Dear Doctor: I have been diagnosed with Meniere's disease in my right ear. So far I've used conservative measures, such as dietary changes, diuretics, sedatives and oral steroids, but they haven't helped. My ear, nose and throat doctor has suggested a procedure called "inner ear perfusion." Could this lead to hearing loss?

Dear Reader: You obviously know much about Meniere's disease, but please allow me to review it for other readers. It is an inner ear dysfunction that leads to three classic symptoms: vertigo (a sensation of spinning or rocking), tinnitus (a ringing or persistent noise within the ear) and hearing loss, which can be permanent. When severe, these symptoms can be extremely debilitating. Health experts have many theories about why these symptoms occur; the most common is that fluid in an area of the ear called the endolymphatic sac becomes blocked, so fluid builds up within the sac. This is termed "endolymphatic hydrops," and it affects the hearing and balance centers in the inner ear.

Basic treatments include dietary changes such as restricting caffeine, alcohol, nicotine and salt. Diuretics and antihistamines can ease the vertigo, but they have no effect on hearing loss. As you know too well, both types of measures can show some degree of benefit, but often they fail to be sufficient.

It's true that some procedures that can ease the vertigo -- such as a labyrinthectomy, or the destruction of the vestibular nerve -- are destructive to the inner ear and can exacerbate hearing loss. As for inner ear perfusion, the extent of the risk depends upon the medication used.

In inner ear perfusion, medication is injected through the eardrum and into the middle ear. From there, the medicine penetrates the inner ear, where it exerts its effect. Because oral steroids have been shown to help patients with Meniere's disease, this procedure often uses injectable steroids. Some studies of the procedure show that, after multiple injections, 42 to 82 percent of patients experienced a complete resolution of vertigo and some subjective improvement of hearing. But, for some, the symptoms do return and steroids have to be injected again.

Aminoglycoside antibiotics are also used in this procedure, but they're toxic to the inner ear and are known to cause hearing loss. For example, one of these antibiotics, gentamicin, is toxic to the cochlea and leads to irreversible hearing loss in up to 30 percent of patients. That said, it has been shown to decrease rates of vertigo by 80 to 90 percent, making it much more effective than steroid injections but at an often heavy price.

But a different drug option may have merit, specifically combining a steroid with an aminoglycoside antibiotic. In one 2011 study, 299 Meniere's patients were injected with a combination of the antibiotic streptomycin and the steroid dexamethasone for three consecutive days; the patients also received intravenous steroids for those three days. Afterward, 94 to 98 percent reported control of their vertigo, with 18 percent reporting hearing loss -- meaning the combination of the two may be more effective and less likely to have side effects.

If you are concerned about the loss of your hearing -- as well you should be -- consider the steroid injections first. These may need to be repeated multiple times. If this does not work, consider the combination streptomycin/dexamethasone injections in the middle ear or perhaps the gentamicin injections. Yes, they have an increased risk of irreversible hearing loss, but you've exhausted the other treatments. Because severe Meniere's can be so debilitating, the risk may prove to be worth it.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I never have headaches, but I have visual disturbances that I believe are migraine auras. They're not bothersome and clear up within 10 minutes. But are they dangerous in any way? Am I having a migraine?

Dear Reader: When we venture into the area of migraine, we're entering the unknown. It's one of the leading disorders in the world, and yet when it comes to understanding how or even why migraines occur, we are just beginning to find answers.

The word "migraine" calls up the idea of a monster headache, but the disorder is in fact a collection of symptoms. Sufferers can experience nausea, dizziness, depression, exhaustion, sensory hallucinations, severe neck pain and, as you know firsthand, visual disturbances.

Until recently, migraine was thought to have vascular origins. That is, researchers believed it was the result of the constriction and expansion of blood vessels within and around the brain. With the advent of highly sensitive imaging technologies, however, and thanks to volunteers who have allowed the course of their migraine attacks to be visualized in real time, the focus has now shifted to the brain itself.

