What is Meniere’s Disease

What Is Meniere’s Disease?

Meniere’s disease is a collection of symptoms caused by a disorder of the inner ear.

It is due to an abnormality in the fluids of the inner ear.

It results in attacks of dizziness (also known as vertigo), hearing impairment, noises in the ear or head (also known as tinnitus), and a feeling of fullness or pressure in the ears. (the symptoms are discussed in detail in the section below What Are The Symptoms Of Meniere’s Disease?)

The French doctor Prosper Meniere in 1861 was the first to draw attention to the inner ear as the source of these diverse symptoms.

It is not known what actually causes this disorder, but it is believed that the symptoms are somehow associated with an abnormal swelling of a fluid compartment inside the inner ear that contains the specialized fluid called endolymph.

Many experts believe that the sudden attacks of dizziness and hearing loss are caused by ruptures of this swollen fluid space in the inner ear. This results in mixing of the different inner ear fluids. The sudden change in the composition of the fluid bathing the specialized cells of the inner ear disrupts their normal activity so that the brain’s input from one ear becomes drastically different than the input from the other ear. This imbalance gives rise to the symptoms of Meniere’s disease.

Healing of the rupture results in recovery of inner ear function but not always without some permanent damage.

Fluid overload of the inner ear may occur in a number of ear disorders. Any condition that causes inflammation of these tissues can result in similar symptoms. If an underlying or predisposing cause cannot be found, the disorder is called Meniere’s disease.

Some thought has been given recently to the possibility that a few cases of Meniere’s disease may be related to a problem with the immune system in the inner ear. In other instances, it may be due to previous viral infection of the inner ear or a past head injury.

Extensive medical research has, however, established quite conclusively that the symptoms from Meniere’s Disease are due to an inner ear problem and that the brain and its connecting nerves are entirely normal.

Meniere’s disease can affect anyone. While it can occur at any age, Meniere’s disease most commonly occurs between the ages of 30 and 50. It is quite rare in childhood, very uncommon in adolescents, and seldom begins after age 50. It affects men and women about equally. Typically a person who develops symptoms is otherwise in good health.

 

 

 

 

What Are The Symptoms Of Meniere’s Disease?

These are the symptoms one might expect during an episode of Meniere’s disease:

• Sudden and unexpected attacks of dizziness, like a sensation of spinning, accompanied by a feeling of being off balance. This is known as vertigo. It may last from 20 minutes to a few hours or longer. It may be accompanied by nausea—which can be severe—and sometimes vomiting.

• Noises in the ear like a buzzing, ringing or roaring sound. This is known as tinnitus. To read a separate detailed article on Tinnitus go to Tinnitus.

• An intermittent feeling that the ear is full or stuffed.

• An intermittent hearing loss that usually fluctuates in severity and typically affects one ear. The ability to hear certain pitches may be lost over a longer period of time.

 

During severe attacks, sometimes called “drop attacks,” most people are unable to perform their normal activities, and may even drop to the ground from severe nausea and dizziness. After an attack, an individual may feel sleepy for several hours. For some the sensation of being off balance may last a few days.

 

How is Meniere’s Disease first noticed?

The symptom that usually brings people to the doctor first is dizziness. A sensation of spinning is most common but others describe feelings of falling or tumbling head over heels, or extreme nausea and vomiting, much like severe seasickness. The episode may last from 30 minutes to several hours. Less often a change in hearing or stuffy feelings in the ear will be noticed first.

Since the attacks are largely unpredictable, the first two or three bouts are likely to be attributed to some other cause—such as the flu, an upset stomach, or a viral infection.

The diagnosis can be made only if and when a pattern of attacks develop with all the typical symptoms, and other causes have been ruled out by a physician:

• Hearing loss

• Noises in the ear (tinnitus)

• Dizziness (vertigo)

• A feeling of fullness or pressure in the ear

 

 

How frequently do attacks occur?

It is common for people with Meniere’s disease to experience one or two mild episodes and then be free of any symptoms for months or even years. Other people may have a more dramatic onset—a full set of symptoms within weeks that continue intermittently for months or years.

One of the puzzling things about Meniere’s disease is that symptoms may occur in an irregular fashion. This makes it difficult to know if a treatment has been effective, because the “cure” may just as easily have been a spontaneous remission (self-healing).

 

Is Menieres Disease caused by stress or anxiety?

