Photo: John Snider

By Diane Krieger

When Courtney Voelker, MD, PhD, first saw John Snider in 2017, he was “really, really sick. He felt completely dizzy or lightheaded nearly every day.”

Though Snider had lived with Ménière’s disease since 2009, the mysterious chronic illness of the inner ear was under control for much of that time. With drug therapy and a low-salt, no-caffeine, no-alcohol diet, Snider had been vertigo-free for five years.

Then out of the blue, his world started reeling again. He experienced 23 attacks in 45 days — each throwing him into vestibular chaos, collapse and a desperate crawl toward his bed. The violent spinning sensation would last for hours and leave him feeling physically battered.    

The ear doctor he had been seeing was pushing for surgery or chemical ablation — despite the very real chance it could permanently upend Snider’s everyday equilibrium and destroy what hearing remained in his already-impaired left ear.

Snider came to the USC Caruso Department of Otolaryngology–Head & Neck Surgery at Keck Medicine of USC, seeking alternatives.

When he left that initial consultation with Voelker, there was a spring in his stride.

“We connected from the very start,” Snider says, of his meeting with the board-certified neurotologist. “She showed me great care, and she did not talk surgery!”

Instead, Voelker put him back on sublingual drops of betahistine, the anti-vertigo medication that had kept Snider’s attacks at bay for years. The vertigo had returned with a vengeance after he switched to an oral formulation of the same drug.

He thought there was no choice. When Snider complained that his pharmacy no longer dispensed the sublingual drops, his previous doctor had shrugged.

Voelker knew better. She special-ordered the drops from a compound pharmacy that same day. She also greenlighted Snider’s request to try acupuncture and massage therapy — treatments his previous doctor had rejected as useless.

Within days, Snider was a new man.  

“My situation greatly improved with no surgery,” he says, triumphantly.

In Ménière’s disease, surgery is a treatment of last resort.

“We reserve it for people with the most intractable cases. And I say that as a surgeon,” says Voelker, who is chief of the division of otology, neurotology and skull base surgery and director of the USC Pediatric Cochlear Implant Program. “I love doing surgery, but until all other possibilities are exhausted, I won’t jump into it with a patient with Ménière’s. John is an example of a patient we were able to turn around from being really, really sick to medically managing his chronic illness.”

Snider appreciates her incremental approach, having butted heads with his previous doctor, who made him feel “like a commodity — just part of the assembly line.”

His experience with Voelker has been refreshingly personal.

“I love her bedside manner,” he says. “She listens. I never feel like I’m being rushed. She takes a long time with me whenever I see her—which is every three or four months. I know she cares very deeply.”

A multidisciplinary team, including physician’s assistant Erica Quenville, supports the care Snider receives from the USC Caruso Department of Otolaryngology – Head & Neck Surgery.

“Erica is the point-person on all of my prescriptions,” he says. “She’s very knowledgeable, almost like a partner.”

Personal attention is especially important for patients with Ménière’s, as no two cases are alike.

“The one predictable thing about this disease is its unpredictably,” Voelker notes. “As a doctor, you have to look at each patient individually and just walk the path with them.”

Some people endure symptoms their whole lives. Others go through waves. With younger patients, the frequency and severity of attacks can decrease as the body chemistry changes. With older patients, as hearing fades, sometimes the vertigo retreats.

“For some folks, it’s really bad no matter what we do. They have constant episodic vertigo — two to three bad attacks a week, sometimes one every day,” Voelker says.

Snider counts his blessings. He’s one of the lucky ones. “When I’m not having an episode — which is 99.5 percent of the time—I’m completely normal. I have no lightheadedness,” he says.

In September, he celebrated a year without an attack. He’s had three mild to moderate episodes since then, but he remains optimistic.

At 65, he leads an active life. Most days begin with a miles-long walk in the foothills around his home in Arcadia, California. Since retiring from a high-stress career, Snider has taken his wife Mary on European river cruises and crisscrossed North America indulging a passion for Major League Baseball stadiums: only three remain on their touring bucket list.

A USC graduate (MBA ’84), Snider stepped back from his job as a senior portfolio manager with a Los Angeles-based asset management group in 2018, though he continues to serve on corporate and philanthropic boards. A self-described “numbers guy” who crunches baseball stats for pleasure, he now consults for clients in the world of professional baseball and uses his data analytics chops to boost his performance in a competitive fantasy baseball league.

“Bottom line: I feel great,” Snider says. “I went out for a five-mile walk today. I know people with Ménière’s disease who couldn’t walk to the end of the block without getting dizzy.”

There are no guarantees for the future, but he takes comfort knowing that “at Keck Medicine of USC, they treat me like an individual.”

First Attack

“I went to work on Wednesday, December 9, 2009, and everything was normal. I was a healthy 54-year-old-man. I came home, got in a workout, had dinner and I was sitting on the couch watching TV when the world just started to spin. I’ve never been dizzy in my life. I thought I was having a stroke. My wife helped me to bed. Trying to fall asleep with the world spinning — it’s just horrible. When I woke up around 1 a.m., I felt completely normal.

“A month or two later it happened again. The terrible thing about Ménière’s disease is you don’t know when the next attack is going to come. You worry about driving, traveling, sports. Sometimes you have a drop attack, where you can be standing up and you’ll suddenly be on the floor. For me the only way to feel better is to physically go to bed. Whether it’s 8 a.m. or 1 p.m., I’ve got to sleep for three, four, five, six hours. And when I wake up, it feels like I was hit by a truck.”

About Meniere’s Disease

According to the American Hearing Research Foundation, Ménière’s affects about 615,000 people in the United States. Onset can happen at any age, but most patients are 40 or older. Although the disease’s underlying cause is unknown, its mechanics are well understood: a fluid, called endolymph, normally circulates within the membranous labyrinth of the inner ear. With Ménière’s this fluid begins to build up, causing swelling and disrupting the normal balance signals sent to the brain. Maddeningly unpredictable in its fluctuations, the disease is characterized by sudden, extreme bouts of vertigo, muffled hearing, tinnitus, blurred vision and hearing loss.

“Ménière’s disease is a big black box in our field,” Voelker says. “It’s a difficult disorder to study because it fluctuates. When you give an intervention, you don’t know if it’s the natural course of the disease’s fluctuations or the intervention you gave that made the patient feel better.”

While there’s no cure, Ménière’s can be treated with diuretics, steroids and antihistamines, along with dietary changes and supplements. In extreme cases, neurotologists can provide surgical relief to patients who experience continuous vertigo. The range of possible procedures includes decompressing the endolymphatic sac, severing the vestibular nerve or injecting an ototoxic drug through the eardrum into the inner ear.