Meniere’s Disease

If you’ve ever experienced a combination of dizziness, hearing phantom sounds, and hearing loss, it may be Meniere’s disease. Meniere’s disease is a condition affecting the inner ear, usually just on one side. Across the USA, around 615,000 people – or 0.2% of the population – are currently diagnosed with Meniere’s, with almost 50,000 new diagnoses annually.

Symptoms of Meniere’s Disease

The symptoms of Meniere’s come and go. Also known as “attacks”, some people may experience infrequent episodes of vertigo while others have a cluster of multiple attacks within a matter of days.

Those with Meniere’s disease experience symptoms including:

• Vertigo. Vertigo comes on as severe dizziness. You may feel like the room is spinning, and it can be associated with nausea and loss of balance.
• Hearing loss. In the early stages of Meniere’s you may notice your hearing becomes muffled for short periods of time. In the long-term, hearing loss from Meniere’s can become permanent.
• Tinnitus. Tinnitus is when you hear a sound that’s not produced from an external source. It may sound like whooshing, buzzing, ringing, clicking, roaring, or some other description.
• Aural fullness. This simply refers to the sensation of a full ear or pressure in the ear.

Vertigo attacks can occur suddenly after you notice tinnitus or changes to your hearing, and can last between 20 minutes up to 24 hours. In Meniere’s, vertigo can be so severe that it can cause a fall, which are often termed “drop attacks”.

The symptoms of Meniere’s are thought to be due to an accumulation of endolymph fluid within the inner ear. The receptors and components of the inner ear are responsible for monitoring the position and movement of your body, as well as playing a part in hearing. If endolymph fluid builds up in the inner ear, it interferes with your balance and hearing, which results in the classic symptoms of Meniere’s.

What Causes Meniere’s Disease?

At this point in time, the exact causes of Meniere’s aren’t fully understood. However, there are some theories from experts, including:

• Genetic abnormalities causing abnormal regulation of endolymph
• Viral infection
• Autoimmune disorders
• Allergies
• Deficient endolymph fluid drainage due to a blockage
• Abnormal constriction of blood vessels

It is possible that the cause of Meniere’s is a combination of the above factors, or even factors that haven’t yet been discovered.

Some groups of people, or certain characteristics, have been implicated as risks for developing Meniere’s. We know that it’s most prevalent in adults between 40 and 60 years old, though it can come on at any age. Other risk factors associated with Meniere’s include having a sleep disorder or poor mental health.

Meniere’s Disease Treatment and Management

The diagnosis of Meniere’s is based on a collection of results, including history of your symptoms. In order to be diagnosed with Meniere’s, your symptoms must include:

• At least two episodes of vertigo last for at least 20 minutes each
• Measurable and temporary hearing loss
• Tinnitus
• Aural fullness

Your hearing is typically measured with a test known as audiometry. Tones of varying pitches and volumes will be presented through a pair of headphones; when you think you detect the tone, you respond by pressing a button. Hearing loss in Meniere’s is often found in the low and/or higher frequencies, while leaving the midrange frequencies intact.

Your treating doctor, which will most likely be an ENT (ear, nose, throat) specialist, may also conduct further tests to rule out other conditions with similar symptoms to Meniere’s. These tests can include brain MRI or CT scans.

Unfortunately, there is currently no cure for Meniere’s disease, but it can be managed with various solutions. Existing treatment options for Meniere’s include:

• Medications to manage vertigo, including motion sickness drugs and anti-nausea drugs, or diuretics to reduce fluid retention in the body
• Dietary changes including lowering the salt content of your diet (to reduce fluid retention, similar to diuretic medication). For some people with Meniere’s, they find that limiting or avoiding caffeine, chocolate, and alcohol helps to minimize their symptoms
• Some find that quitting smoking can also help to manage symptoms
• Injections of medications into the middle ear can be effective at helping to control vertigo. These may include gentamicin, though this has been linked to a risk of exacerbating hearing loss. An alternative is a corticosteroid called dexamethasone, which tends to be less effective than gentamicin but carries a lower risk of inducing further hearing loss.
• Cognitive behavioral therapy is a type of psychological therapy aimed at equipping individuals with strategies to cope with the symptoms such as those of Meniere’s. It can be useful for helping to reduce the anxiety around unexpected vertigo attacks.

For some, surgery may be necessary if all other, less-invasive treatments have been shown to be unsuccessful or inappropriate. Though approximately 60% of people experiencing Meniere’s improve on their own over time or are able to control their symptoms using the above-mentioned therapies, a small group can only be helped with surgery. Surgical procedures for Meniere’s include:

• Endolymphatic sac surgery to relieve pressure around sac and better regulate endolymph fluid
• Labyrinthectomy to remove the damaged parts of the inner ear inducing vertigo. However, this technique results in total hearing loss in the treated ear, so is only recommended for those already with profound hearing loss
• Vestibular nerve section. The vestibular nerve is responsible for sending information about balance and movement from the ear to the brain. By severing this nerve, vertigo symptoms can be resolved without affecting hearing

If you suspect you may be experiencing Meniere’s symptoms, speak to your primary care physician. A referral to an ENT specialist can then be organized for further testing and management.