There is no firm evidence that either stress or excessive worry cause Meniere’s disease. It is possible, however, that stress can aggravate the symptoms of Meniere’s disease. It is not uncommon to hear individuals describing the onset of their symptoms or relapses associated with particularly stressful events, such as changes in work schedules, marital breakdown or loss of a close relative.

 

How Is Meniere’s Disease Diagnosed?

Medical advice should be sought to make sure that something else is not causing the symptoms. There is no 100% certain test for Meniere’s disease, but modern methods of diagnosis are often conclusive. These would normally include:

• A hearing test to determine sensory hearing loss in the affected ear.

• A balance test, called an electronystagmograph (ENG), during which warm and cool water or air is gently introduced into each ear canal and eye movements observed. Eye movements can be used to test the balance system since the eyes are coordinated with the ears through the nervous system.

 

The balance function is reduced in about 50% of patients with Meniere’s disease.

Other tests may be necessary, depending upon the person’s individual history and the doctor’s findings. These may include:

• Blood chemistry measurements

• X-rays of the ear bones to look for structural problems

• Magnetic resonance imaging (MRI), a high-tech test using powerful magnets and sound waves to create images of the inside of the body, to eliminate the possibility of a tumor causing the vertigo and hearing loss. For more detailed information about magnetic resonance imaging, go to MRI. Auditory brainstem response (ABR) test, measures the electrical activity of the pathway from the ear to the brainstem to identify the location of the hearing loss.

• Electrocochleography (ECoG), displays recordings directly from the inner ear itself to see whether there is significant bulging of the inner ear fluid compartment.

 

How Is Meniere’s Disease Treated?

Although there is no single cure for Meniere’s Disease , several treatments are available that are effective on an individual basis.

They include:

• Symptomatic treatments

• Preventive treatments

• Nonsurgical procedures

• Surgery

 

Symptomatic Treatments

Controlling symptoms of Meniere’s disease with medications is the initial treatment favored by most doctors

Drug treatments are effective in about 75% of cases. Some drugs are very helpful for certain patients but not for others. Initial treatment is often by “trial and error.”

Anti-nausea or anti-seasickness medications will reduce or eliminate nausea and dizziness. Several products can now be purchased over-the-counter. In the United States the common ones are Dramamine, Marezine, and Bonine. Other medications, including Meclazine (Antivert), Prochlorperizine (Compazine), Promethazine (Phenergan), and Scopolamine patches (Transderm-scop), still require a doctor’s prescription because they have more side effects that require monitoring. These medications need only be taken when there are symptoms, not on a regular basis.

Some doctors prescribe muscle relaxants or mild tranquilizers, such as Diazepam (Valium). They can be effective in reducing stress or the emotional upset which invariably accompanies the symptoms of Meniere’s disease. For some people these medications also have a sedative effect. While they are sometimes prescribed for regular daily use, they can be habit-forming.

 

Preventive Treatments

The most commonly used preventive treatments attempt to reduce fluid pressure in the inner ear, the underlying cause of the symptoms:

• Reducing sodium (salt) intake: The most popular approach aims to reduce the amount of fluid in the body by reducing sodium (salt) intake. Increased salt in the diet leads to retention of fluid which may aggravate inner ear fluid overload. Meniere’s patients may need to visit a nutritionist who is familiar with the “hydrops diet,” a low salt and sugar diet that has been shown to help reduce symptoms.

• Diuretics (commonly known as “water pills”) are also sometimes used. They cause the kidneys to excrete excess fluid. The theory behind this treatment is that such fluid reduction will also reduce fluid swelling in the inner ear.

 

Reducing salt intake or taking diuretics is effective for some people, but not for all. Other dietary restrictions have also been effective in some cases:

• Caffeine. Some doctors suggest eliminating caffeine from the diet. They believe that the stimulant effect of caffeine can bring on the symptoms and actually make the “ringing” sounds of tinnitus  louder. Caffeine is found not only in coffee, but also in tea, chocolate, and certain prescription and over-the-counter medications.

• Alcohol. It is usually recommended to cut alcohol intake to a glass of beer or wine a day. Alcohol is known to sometimes cause vertigo in migraine sufferers and may have the same effect on those with Meniere’s disease.

• MSG (monosodium glutamate). It may be worth avoiding foods containing the preservative MSG , which has also been known to cause incidents of vertigo. MSG is commonly used in Chinese food and pre-packaged foods.

