Ménière’s Disease

Ménière’s disease (idiopathic endolymphatic hydrops) is a rare inner ear disorder that affects your sense of balance and hearing. It can make you feel as if the world is spinning around you when you’re standing still (vertigo). It can cause ringing in your ears (tinnitus) and difficulty hearing. Symptoms start without warning, then go away — only to come back time and time again.

Left untreated, Ménière’s disease symptoms worsen over time. They may cause permanent hearing loss and ongoing balance issues. But working with a healthcare provider to find the right treatments can help manage the condition.

Symptoms of Ménière’s disease

Symptoms start in episodes that may last as little as 20 minutes, up to 24 hours. You may have frequent episodes back-to-back. Or, you may have long periods with no symptoms between episodes.

The main symptoms of a Ménière’s disease episode are:

• Vertigo. Some people have “drop attacks,” where the vertigo is so severe that they topple over and fall.
• Trouble hearing and hearing loss. Hearing issues usually impact one ear. At first, many people have difficulty hearing lower pitches, specifically. Without treatment, the hearing loss can get worse.
• Tinnitus. You may feel as if one of your ears is ringing. The sound may remind you of machines whirring or the whooshing noise you hear when holding a seashell up to your ear.
• Pressure. You may feel pressure or fullness in the affected ear.

Other symptoms include nausea and vomiting.

Ménière’s disease causes

Experts don’t know what causes Ménière’s disease. But many believe that a buildup of inner ear fluid called endolymph plays a role. Too much endolymph can disrupt hearing and balance signals going to your brain.

Conditions that may cause too much endolymph to build up include:

• Allergies
• Blockages in your inner ear that prevent endolymph drainage
• Head injuries
• Infections
• Migraine headaches

More research is needed to understand the relationships between these conditions and Ménière’s disease.

Risk factors

Risk factors include:

• Age. Ménière’s disease typically affects people ages 40 to 60.
• Sex. Some studies show that females are slightly more likely to develop this condition.
• Genes. About 7% to 10% of people with Ménière’s disease have a family history of the disorder. This means you may inherit the condition.
• Autoimmune diseases. You may be more likely to develop Ménière’s disease if you have an autoimmune disease. These include rheumatoid arthritis, lupus and ankylosing spondylitis.

Complications of this condition

Severe vertigo attacks related to Ménière’s disease can lead to serious falls. They can make everyday activities (like climbing a ladder or driving a car) too risky to attempt. Over time (usually after eight to 10 years), the condition can lead to permanent hearing loss.

Ménière’s disease can take a toll on your mental health, too. Worrying about the long-term impacts can lead to anxiety and depression.

Talk with your healthcare provider about both the physical and mental impacts of this condition, so they can help.

How doctors diagnose this condition

Otolaryngologists (ENTs) diagnose Ménière’s disease. During your visit, your provider will perform a physical exam and neurological exam. They’ll ask about your symptoms. They may do tests to rule out conditions that cause symptoms like Ménière’s disease. Tests include:

• Hearing test. The test will show if you have hearing loss.
• Vestibular test battery. These tests check the reflex of your inner ear (vestibular) balance system and eye muscles.
• Brain MRI with contrast. This imaging test helps rule out brain tumors or other issues that may cause dizziness or hearing loss.

How is Ménière’s disease treated?

There isn’t a cure for Ménière’s disease, but treatments can reduce how severe and long-lasting your attacks are. Your healthcare provider will recommend conservative treatments first. If these treatments don’t help, you may need surgery.

Lifestyle changes

Changing your routine can reduce Ménière’s disease symptoms. You can:

• Consume less caffeine and alcohol
• Manage stress and get enough rest
• Follow a low-sodium diet

Healthcare providers recommend no more than 1,500 milligrams of salt daily. This is about three-quarters of a teaspoon. They may also tell you to avoid foods containing monosodium glutamate, or MSG.

Medications

Medicines for Ménière’s disease include pills you take by mouth, like:

• Water pills (diuretics) and betahistine. Water pills reduce the amount of fluid in your body. Betahistine relieves fluid pressure by improving blood flow and circulation in your inner ear.
• Motion sickness and anti-nausea medications. These medications help control vertigo episodes or ease the nausea from the spinning. Medicines include diazepam (Valium^®) and meclizine (Antivert^®).

If these medicines don’t help, your provider may recommend medicines you get in the form of a shot (injection). They include:

• Intratympanic steroid injection. A medical provider may inject steroids through your eardrum to control episodes of Ménière’s disease.
• Gentamicin. This antibiotic damages the part of your inner ear that’s causing your symptoms. The healthy part continues helping you maintain your balance and hearing. But there’s a risk that gentamicin can lead to further hearing loss.

Therapies and devices

Therapies and devices that treat Ménière’s disease include:

• Vestibular rehabilitation. You’ll learn exercises that help improve your balance and manage vertigo symptoms.
• Hearing aids. You may need hearing aids at some point. They’re rarely used at the beginning of a diagnosis since hearing tends to fluctuate more. It gets worse during episodes, then improves afterward.
• Cochlear implant. Depending on how severe your hearing loss is and how much benefit you’re getting from hearing aids, you may need a cochlear implant.
• Pressure pulse treatment. A device that fits in your outer ear “puffs” air pressure pulses in your middle ear. Air pressure on your middle ear may help manage endolymph levels. Experts disagree about how effective this treatment is.
• Cognitive behavioral therapy (CBT). CBT may help you cope with the stress, anxiety and depression Ménière’s disease may cause.

Surgery

Surgeries for severe cases of Ménière’s disease redirect or relieve the pressure from your inner ear fluid. Procedures include:

• Endolymphatic sac procedure. Your endolymphatic sac is a hollow pouch that drains inner ear fluid. In this procedure, providers release the excess fluid by cutting into the sac. They may place a small tube (stent) in the sac so fluid continues to drain.
• Vestibular nerve section. Your vestibular nerve sends balance signals to your brain. During the procedure, a provider cuts the nerve to prevent vertigo attacks (while preserving your hearing).
• Labyrinthectomy. This surgery removes the part of your inner ear that controls balance (labyrinth). But this surgery also causes hearing loss in your affected ear. Providers typically do this surgery only after you’ve lost hearing in that ear.

Will Ménière’s disease go away?

Ménière’s disease may go away for months or years, but it always comes back. Although there’s no cure, healthcare providers have treatments that reduce vertigo symptoms.

Is there anything I can do to feel better?

Follow your healthcare provider’s advice about lifestyle changes that can reduce symptoms. And always be sure to have your medications with you. Taking them when an episode starts can help you feel better sooner.