Ménières disease describes a set of episodic symptoms including vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Episodes typically last from 20 minutes up to 4 hours.
Hearing loss is often intermittent, occurring mainly at the time of the attacks of vertigo. Loud sounds may seem distorted and cause discomfort. Usually, the hearing loss involves mainly the lower pitches, but over time this often affects tones of all pitches.
After months or years of the disease, hearing loss often becomes permanent. Tinnitus and fullness of the ear may come and go with changes in hearing, occur during or just before attacks, or be constant.
Ménières disease is also called idiopathic endolymphatic hydrops and is one of the most common causes of dizziness originating in the inner ear.
In most cases only one ear is involved, but both ears may be affected in about 15 percent of patients. Ménières disease typically starts between the ages of 20 and 50 years. Men and women are affected in equal numbers.
Because Ménières disease affects each person differently, your doctor will suggest strategies to help reduce your symptoms and will help you choose the treatment that is best for you.
What causes Meniere’s disease?
Although the cause of Meniere’s disease is unknown, it probably results from an abnormality in the way fluid of the inner ear is regulated.
In most cases only one ear is involved, but both ears may be affected in about 15% of patients. Meniere’s disease typically starts between the ages of 20 and 50 years of age (although it has been reported in nearly all age groups).
Men and women are equally affected. The symptoms may be only a minor nuisance, or can become disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning.
Meniere’s disease is also called idiopathic endolymphatic hydrops.
What are the symptoms of Meniere’s disease?
The symptoms of Meniere’s disease typically include at least several of the following:
Episodic rotational vertigo: Attacks of a spinning sensation accompanied by disequilibrium (an off-balanced sensation), nausea, and sometimes vomiting.
This is usually the most troublesome symptom. The vertigo usually last 20 minutes to four hours or longer. During attacks, patients are very disabled, and sleepiness may follow. An off-balanced sensation may last for several days.
Tinnitus: A roaring, buzzing, machine-like, or ringing sound in the ear. It may be episodic with an attack of vertigo or it may be constant.
Usually the tinnitus gets worse or will appear just before the onset of the vertigo.
Hearing loss: It may be intermittent early in the onset of the disease, but overtime it may become a fixed hearing loss.
It may involve all frequencies, but most commonly occurs in the lower frequencies. Loud sounds may be uncomfortable and appear distorted in the affected ear.
Ear fullness: Usually this full feeling occurs just before the onset of an attack of vertigo.
How is a diagnosis made?
Your physician will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears.
When the history has been completed, diagnostic tests will check your hearing and balance functions. They may include:
An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in the affected ear.
Speech discrimination (the patients ability to distinguish between words like sit and fit) is often diminished in the affected ear.
An ENG (electronystagmogram) may be performed to evaluate balance function. In a darkened room, eye movements are recorded as warm and cool water or air are gently introduced into each ear canal.
Since the eyes and ears work in coordination through the nervous system, measurement of eye movements can be used to test the balance system.
In about 50 percent of patients, the balance function is reduced in the affected ear.
Rotational or balance platform testing, may also be performed to evaluate the balance system.
Electrocochleography (ECoG) may indicate increased inner ear fluid pressure in some cases of Ménières disease.
The auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computed tomography (CT), or magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing and balance nerve.
Such tumors are rare, but they can cause symptoms similar to Ménières disease.
What should I do during an attack of Meniere’s Disease?
Lie flat and still and focus on an unmoving object. Often people fall asleep while lying down and feel better when they awaken.
How can I reduce the frquency of Meniere’s Disease episodes?
Avoid stress and excess salt ingestion, caffeine, smoking, and alcohol. Get regular sleep and eat properly. Remain physically active, but avoid excessive fatigue. Consult your otolaryngologist about other treatment options.
How can Meniere’s disease be treated?
Medications: A diuretic (water pill) such as triamterene (Dyazide, Maxzide) combined with a low salt diet, is the primary treatment of Meniere’s disease.
Anti-vertigo medications such as meclizine (Antivert, Bonine, Meni-D, Antrizine) mask the symptoms, providing relief, or diazepam (Valium) may provide temporary relief during more severe attacks of vertigo.
Anti-nausea medications [for example, promethazine (Phenergan)] sometimes also are prescribed.
In some cases, steroids and certain antibiotic medications (gentamicin) injected into the middle ear may provide some relief from vertigo symptoms. Both anti-vertigo and anti-nausea medications may cause drowsiness. B
ecause the nausea can be so severe at times, medications may be prescribed in the form of a suppository
Surgery: If vertigo attacks are not controlled medically and are disabling, one of the following surgical procedures may be recommended depending on the individual patient’s situation:
- endolymphatic shunt (A surgical procedure in which a shunt (tube) is placed in the endolymphatic sac that drains excess fluid from the ear.)
- selective vestibular neurectomy
- labyrinthectomy (surgical removal of the labyrinth of the ear) and eighth nerve section.
Although there is no real cure for Meniere’s disease, the attacks of vertigo can be controlled in nearly all cases. If you have vertigo without warning, you should not drive, because failure to control the vehicle may be hazardous to yourself and to others.
Safety may require you to forego ladders, scaffolds, and swimming.