At UCLA, we're extremely fortunate to have the Headache Research and Treatment Program, headed by Andrew Charles, M.D., a neurologist and a leading migraine specialist. It's through his research that we now know that fluctuations in brain chemicals, as well as abnormal electrical activity in certain regions of the brain, play a significant role in migraine attacks. This includes not only the extreme headache pain associated with migraine, but the other symptoms as well. In fact, the throbbing, pulsating nature of a migraine headache, once considered to reflect the sufferer's heartbeat, is now believed to sync up with brain waves.

All of which brings us to your question. Visual disturbances that are not accompanied by a headache are known as an ocular migraine. These disturbances can include a circle of flickering zigzag lines that suddenly appear and then slowly expand outward until they leave your field of vision. Some people experience temporary blind spots in their vision, see shimmering patterns or stars, or get random flashes of light.

Scans of migraine patients' brains show waves of abnormal activity that spread across the surface of the brain. There is also stimulation of nerve centers deep within the brain stem. Thanks to the new focus on the brain itself as the source of migraine, researchers are now looking into how ocular migraines tie into altered brain activity.

When it comes to ocular migraine, the symptoms can be temporarily disruptive but are not generally considered serious. In light of the scope of nonheadache symptoms that migraine encompasses, it's a good idea to do a self-check and see whether fatigue, depression, light sensitivity or neck pain either precede or follow your ocular migraine attacks.

Since you're experiencing these symptoms regularly, we suggest a visit with your primary care physician for a definitive diagnosis. Pay attention during the next episode, so you can provide accurate details and a precise timeline of the attack. It will help your physician better understand what is going on and potentially rule out conditions with similar symptoms.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My husband is in kidney failure, has chronic obstructive pulmonary disease, congestive heart failure and Type 2 diabetes. We have been married 48 years. He sleeps most of the day, is so short of breath that a walk to the bathroom is difficult and never leaves the house except to go to the doctor. He is angry and depressed, often taking his temper out on me. What can I do to help him (and us) besides watch his diet?

Dear Reader: My heart goes out to you and your husband. As you're now painfully aware, and as I've learned as a physician, illness affects not just the person stricken, but their loved ones as well. In your long marriage, you and your husband have undoubtedly had your share of ups and downs, persevering and working together. Now you have new challenges, possibly unimaginable when you were younger, focused on your husband's illnesses.

Let's start with the depression. Some people have the mistaken notion that depression is part of the aging process. In fact, healthy independent elderly adults have a lower rate of depression than the general adult population. But each physical malady increases the risk.

With his many troubles, treating your husband's irritability and depression won't be easy. He may not acknowledge that he is suffering from depression, or he may suggest that, because of his physical ailments, he has every right to be depressed and every right not to go out of the house.

So, if the only time he goes out of the house is to see the doctor, go with him to the doctor. Talk to the doctor about your husband's increasing isolation, his feelings of depression, his irritability -- and his nighttime sleep, which can be affected by his conditions. Notice whether he's having trouble breathing while asleep, snores or awakens frequently to urinate. There may be aspects of his medication that the doctor may want to change to help him sleep more at night and less during the day.

Also, ask your doctor about whether his medications may be causing drowsiness or having depressant effects. These include, but are not limited to, opiates, benzodiazepines (Ativan, Klonopin, Valium, Xanax) and gabapentin, which is often used in diabetic patients for painful neuropathy. Further, pain itself can lead to feelings of depression. So take note of your husband's level of pain and share it with the physician if your husband does not.

Regardless of the root of his depression, psychotherapy could help your husband feel more in control of his situation and help him communicate his needs to you. Similarly, although your husband is likely taking a host of medications and would be hesitant to start another medication, anti-depressants can help decrease his irritability and make him more alert.

With therapy and possibly medication, your husband may be more apt to go outside and do some form of exercise, which will additionally help his mood.

Your love and support for your husband may seem to go unnoticed, but be assured it's a stabilizing foundation for him. That said, improving his mood is ultimately up to him. Your doctor can partner with you both, but your husband has to commit to getting better. Whether he does or doesn't, only time will tell. But, regardless, please take care of yourself. That, too, will benefit you both.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)