Ménière’s Disease

What is Ménière’s disease?

Ménière’s disease (idiopathic endolymphatic hydrops) is a rare inner ear disorder that affects your sense of balance and hearing. People with this condition experience symptoms like vertigo, ringing in their ears (tinnitus) and difficulty hearing. Symptoms start without warning, then go away — only to come back time and time again. The condition can take a major toll on your daily life.

Left untreated, Ménière’s disease symptoms worsen over time and 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.

How common is Ménière’s disease?

Ménière’s disease is rare. According to the most recent data from the National Institute on Deafness and Other Communication Disorders, about 615,000 people in the United States have the disorder. (There are more than 330 million people in the United States.)

What are the symptoms of Ménière’s disease?

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 of remission (no symptoms) in between episodes.

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

• Vertigo: You may feel as if the world is spinning around you even when you’re standing still. Some people have “drop attacks,” where the vertigo is so severe they topple over and fall.
• Trouble hearing and hearing loss. You may have trouble hearing during an attack (usually only in one ear). In the beginning, many people have difficulty hearing lower pitches in particular. Without treatment, the condition can lead to hearing loss.
• Tinnitus. It may feel as if one of your ears is ringing. People with Ménière’s disease sometimes describe the sound as similar to machines whirring or the whooshing sound you hear when holding a seashell up to your ear.
• Pressure. You may feel pressure or fullness in the affected ear.

Other symptoms may include nausea and vomiting.

What causes Ménière’s disease?

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

Experts haven’t identified a single condition that causes too much endolymph to build up, but possibilities include:

• Allergies.
• An infection.
• A head injury.
• Migraine headaches.

A blockage in your inner ear that prevents endolymph drainage.

More research is needed to understand the potential relationships among these conditions, endolymph buildup and Ménière’s disease.

Risk factors of Ménière’s disease

Risk factors include:

• Age: Ménière’s disease typically affects people ages 40 to 60.
• Sex: Some studies show that people assigned female at birth (AFAB) are slightly more likely to develop this condition.
• Genetics: 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: Some studies show that you may be more likely to develop Ménière’s disease if you have an autoimmune condition, like rheumatoid arthritis, lupus and ankylosing spondylitis.

What are the complications of this condition?

Ménière’s disease isn’t a life-threatening illness, but it can affect your overall quality of life and pose health risks. It can lead to:

• Serious falls: Unexpected, severe vertigo attacks can put you at risk of falls. It can make everyday activities (like climbing a ladder or driving a car) too risky to attempt.
• Hearing loss: Untreated Ménière’s disease can lead to permanent hearing loss over time (usually after eight to 10 years).
• Mental health conditions: Ménière’s disease can take a toll on your mental health, too. Some people with Ménière’s disease develop anxiety, worrying about when and how future vertigo attacks will affect them. Some people develop depression due to the symptoms that affect hearing and balance.

How is Ménière’s disease diagnosed?

Otolaryngologists (ENTs) diagnose Ménière’s disease. During your visit, your provider will perform a physical exam and neurological exam and ask about your symptoms. They may ask if you have regular episodes of vertigo and hearing loss. If you do, they’ll ask about how severe they are and how long they last.

They may do tests to rule out other potential conditions to confirm you have Ménière’s disease, including:

• Hearing test: The test will show if you’ve experienced hearing loss. During this test, a hearing specialist called an audiologist plays sounds through headphones. You’ll press a button when you hear a sound.
• Vestibular test battery: Audiologists perform a series of tests to check the reflex of your inner ear (vestibular) balance system and eye muscles. Although your balance mostly returns to normal when you’re not experiencing a vertigo attack, there may be leftover effects the tests can detect.
• Brain magnetic resonance imaging (MRI) with contrast: This imaging test helps to rule out potential 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, like lifestyle changes, medication and therapy. If these treatments don’t help, you may need surgery.

