Meniere’s disease

Meniere’s disease is a disorder of the inner ear that causes abnormal sensory perceptions, including a sensation of a spinning motion (vertigo), hearing loss usually in one ear, fullness or pressure in the same ear, and ringing in the same ear (tinnitus).

People in their 40s and 50s are more likely than people in other age groups to develop Meniere’s disease. Estimates of the number of people with Meniere’s disease vary significantly, but according to the National Institute on Deafness and Other Communication Disorders, about 615,000 people in the United States have the disease.

Symptoms of Meniere’s disease are:

  • Recurring episodes of vertigo. Vertigo is similar to the sensation you experience if you spin around quickly several times and suddenly stop. You feel as if the room is still spinning, and you lose your balance. Episodes of vertigo occur without warning and usually last 20 minutes to two hours or more. Severe vertigo can cause nausea and vomiting.
  • Hearing loss. Hearing loss in Meniere’s disease may fluctuate, particularly early in the course of the disease. Eventually, most people experience some degree of permanent hearing loss.
  • Tinnitus. Tinnitus is the perception of a ringing, buzzing, roaring, whistling or hissing sound in your ear.
  • Aural fullness. Aural fullness is the feeling of fullness or pressure in the ear.

The severity, frequency and duration of each of these sensory perception problems vary. For example, you could have frequent episodes with severe vertigo and only mild disturbances in other sensations. Or you may experience mild vertigo and hearing loss infrequently but have frequent tinnitus that disturbs your sleep.

The cause of Meniere’s disease isn’t well understood. It appears to be the result of the abnormal volume or composition of fluid in the inner ear. But what factors actually cause these changes in the inner ear fluid is unknown.

The inner ear is a cluster of connected passages and cavities called a labyrinth. The outside of the inner ear is made of bone (bony labyrinth). Inside is a soft structure of membrane (membranous labyrinth) that’s a slightly smaller, similarly shaped version of the bony labyrinth.

The membranous labyrinth contains a fluid (endolymph) and is lined with hair-like sensors that respond to movement of the fluid. These sensors create nerve impulses that are sent to the brain. Each part of the inner ear is responsible for a different type of sensory perception:

  • Sensors in a portion of the membrane in the center section of the labyrinth (vestibule) enable you to detect your own acceleration movement in any direction.
  • Branching off from one side of the vestibule are three loops (semicircular canals). Sensors in the semicircular canals enable you to sense your own rotational motion and are important for maintaining your balance.
  • On the other side of the vestibule is a snail-shaped structure (cochlea), the hearing part of the inner ear. Vibrating bones of the middle ear create waves in the inner ear fluid, which sensors in the cochlea translate into impulses sent to the brain.

In order for all of the sensors in the inner ear to function properly, the fluid needs to retain a certain volume, pressure and chemical composition. Factors that alter the properties of inner ear fluid may help cause Meniere’s disease.

Meniere’s disease generally occurs in only one ear. In rare cases, both ears can be affected.

A diagnosis of Meniere’s disease requires:

  • Two spontaneous episodes of vertigo, each lasting 20 minutes or longer
  • Hearing loss verified by a hearing test on at least one occasion
  • Tinnitus or aural fullness
  • Exclusion of other known causes of these sensory problems

If you have signs or symptoms associated with Meniere’s disease, your doctor will ask you questions about your sensory problems, order tests that evaluate the quality of inner ear function and order other tests to screen for possible causes of the problems. He or she may refer you to an ear, nose and throat (ENT) specialist, or otolaryngologist; a hearing specialist (audiologist); or a nervous system specialist (neurologist).

Physical examination and history
Your doctor will conduct a physical examination and ask questions about:

  • The severity, duration and frequency of the sensory problems
  • Your history of infectious diseases or allergies
  • Medication use
  • Past ear problems
  • Your general health
  • History of inner ear problems in your family

Hearing assessment
A hearing test (audiometry) assesses how well you detect sounds at different pitches and volumes and how well you distinguish between similar-sounding words. The test not only reveals the quality of your hearing but also may help determine if the source of hearing problems is in the inner ear or the nerve that connects the inner ear to the brain.

Balance assessment
Between episodes of vertigo, the sense of balance returns to normal for most people with Meniere’s disease. But there may be some degree of ongoing balance problems.

Electronystagmography (ENG) evaluates balance function by assessing eye movement. Balance-related sensors in the inner ear are linked to muscles that control movement of the eye in all directions. This connection is what enables you to move your head around while keeping your eyes focused on a single point.

In an ENG evaluation, electrodes are placed on the skin near the eyes and on the forehead. Then warm and cool water, or warm and cool air, are introduced into the ear canal. Measurements of involuntary eye movements in response to this stimulation are performed. Abnormalities of this test may indicate an inner ear problem.

An ENT specialist may use additional tests that assess function of the inner ear. Some or all of these tests can yield abnormal results in a person with Meniere’s disease. These tests include:

  • Rotary-chair testing. Like an ENG, this measures inner ear function based on eye movement. In this case, stimulus to your inner ear is provided by movement of a special rotating chair precisely controlled by a computer.
  • Vestibular evoked myogenic potentials (VEMP) testing. VEMP testing measures the function of sensors in the vestibule of the inner ear that help you detect acceleration movement. These sensors also have a slight sensitivity to sound. When these sensors react to sound, tiny measurable variations in neck muscle contractions occur. These contractions serve as an indirect measure of inner ear function.
  • Posturography. This computerized test reveals which part of the balance system — vision; inner ear function; or sensations from the skin, muscles, tendons and joints — you rely on the most and which parts may cause problems. While wearing a safety harnesss, you stand in bare feet on a special platform and keep your balance under various conditions.