 

Meniere’s disease sufferers should also avoid smoking, since nicotine constricts blood vessels and may disrupt blood flow to the inner ear, worsening symptoms. Aspirin and medications containing aspirin may make dizziness worse, and should not be taken.

 

A number of other treatments are used with varying degrees of success:

• Calcium channel blockers, medications that prevent or slow the influx of calcium ions into smooth muscle cells and are often used to treat cardiac conditions, have proven helpful. A few studies have shown that in some patients with Meniere’s disease the calcium level in the inner ear fluid is high. Treatment that affects the calcium exchange is being increasingly used.

• Steroids, similar to naturally occurring substances in the body, have the effect of suppressing the immune system. Steroids such as Prednisone or Dexmathasone have been prescribed when it is suspected that an autoimmune problem of the inner ear may be the cause of the symptoms. However, steroids have serious side effects including lowering the body’s resistance to infection.

• Niacin, a B vitamin, is sometimes prescribed on the theory that it improves blood circulation to the inner ear. While it may be helpful for some, there’s no scientific evidence that proves its effectiveness in treating Meniere’s disease.

• Flavinoids occur naturally in lemons, grapes, berries, and oranges. There have been recent claims that flavinoids taken as a dietary supplement (vitamin) may help reduce symptoms. Again, there’s been no scientific evidence to suggest that these are helpful.

 

Surgery

Surgical treatments are only offered when all else has failed. The aim of surgery is to either reduce the amount of fluid in the inner ear or destroy the balance function of the affected ear.

Several methods are used to prevent or manage the fluid accumulation in the ear associated with Meniere’s disease. One that remains in common usage is the endolymphatic shunt. A small plastic drainage tube or shunt is inserted into the endolymphatic sac in the inner ear to relieve the fluid pressure.

This operation has been successful in eliminating dizzy attacks in many people. However, quite a few studies suggest that it is not really effective, possibly because the shunt gets blocked. Some doctors consider the operation controversial while others believe it has a place in the treatment of Meniere’s disease.

Operations designed to deliberately destroy the balance function of the affected ear have a high success rate. Unfortunately, these operations risk additional damage to hearing. They are considered a “last resort,” reserved for those who suffer frequent drop attacks, when vertigo and nausea are so severe the person loses function. This risk may be acceptable if the hearing is already so degenerated that it is useless, but doctors may be reluctant to risk useful hearing in the affected ear because there is always a risk that Meniere’s disease may develop in the other ear at a later date.

Patients who have severe disabling dizziness can be cured of this symptom either by severing the balance nerve (vestibular neurectomy) or by removing the balance organ (labyrinthectomy).

 

• Vestibular neurectomy. This is the operation of choice if hearing is still good in the affected ear. Hearing is left unchanged in 95% of the cases. In this operation, the vestibular nerve—responsible for sending balance messages to the brain—is severed. There are some risks involved. During the recovery period the brain has to make adaptations to resume normal balance functions. Older people seem to have a more difficult time with this recovery. Also, because the vestibular nerve is located very close to the nerves that control hearing and facial movement, there is the danger of damaging these other nerves. Although the procedure cures vertigo, some people continue to experience balance problems after the surgery

 

• Labyrinthectomy. This operation removes all or part of the vestibular labyrinth, the balance organ of the inner ear. While usually successful in eliminating vertigo, the operation will result in total hearing loss in the affected ear. It is only considered when the disease has caused severe hearing impairment and the other ear is normal, or when the above operation, vestibular neurectomy, has too many risks involved.

These operations demand a high degree of technical skill, and are usually only undertaken in major hospital centers by highly trained and experienced surgeons.

Nonsurgical Procedures

Some nonsurgical procedures attempt to accomplish the same results as surgery:

to reduce inner ear fluid pressure, or, to destroy the inner ear balance function.

While they present fewer risks than surgery, they are usually less effective and not as long lasting.

Tympanostomy involves inserting a tube through a tiny hole in the eardrum, theoretically to reduce the fluid pressure and symptoms of vertigo. The procedure is commonly used to treat middle ear infections. Its effectiveness in treating fluid overload in Meniere’s disease is controversial since the pressure experienced by Meniere’s patients arises from the inner ear fluid compartments, not from the middle ear. However, there have been some reported successes in reducing inner ear pressure and the procedure is less invasive than an endolymphatic shunt.

