Watson shrugged it off, thinking he'd eaten something that hadn't agreed with him. But the same thing happened a few nights later when he was relaxing at home. Fearing the worst, Watson rushed to the doctor, who tested him for a brain tumor.

The tests proved negative, but the attacks continued, becoming more frequent and severe. Watson finally consulted an otolaryngologist who tested his balance, hearing and the fluid pressure in his inner ear. At last, he had a diagnosis: Meniere's disease.

Named after 19th-century French physician Prosper Ménière, Meniere's disease -- also known as endolymphatic hydrops -- is a recurring and sometimes disabling disorder of the inner ear. Although its cause remains a mystery, the problem appears to arise from an abnormality of the tissue lining the canals of the inner ear.

This lining produces and filters the endolymph, or the fluid that fills the balancing and hearing mechanisms of the inner ear. When excess fluid accumulates, the pressure stretches the membranes that divide the compartments of the inner ear, causing hearing loss and tinnitus. A rupture in the membranes may cause the endolymph to mix with perilymph, another inner ear fluid. The mixture of these fluids -- one rich in sodium, the other rich in potassium -- is thought to bring on the vertigo. Usually only one ear is affected, although in a small number of cases both can be symptomatic.

While not life-threatening, an onset of Meniere's can be frightening because its symptoms mimic a variety of other serious illnesses. For instance, infections such as syphilis and Lyme disease may produce episodes of vertigo and hearing loss similar to Meniere's, although their symptoms usually affect both ears. Tumors of the inner ear nerve also can present symptoms like Meniere's, but the hearing loss doesn't have periods of improvement as it does with Meniere's.

Sometimes the classic symptoms of Meniere's aren't present, making it difficult for the patient to report the problem to the doctor. Occasionally, hearing loss will precede episodes of vertigo by several years. At other times, symptoms will appear then disappear, only to return later. In the very early stages of the disorder the only symptoms may be a sense of fullness or pressure in one ear.

"The greatest fear for patients is not knowing what's going on," said Dr. William M. Sheppard, an otolaryngologist with Otolaryngology Consultants in Wilmington. "Once they get a diagnosis and they know what they have, they feel they have more control, and the fear is gone."

Several tests needed for diagnosis

There is no definitive test for Meniere's disease; instead, doctors use certain tests in combination to help diagnose the disorder. A comprehensive hearing test or audiogram is taken to see whether there is the low-frequency hearing loss typical of Meniere's. Additional tests include an electronystagmography, or balance test, and an electrocochleography, which may indicate increased fluid pressure in the inner ear. An MRI also may be performed to rule out central nervous disorders.

Meniere's has no cure, so treatment focuses on reducing the frequency and severity of the vertigo, which can be debilitating. Before treatment, Watson had to give up playing basketball for fear he'd injure himself or someone else.

"You just never know what's going to happen on a lay-up," said the 35-year-old Wilmington resident, who coaches football at Henry B. DuPont Middle School in Hockessin.

The most conservative long-term treatment for Meniere's involves dietary changes and medication. Limiting salt and monosodium glutamate can help reduce fluctuation in fluid pressure in the inner ear. Caffeine in chocolate, coffee, tea and certain soft drinks also should be eliminated, since it has stimulant properties that can irritate nerve endings, making tinnitus worse. Avoiding nicotine also can help.

Anti-vertigo medications such as Antivert help control the spinning sensation, while drugs such as Compazine help relieve nausea and vomiting. Diuretics also may be prescribed to reduce the body's fluid retention, thus relieving pressure in the inner ear.

Vestibular rehabilitation therapy may benefit patients who experience problems with balance between attacks, Sheppard said. The goal of the therapy is to help the body and brain regain the ability to process balance information properly.

Surgery can cause hearing loss

When these measures aren't helpful, a patient can be considered for ear surgery or other procedures.

Intratympanic treatments, or middle-ear injections, have become increasingly popular in the past decade. In this procedure, the doctor injects gentamicin, an antibiotic that's toxic to the inner ear, through the eardrum and into the inner ear. This destroys the balance function of the affected ear. Injections with a steroid called dexamethacone are slightly less effective than those with gentamicin, but the drug is less likely to cause hearing loss.

In an operation called selective vestibular nerve section, the balance nerve is cut as it leaves the ear and goes to the brain. Vertigo attacks are permanently controlled in a large number of cases, and hearing is usually preserved.

In the endolymphatic shunt or decompression procedure, a small hole is made in the inner ear to drain excess fluid. Vertigo is controlled in about one-half to two-thirds of cases, according to the American Academy of Otolaryngology, but relief often isn't permanent.

Labyrinthectomy is usually reserved for patients who already have significant hearing loss in the affected ear and suffer from frequent debilitating vertigo. In this procedure, the entire balance and hearing mechanism of the inner ear is removed. It has the highest rate of success but results in complete hearing loss.

As with all surgeries, doctors consider the severity of a patient's symptoms, as well as age, general health and, in Meniere's cases, occupation. "You don't want an airline pilot working with vertigo," Sheppard said.

Fortunately, Watson has benefited from the more conservative treatments. But he's had to make some adjustments. Because he has suffered some hearing loss in his right ear, he has had to learn to read lips when in conversation. He's also had to develop a taste for Reese's Pieces to replace the chocolate he loved.

And while his vertigo occurs less frequently now, he must always be prepared for an attack -- especially when he's driving. "I always have my medications with me and am ready to pull over to a safe place," he said.

Watson credits his family with helping him cope with Meniere's. Wife Janine tries to avoid bringing chocolate into the house and makes sure her husband has his medications with him at all times. Their three children keep things light with some good-natured ribbing about dad not getting a joke because he couldn't hear it.

"With encouragement and love from your family and a good doctor, you can get through Meniere's," Watson said.

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