Other tests
Other tests may be used to rule out disorders that can cause problems similar to those of Meniere’s disease, such as a tumor in the brain or multiple sclerosis. These tests include:

  • Magnetic resonance imaging (MRI). This technique uses a magnetic field and radio waves to create images of soft tissues in the body. It can be used to produce either a thin cross-sectional “slice” or a 3-D image of your brain.
  • Computerized tomography (CT). This X-ray technique produces cross-sectional images of internal structures in your body.
  • Auditory brainstem response audiometry. This is a computerized test of the hearing nerves and hearing centers of the brain. It can help detect the presence of a tumor disrupting the function of auditory nerves.

There is no cure for Meniere’s disease, but a number of strategies may help you manage some symptoms.

Medications for vertigo
Your doctor may prescribe medications to be taken during an episode of vertigo to lessen the severity of an attack:

  • Motion sickness medications, such as meclizine (Antivert) or diazepam (Valium), may reduce the spinning sensation of vertigo and help control nausea and vomiting.
  • Anti-nausea medications, such as prochlorperazine, may control nausea and vomiting during an episode of vertigo.

Long-term medication use
Your doctor may prescribe a medication to reduce fluid retention (diuretic), such as the drug combination triamterene and hydrochlorothiazide (Dyazide, Maxzide). Reducing the amount of fluid your body retains may help regulate the fluid volume and pressure in your inner ear. For some people a diuretic helps control the severity and frequency of Meniere’s disease symptoms.

Because diuretic medications cause you to urinate more frequently, your system may become depleted of certain minerals, such as potassium. If you take a diuretic, supplement your diet each week with three or four extra servings of potassium-rich foods, such as bananas, cantaloupe, oranges, spinach and sweet potatoes.

Dietary changes
Modifying your diet can reduce your body’s fluid retention and help decrease fluid in your inner ear. Your doctor may suggest you follow these dietary changes to lessen the severity and frequency of Meniere’s disease symptoms:

  • Eat regularly. Distributing evenly what you eat and drink throughout the day helps regulate your body fluids. Eat approximately the same amount of food at each meal. You may also eat five or six smaller meals rather than three meals a day.
  • Limit salt. Consuming foods and beverages high in salt can increase fluid retention. Aim for an intake of 1,000 to 1,500 milligrams (mg) or less of sodium each day.
  • Avoid monosodium glutamate (MSG). Prepackaged food products and some Asian foods include MSG, a type of sodium. MSG can contribute to fluid retention.

Other lifestyle changes
Some evidence suggests that lifestyle factors may worsen symptoms of Meniere’s disease or act as triggers for the onset of symptoms. Your doctor may recommend the following changes to alleviate symptoms or help prevent the onset of symptoms.

  • Avoid caffeine. Foods and beverages that contain caffeine, such as chocolate, coffee, tea and certain soft drinks, have stimulant properties that can make symptoms worse. For instance, caffeine may make ringing in the ear (tinnitus) louder.
  • Stop smoking. Avoiding nicotine may lessen the severity of Meniere’s disease symptoms.
  • Manage stress and anxiety. It’s difficult to know whether stress and anxiety act as triggers for Meniere’s disease symptoms or are the result of having the disorder. Some evidence suggests, however, that managing stress and anxiety may lessen the severity of symptoms and enable you to cope with the disorder. Professional psychotherapy may help you identify stressors and develop strategies for dealing with stress and anxiety. Medications to alleviate anxiety also may be beneficial.

Middle ear injections
Medications injected into the middle ear, and then absorbed into the inner ear, may improve vertigo symptoms:

  • Gentamicin, an antibiotic that’s toxic to your inner ear, reduces the balancing function of your ear, and your other ear assumes responsibility for balance. The procedure, which can be performed with local anesthesia in your doctor’s office, often reduces the frequency and severity of vertigo attacks. There is a risk, however, of further hearing loss.
  • Steroids, such as dexamethasone, also may help control vertigo attacks in some people. This procedure can also be performed with local anesthesia by your doctor. Although dexamethasone injections may be slightly less effective than gentamicin, dexamethasone is less likely than gentamicin to cause further hearing loss.

Surgery
If vertigo attacks associated with Meniere’s disease are severe and debilitating and other treatments don’t help, surgery may be an option. Procedures may include:

  • Endolymphatic sac procedures. The endolymphatic sac plays a role in regulating inner ear fluid levels. These surgical procedures may alleviate vertigo by decreasing fluid production or increasing fluid absorption.In endolymphatic sac decompression, a small portion of bone is removed from over the endolymphatic sac. In some cases, this procedure is coupled with the placement of a shunt, a tube that drains excess fluid from your inner ear.
  • Labyrinthectomy. With this procedure, the surgeon removes a portion or all of the inner ear, thereby removing both balance and hearing function from the affected ear. This procedure is only performed if you already have near-total or total hearing loss in your affected ear.
  • Vestibular nerve section. This procedure involves cutting the nerve that connects balance and movement sensors in your inner ear to the brain (vestibular nerve). This procedure usually corrects problems with vertigo while attempting to preserve hearing in the affected ear.

Rehabilitation
If you experience problems with your balance between episodes of vertigo, you may benefit from vestibular rehabilitation therapy. The goal of this therapy, which may include exercises and activities that you perform during therapy sessions and at home, is to help your body and brain regain the ability to process balance information correctly.

Hearing aid
A hearing aid in the ear affected by Meniere’s disease may improve your hearing. Your doctor can refer you to an audiologist to discuss what hearing aid options would be best for you.

Meniere’s disease may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find encouragement and understanding in a support group. Group members can provide information, resources, support and coping strategies. Your doctor may be able to recommend a group in your area, or you may find information about local groups from the Vestibular Disorders Association.