Antibiotics are being used to selectively damage the sensory cells of the balance system without damaging the less sensitive hearing cells. An antibiotic is injected into the inner ear through a tiny tube placed through the eardrum. Four or five injections are usually given over the course of a month. Dizziness may sometimes recur many months later. While additional injections can be offered to the patient, the more injections given, the higher the risk that the hearing cells will also be damaged in the process.

 

 

 

In Between Attacks:

With even the most severe form of Meniere’s disease, sufferers are symptom-free most of the time. However, when people don’t feel good time seems to pass more slowly. But it does pass, and the symptoms will get better. People who seem to have the most difficulties are those who allow the symptoms to dictate how they spend their lives when they are not having an attack. A normal and regular routine and a positive attitude do help in this particular disorder.

 

What Is The Outlook For Meniere’s Disease?

The most important symptom for most people is dizziness. Very frequent attacks of dizziness can have a devastating effect on both their work and social life, and the burden is shared by family and loved ones. Fortunately, in 75% of all cases the dizziness is helped by drug treatment or disappears of its own accord.

Most people will be left with some inner ear damage causing partial hearing loss and tinnitus. In some, further symptoms may recur (relapses) and then clear up once again (remission).

Meniere’s disease can also cause depression and anxiety, and antidepressant and anti-anxiety medications as well as talk therapy and support may be necessary to help the patient cope.

About one in every four people with Meniere’s disease will continue to have frequent and disabling attacks despite trying various drugs and other treatments. The attacks themselves, as well as the uncertainty about when and where they may occur, can cause frustration and depression. Surgery is often recommended in these cases.

Scientists are investigating whether environmental or biological factors cause or affect attacks. Current research indicates that some allergies cause swelling of the endolymphatic sac. Also, new studies on the mechanisms of hearing and balance will hopefully bring more insight into the process of Meniere’s disease and result in the development of more effective treatment and successful prevention.

 

Frequently Asked Questions

How can I be sure that my dizziness is not caused by a brain tumor?

Even today, people frequently seek specialist advice worried that they may be suffering from an underlying disorder of the brain, possibly even a tumor. It’s important to remember that brain tumors are fairly rare, and in most cases dizziness and other symptoms are caused by a treatable problem. If you are concerned about dizziness, see a doctor; diagnostic testing can rule out the possibility of a tumor and help you find relief.

I used to experience such severe dizziness that I finally had surgery, but I still have ringing in my ears that is very disturbing to me. Shouldn’t the surgery have taken care of that and is there anything I can do about it?

Surgery normally only addresses the vertigo or dizziness; it is not expected to solve the problems of tinnitus, or noises in the ear. However, there are several treatments for tinnitus that have been helpful such as anti-anxiety drugs, alternative therapies, and masking, a method of introducing different sounds to the ear to “mask” the sounds of tinnitus.

It’s been eight years since I was first diagnosed with Meniere’s disease. I never had surgery. I still have hearing loss and ringing in my ears, yet my attacks of dizziness have almost completely disappeared. Why did the dizziness disappear but not the other symptoms?

This describes a common pattern of the disease for many patients. The reason the attacks of vertigo disappear after some years is probably due to the damage to the balance system that occurred during the course of the previous attacks.

About 10 years ago I had a vestibular neurectomy in my right ear to control my vertigo attacks. My doctor now tells me that the disease has progressed to my left ear. Can a second neurectomy be performed on my left ear?

Most doctors will not perform this surgery on both ears because of how it would affect the ability to visually focus. When our head moves, our balance system coordinates the movement of our eyes. The loss of both balance organs would affect the ability of the brain to perform this function. The outcome would be blurred vision when the head moves or possibly a constant sensation that the visual field is moving.

Is it true that Meniere’s disease could be caused by allergies?

In some cases, allergy to certain foods (for example, milk) has been found to cause the symptoms of Meniere’s disease. This may be worth looking into if there is a strong personal or family history of allergies.  To learn more about food allergies read  Food Allergies.

 

Additional Sources Of Information

The American Academy of Otolaryngology – Head & Neck Surgery

www.entnet.org

The Better Hearing Institute

www.betterhearing.org

Deafness Research Foundation
www.drf.org

Menieres.org

www.meniers.org

Meniere’s Disease Information Center

www.menieresinfo.com

Vestibular Disorders Association

www.vestibular.org

 

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