Meniere’s Disease

What Is Meniere’s Disease?

Meniere’s disease is an inner-ear condition that can cause vertigo, a specific type of dizziness in which you feel as though you’re spinning.

It also can cause ringing in your ear ( tinnitus), hearing loss that comes and goes, and a feeling of fullness or pressure in your ear. Usually, only one ear is affected. The hearing loss eventually can be permanent.

The disorder takes its name from a French doctor, Prosper Meniere, who suggested in the 1860s that the symptoms came from the inner ear and not the brain, as most people believed.

Meniere’s Disease Causes

The cause of Meniere’s disease isn’t known, but doctors think they understand how the symptoms of Meniere’s happen.

Fluid builds up inside a part of your inner ear called the labyrinth, which holds structures that help with hearing and balance. The extra fluid interferes with the signals your brain receives, causing vertigo and hearing problems.

Why people get Meniere’s isn’t clear. Researchers have several theories about what might affect the fluid in the inner ear, though:

  • Poor drainage (because of blockage or an abnormal structure in your ear)
  • Autoimmune response (when your body’s defense system attacks healthy cells)
  • Allergic reaction
  • Viral infection
  • Inherited tendency
  • Blow to the head
  • Migraine headaches

It’s possible that a combination of issues come together to cause Meniere’s.

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Meniere’s Disease Symptoms

Meniere’s is a progressive disease, which means it gets worse over time. It may start slowly with occasional hearing loss. Vertigo may develop later. If you’re dizzy, sit or lie down right away. Don’t do any type of movement that might make your vertigo worse. Don’t try to drive.

Along with the main symptoms, some people may have:

Attacks can last 20 minutes or as long as 24 hours. You might get several in a week, or they might come months or even years apart. Afterward, you may feel tired and need to rest.

As your Meniere’s progresses, your symptoms may change. Your hearing loss and tinnitus may become constant. You might have problems with balance and vision instead of having occasional bouts of vertigo.

If you think you might have Meniere’s disease, call your doctor. Don’t assume it will get better on its own.

Meniere’s Disease ​​​​​​​Diagnosis

You and your doctor will talk about your symptoms and medical history. A series of diagnostic tests can check your balance and hearing. These might include:

  • Audiometric exam. This will find hearing loss in the affected ear. It might include a test to gauge your ability to tell the difference between words like “fit” and “sit.” That’s called speech discrimination.
  • Electronystagmogram. This evaluates your balance. You will be placed in a darkened room and have your eye movements measured as cool and warm air blows through your ear canal.
  • Electrocochleography. This measures fluid pressure in your inner ear.
  • Rotary chair testing. This lets your doctor see how eye movement affects your inner ear. You sit in a turning chair that’s controlled by a computer.
  • Vestibular evoked myogenic potential (VEMP). This measures your reaction to sudden, loud noises. 
  • Posturography. This tests your balance and how well you can keep it. You stand barefoot on a platform that can move in several directions. You wear a harness that lets your doctor see how you respond when the platform moves in certain ways. 
  • Video head impulse test (VHIT). This uses video images to see how well you can focus and how your eyes respond to sudden movement.
  • Auditory brainstem response test (ABR). With this test, you wear headphones, and a computer measures your brain waves as you respond to different sounds. It’s typically only used for people who can’t have other types of hearing tests (like babies) or who can’t have imaging tests.
  • Additional imaging tests. Your doctor also might recommend an MRI or CT scan to rule out the possibility that something other than Meniere’s is causing your symptoms.

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Meniere’s Disease Treatments

A hearing aid may help, and some treatments can ease both your vertigo and the fluid buildup in your ear. 

Oral Medications

Medication for motion sickness might help with your vertigo, and medicine for nausea might help with vomiting if that’s a side effect of your dizziness. Other drug treatments include:

  • Diuretics. To reduce fluid in your ear, your doctor might prescribe a diuretic -- medicine that keeps your body from retaining fluids. If you take a diuretic, your doctor probably also will ask you to cut the amount of salt in your diet.
  • Steroids. If your doctor thinks you have an underlying immune system problem, you might also take a short course of steroids.

Other Therapies

In addition to medication, you might try therapy targeted to help with balance issues. 

  • Physical therapy. A physical therapist will give you a series of exercises that, when done routinely, can help with imbalance, dizziness, and other issues. Staying active and getting exercise, like walking, can help, too, especially after you finish PT.
  • Vestibular rehabilitation therapy. VRT is an exercise program that retrains your brain to use other senses, such as your vision, to help with your balance.
  • Positive pressure therapy (Meniett device). This approach uses a device to apply pressure to your ear canal through a tube. This improves how fluid moves through your ear. You can do these treatments at home.

Injections

These go straight into your ear and may ease your vertigo. Your doctors might choose an antibiotic called gentamicin (Garamycin, Gentak), which is toxic to your inner ear. It reduces the function of the affected ear so that your “good” ear takes over your balance. This procedure is done in a doctor’s office, where you’ll be given something to numb the pain before the injection. Or your doctor might choose to inject a steroid.

Surgery

A few patients won’t respond to any of these treatments and will need surgery. Those procedures  include:

  • Endolymphatic sac shunt surgery. The part of your ear that is responsible for reabsorbing fluid is opened and drained. You’ll be given anesthesia so that you won’t be awake or feel pain during the operation. You will probably spend the night in the hospital.
  • Vestibular nerve sectioning. A neurosurgeon does this procedure, and you need a longer hospital stay, up to 5 days. The surgeon will destroy the nerve that sends signals about balance to the brain to stop the messages that are causing your vertigo.
  • Cochleosacculotomy. This is another procedure aimed at draining fluid. You’re given something to numb any pain, and it takes about 30 minutes. It can cause hearing loss, though.
  • Labyrinthectomy. Your surgeon destroys the parts of the ear that control balance. You aren’t awake during this procedure, and you stay in the hospital a few days. You will have hearing loss afterward, so it’s for people who have really bad vertigo and already don’t hear well.

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Meniere’s Disease Home Treatments

It’s not clear you can do anything to prevent Meniere’s disease, but you can do a few things to help manage your symptoms.

If  you’re having an attack of vertigo:

  • Try to sit down and stay still. 

  • Don’t make sudden movements, and avoid bright light, loud noise, and other triggers. Watching TV or even reading also can be harmful. 

  • Fix your gaze on something steady. 

In addition to eating a low-salt diet, you may want to cut down on alcohol and caffeine. Some people think such diet changes lessen the effects of the disease. Tobacco use also can be harmful, as cigarettes have chemicals in them that restrict blood vessels. If this happens in your ears, it can lead to hearing loss. Studies show that smokers are much more likely to have hearing loss than nonsmokers.

Vertigo attacks can be triggered by different things in different people. Try to write down as many things as you can remember about the episode. Triggers might include:

  • Stress

  • Overwork

  • Fatigue

  • Sharp changes in weather, specifically air pressure

  • Underlying illness

WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on June 16, 2020

Sources

SOURCES:

Mayo Clinic: “Diseases and Conditions – Ménière’s Disease.”

Vestibular Disorders Association: “Ménière’s Disease,”“Diagnosis,” “What Is Vestibular Rehabilitation?”

National Institute on Deafness and Other Communication Disorders: “Ménière’s Disease.”

National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Understanding Autoimmune Diseases.”

American Academy of Otolaryngology – Head and Neck Surgery: “Ménière’s Disease.”

University of California San Diego Health System: “Ménière’s Disease.”

Meniere’s.org: “Meniere’s Disease Triggers.”

Academy of Neurologic Physical Therapy: “What Is Meniere’s Disease.”

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