Meniere’s Disease

Passenger traveling and feeling dizzy with headache in a train travel

What is Meniere’s Disease?

Meniere’s Disease (MD) is named after an insightful French physician, Prosper Meniere who in 1861 pieced together the unusual symptoms to identify a single disorder that affected hearing and balance caused by an inner ear condition. The disease is also known as primary endolymphatic hydrops. While 255 years have passed since the disease was identified, the cause of the disease is uncertain, but researchers feel that it is related to genetics and environmental factors. Patients who suffer from Meniere’s Disease have episodes of severe vertigo with a sense that the world is spinning, and a sense of fullness in the ear. These attacks can last from twenty minutes to four hours. There is no cure.

To understand Meniere’s Disease, it is essential to understand the inner ear that sits behind the eardrum. In a very small space there are several physical features that not only support hearing, but also support balance. Our ability to stand up is controlled by tiny, semi-circular canals in our inner ear that are called the vestibular system. These small canals provide our brain with information such as our angular and linear acceleration that allow us to navigate the world without falling flat on our faces. The fluid in the vestibular systems is called endolymph. One theory concerning Meniere’s Disease is that too much fluid will distend the tiny vestibular canals, resulting in vertigo. It is still not clear why hearing loss is associated with Meniere’s Disease.

Also located in the inner ear, you will find a sophisticated nerve network that collects and transmits hearing (cochlear nerve) and balance (vestibular nerve) data that is transferred via the vestibulocochlear nerve to the brain. This nerve also plays a role in controlling Meniere’s Disease.

What are the symptoms of Meniere’s Disease?

  • Repeated episodes of vertigo
  • Loss of hearing
  • Persistent ringing in the ear (tinnitus)
  • Feeling of sweating, nausea and vomiting resulting from vertigo
  • Sudden falls, a feeling of being pushed from behind
  • Headaches bordering on migraines

What causes Meniere’s Disease?

As already stated, the cause of Meniere’s Disease is still unclear. There is a potential genetic link since 10% of patients who suffer from it also have a parent who has had MD in the past. Allergies and autoimmune disorders may play a role, possibly causing a build-up of fluids in the inner ear.

How do you manage an attack of Meniere’s Disease?

The best way to manage the severe vertigo of MD is to lie flat and focus on an unmoving object. Falling asleep is a good idea. People often awake symptom free.

How do you avoid a Meniere’s Disease attack?

The best course is to avoid caffeine, smoking, alcohol, excess salt and stress. Regular sleep and proper diet are important. It will help if you contact a specialist at ENT & Audiology to develop a treatment plan.

What can happen if my Meniere’s Disease is not treated by a doctor?

  • Continued attacks of severe vertigo
  • Driving or handling heavy equipment is not recommended
  • Hearing loss during attacks

How is Meniere’s Diseases diagnosed by your doctor?

Your doctor will ask you several questions about the frequency, duration and severity of your MD attacks. He or she will ask you environmental questions to identify potential triggers; extent of your hearing loss; the presence of tinnitus; whether you experienced a feeling of fullness in your ears; and he or she may inquire about your diet and stress levels.

Your doctor may then recommend a hearing test and an ENG (electonystagmogram) test for balance. To get more data about your inner ear fluid pressure, your specialist may suggest you take an ECOG (electrocochleography) test. Plus he or she may suggest a CT (computed tomography) test or MRI (magnetic resonance imaging) test to rule out the presence of a tumor. Your doctor can then make an assessment whether your case of Meniere’s Disease is definite or probable and then develop a treatment strategy for you.

How do you treat Meniere’s Disease?

Focused Management

Despite the fact that there is no single cure for Meniere’s Disease, patients do learn to cope with the disease through a personalized strategy that can be guided by a trained ENT & Audiology specialist. Your medical team may propose a combination of diet, physical therapy, counseling, medications and surgical options to manage the disease. With your ENT & Audiology team by your side, you are not alone in your effort to control Meniere’s Disease.

Diet

Diets with low salt are advised. Some clinicians view MD attacks in much the same way as migraine attacks; thus triggers like caffeine, stress and bright lights are avoided.

Physical Therapy and Counseling

Part of an ENT & Audiology strategy may recommend the use of physical therapy to rebuild confidence and to improve balance over the long term. The sudden onset of MD, often after the age of 55, creates stress which can be effectively managed through therapy and with relaxation techniques.

Medications

Your doctor may suggest that you take anit-nausea and anti-anxiety medications to cope with or stave off Meniere’s Disease attacks. Diuretics are widely used to reduce bouts of vertigo. The diuretics may reduce fluid in the ear. Some patients have benefited from taking anti-allergy medications to prevent attacks. For those with severe bouts of vertigo with hearing loss, your ENT specialist may recommend a chemical labyrinthectomy which eliminates part of the vestibular apparatus.

Surgery

Decompression of Endolymphatic Sac

If symptoms of Meniere’s Disease do not improve, your ENT & Audiology doctor may recommend an operation on your inner ear to decompress the endolymphatic sac, which plays a key role in your vestibular system. There are three types: simple decompression, decompression via a shunt, and eliminating the sac completely. Decompression surgeries were found to be successful in reducing vertigo in 75% of cases. Hearing is usually preserved.

Destructive Surgeries

Destructive surgeries such as removal of the inner ear (labyrinthectomy) may relieve the vertigo problem, but hearing in the ear is lost. Another surgical option is a Vestibular Neurectomy in which the surgeon cuts the nerve that controls balance. This option involves brain surgery and a stay of several days in a hospital. Hearing is usually not impaired.