Lifestyle changes

You can do several things to reduce Ménière’s disease symptoms, including:

• Following a low-salt (sodium) diet: Salty foods make you retain fluid. Excess fluid in your inner ear may trigger Ménière’s disease symptoms. Healthcare providers recommend cutting back to no more than 1,500 milligrams of salt daily (about three-quarters of a teaspoon). Your provider may also recommend that you avoid foods containing monosodium glutamate (MSG).
• Consuming less caffeine and alcohol: Some studies show that caffeine may increase how often you get vertigo attacks. Alcohol can trigger episodes, too.
• Managing stress: Some research shows that stress and not getting enough rest can trigger symptoms of Ménière’s disease.

Medications

Medications for Ménière’s disease include pills you take by mouth, such as:

• Diuretics (water pills) and betahistine: Your provider may prescribe diuretics to reduce the amount of fluid in your body. Or they may prescribe betahistine, which 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, and some ease the nausea and vomiting 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 an injection (shot). Options 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 that remains 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: During therapy, you’ll learn exercises that help you improve your balance and manage vertigo symptoms.
• Hearing aids: You may need hearing aids at some point. They’re less commonly used at the beginning of a diagnosis since hearing tends to fluctuate more (get worse during episodes then improve substantially afterward).
• Cochlear implant: Depending on the severity of your hearing loss, you may not benefit from using hearing aids. In that case, your provider may recommend a cochlear implant instead.
• Pressure pulse treatment: This treatment uses a device that fits in your outer ear to “puff” air pressure pulses on your middle ear. Air pressure on your middle ear may help regulate endolymph levels. Experts are divided on how effective this treatment is.
• Cognitive behavioral therapy (CBT): Healthcare providers may recommend CBT to help you cope with the stress, anxiety and depression Ménière’s disease may cause.

Surgery

Surgeries for severe cases of Ménière’s disease either 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 causing issues 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 your labyrinth, the part of your inner ear that controls balance. 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.

Can I reduce my risk of developing Ménière’s disease?

No, but if you have Ménière’s disease, you can reduce your risk that your condition will worsen.

Contact your healthcare provider if you suddenly develop dizzy spells that may be vertigo. The sooner you receive a diagnosis, the sooner you can start treatments that can help.

Will Ménière’s disease go away?

Ménière’s disease may go away for months or years, but it always comes back. Healthcare providers have medication and other treatments that reduce vertigo symptoms, but there’s no cure. Ménière’s disease is a chronic illness that never really goes away.

How do I take care of myself?

There are several ways to care for yourself if you’re living with Ménière’s disease. Try to:

• Have your medication with you always. Always travel with your medications on you. If an episode starts, you can take them immediately and get relief sooner.
• Learn and respond to your body’s triggers. Many different things can trigger Ménière’s disease symptoms — from allergies and salty foods to tiredness and overstimulating environments. But not everyone has the same triggers. Pay attention to your body to learn what your triggers are, so you can avoid them.
• Monitor what you eat and drink closely. It’s essential that you limit sodium and reduce caffeine and alcohol. This can be challenging because while most of us know that some foods (like potato chips) are salty, other high-sodium foods are harder to recognize. Ask your provider what foods to avoid.
• Get plenty of rest. Being too tired can trigger symptoms and so can trying to regroup too quickly after an attack. Try to lie down in a calm, quiet environment if you’re trying to recover from a vertigo attack. Give your body time to adjust.

What questions should I ask my healthcare provider?

Ménière’s disease is a rare condition, which means you may have many questions about it. Questions you may want to ask include:

• Why do I have Ménière’s disease?
• Will my symptoms get worse?
• What are my treatment options?
• What are the side effects of treatment?
• What lifestyle changes should I try to manage the condition?
• What should I do if I feel an episode coming on?

A note from Cleveland Clinic

Having Ménière’s disease may feel like you’re being stalked by a disease that jumps out at you when you least expect it. Symptoms of this condition — vertigo attacks and hearing problems — happen without warning and can be very severe. You may feel like you can’t live a normal life because you don’t know when you’ll have another attack.

Fortunately, healthcare providers have treatments that reduce Ménière’s disease symptoms, including vertigo. They also understand how this condition may affect your mental health. If you have this condition, ask your provider about programs and services that can help.