes to four hours. Common symptoms experienced by people with the inner ear condition include – a feeling of pressure in the ear, sudden dizzy spells, muffled hearing or hearing loss, aural fullness, loss of balance, headache and nausea, vomiting, and sweating (caused by severe vertigo). The signs and symptoms may improve and may disappear entirely for a while after an episode.
How Is Meniere’s Disease Diagnosed and Treated?
Initial diagnosis of Meniere’s disease may begin with a detailed ear examination and analysis of previous medical history. To confirm a diagnosis of the condition, patients need to have experienced at least two episodes of vertigo (each lasting 20 minutes or longer but not longer than 12 hours). Patients also need to experience tinnitus or a feeling of fullness in their ear. A hearing test (audiometry) may be performed to assess how well a patient detects sounds at different pitches and volumes and how well they distinguish between similar sounding words. Typically, people with Meniere’s disease experience problems when hearing low frequencies or combined high and low frequencies with normal hearing in the midrange frequencies.
Even between episodes of vertigo, the sense of balance returns to normal for most people with Meniere’s disease. Specialists may perform several additional tests to correctly assess the function of the inner ear. These tests include – Videonystagmography (VNG), Vestibular evoked myogenic potentials (VEMP) testing, Electrocochleography (ECoG), Video head impulse test (vHIT), Posturography, Auditory brainstem response (ABR) test and Rotary-chair testing. These tests can help assess whether the problem is caused by the inner ear or inner ear nerve. In certain cases, issues with the brain (like multiple sclerosis (MS) or brain tumors) can cause symptoms similar to Meniere’s disease. In such cases, physicians may suggest additional blood tests and imaging tests like MRI or a cranial CT scan to correctly assess the possible problems within the brain.
As mentioned above, there is no specific cure for Meniere’s disease. However, there are several treatment modalities ranging from medication to surgery that can help reduce the intensity of symptoms and reduce the severity and frequency of vertigo episodes. In most people with this ear condition, spontaneous remission is common, although it can take years. Therefore, physicians may suggest a treatment modality that perfectly suits their range of symptoms.
Physicians may prescribe medications like motion sickness medications (such as meclizine or diazepam (Valium) during a vertigo episode to lessen the severity of an attack, that may reduce the spinning sensation and help control nausea and vomiting, and anti-nausea medications (such as promethazine that help control nausea and vomiting during an episode of vertigo). In some cases, physicians may also prescribe medications to reduce fluid retention (diuretic) and advise patients to limit their intake of salt. For some people, this combination may help control the severity and frequency of Meniere’s disease symptoms to a great extent. In addition to medications, other non-invasive therapies and procedures such as physical therapy, vestibular rehabilitation exercises, hearing aids and positive pressure therapy may also be suggested.
If the conservative treatments listed above do not give in the desired results, physicians may recommend some more aggressive treatments like middle ear injections. Injected into the middle ear, these medications get absorbed into the inner ear and may help improve vertigo symptoms. For people who experience severe vertigo attacks associated with Meniere’s disease and wherein other treatments don’t give the desired results, surgery may be a last option. Top surgical procedures include Endolymphatic sac procedure, Vestibular nerve section and Labyrinthectomy.
ICD-10 Codes for Meniere’s disease
Otolaryngology medical billing and coding can be challenging as it requires correct assignment of the medical codes to document the diagnosis, screening and other treatment procedures performed. Billing and coding services provided by reputable medical billing companies can help physicians use the correct codes on their medical claims. ICD-10 codes indicating a diagnosis of Meniere’s disease include –
- H81 Disorders of vestibular function
- H81.0 Meniere’s disease
- H81.01 Meniere’s disease, right ear
- H81.02 Meniere’s disease, left ear
- H81.03 Meniere’s disease, bilateral
- H81.09 Meniere’s disease, unspecified ear
Incorporating certain lifestyle changes and making dietary changes can help reduce the impact of Meniere’s disease and vertigo attacks. Patients may be advised to limit intake of certain foods and substances like salt, caffeine, chocolate, alcohol and monosodium glutamate (MSG) so as to reduce the amount of fluid in the inner ear and ease symptoms. Practicing certain self-care tactics like drinking adequate amount of fluids, resting during vertigo attacks, eating regularly and managing stress and anxiety (through psychotherapy or medication) may help improve the intensity of symptoms.
Billing and coding services provided by an experienced by medical billing company would be a great support for otolaryngology practices to meet their billing and claim submission requirements. With all the challenges involved in billing, such companies will provide the services of skilled AAPC-certified coders and billing specialists who can guarantee that your healthcare practice has fewer unresolved claims.