What is Ménière’s disease?
Ménière’s disease is a disorder of the inner ear that can affect both balance and hearing. It can occur in either ear, although it usually affects just one ear. The condition can cause severe dizziness and a feeling of spinning known as vertigo. It can also cause hearing loss, the sensation of ringing in the ears (called tinnitus), and a feeling of "fullness" in the ear. These sensations can occur spontaneously, and can last for minutes to hours in duration.
Ménière’s disease is also called idiopathic endolymphatic hydrops. It is one of the more common causes of dizziness.
Who gets Ménière’s disease?
Anyone can get Ménière’s disease, but it is more common in adults between 40 and 60 years of age. Approximately 615,000 individuals in the United States are currently diagnosed with Ménière’s disease, and about 45,500 cases are newly diagnosed each year, according to National Institute on Deafness and Other Communication Disorders (NIDCD).
People with a family history of Ménière’s disease are at a higher risk of developing this condition, however we do not know if it is truly an inherited condition.
Symptoms and Causes
What are the causes of Ménière’s disease?
The exact cause of Ménière’s disease is unknown in most cases. The hearing and balance organs are bathed in a fluid called endolymph. This fluid works by stimulating receptors when the body moves, or when sound moves the endolymph. When the receptors are stimulated, signals are sent to the brain about the body's position and movement, as well as what sounds are present. Ménière’s disease results in an abnormal amount of fluid (often overabundance of fluid to the degree of rupturing). The high levels of endolymph interfere with the signals the receptors are sending to the brain. This causes the symptoms of Ménière’s disease. In some cases the fluid pressure is so high the membranes ruptures which can cause severe spells of vertigo, as well as hearing loss. When the membranes heal, the vertigo resolves and the hearing may return to normal. Over time, the hearing loss may become permanent and the spells of vertigo may resolve, but symptoms of imbalance may remain.
What are the symptoms of Ménière’s disease?
Ménière’s disease often develops quickly, without any warning signs. Once someone has developed Ménière’s disease there is a fairly common progression of symptoms: usually individuals will first experience a sensation of ear pressure, and tinnitus with some fluctuating hearing loss and severe episodes of vertigo following this. Attacks of Ménière’s can vary in severity and can occur more than once a day, or just a few times in a year. The main symptoms include:
- A feeling of dizziness or vertigo, as if the world is spinning around you. This can be so extreme that you may not be able to stand up. The dizziness can last from a few minutes to a few hours and can cause you to feel severe nausea, vomiting, and sweating.
- A feeling of pressure or fullness in the ear. This is usually in just one ear.
- A decline in your ability to hear. This may result in a “muffled” effect. The inability to hear low frequencies is usually lost first, though higher pitches may be lost eventually as well. Hearing loss can recover between attacks, but it will permanently worsen over time.
- Ringing in the ear.
Other symptoms may include:
You should see your doctor if you have any of these symptoms.
Diagnosis and Tests
How is Ménière’s disease diagnosed?
Your doctor will begin your exam by asking questions about your attacks. He or she will ask how severe and how long each attack was and how long in total you have been having attacks. You will also be asked about any sensation of hearing loss, ear ringing, or feeling of fullness in your ear.
After taking your medical history, the doctor may perform a series of tests to determine if you have Ménière’s disease. The doctor may recommend a hearing test to check for any permanent hearing loss. A test called a caloric stimulation may be done to check a reflex between your inner ear balance system (vestibular) and eye muscles by warming or cooling the inner ear fluid with warm and cool water. Other vestibular testing may also be recommended to evaluate your sense of balance. Additional testing may include brain MRI with contrast to rule out brain tumors or other possible causes of dizziness and hearing loss.
Once your doctor has the results of these tests, he or she will determine if your symptoms are caused by Ménière’s disease.
Management and Treatment
What are the treatment options for Ménière’s disease?
Ménière’s disease usually improves over time. It is important to first treat the dizziness and vertigo that can be caused by Ménière’s disease, as these can be severe and even debilitating. Treating this major symptom can greatly improve a person's quality of life.
Treatments for this condition usually begins with a low-salt diet and a diuretic (water pill) may also be recommended to relieve fluid pressure in your inner ear. Most patients also find that reducing caffeine, chocolate, and alcohol intake can lessen or eliminate symptoms. Avoiding stressful situations and getting enough rest when possible may also help lessen the symptoms. In addition, occasional anti-vertigo medications such as meclizine, diazepam, glycopyrrolate, and lorazepam are used to relive the dizziness when needed (i.e. during a vertigo episode). An injection of a steroid of gentamicin (an antibiotic) directly into the ear is another treatment option.
For unusually severe cases of Ménière’s disease, surgery may be recommended. Surgical options include redirecting or relieving the pressure from the inner ear fluid. In some cases it may be necessary to cut the vestibular nerve to help control vertigo, or if the hearing is already severely damaged directly removing the inner ear receptors so they cannot continue to trigger the spells. Your doctor can recommend the best treatment plan for you.
As mentioned previously, Ménière’s disease is one of the more common reasons for dizziness. If you or a loved one suffer from this syndrome, in addition to speaking with a healthcare professional, additional support is available in the form of support groups, patient spotlight and other services to connect with others (Vestibular Disorders Association; www.vestibular.org).