Meniere's disease

This chronic disorder affects balance and hearing, causing unpredictable episodes of dizziness and hearing problems.

Meniere's disease is a disorder of the inner ear that can lead to dizzy spells (vertigo) and hearing loss. In most cases, Meniere's disease affects only one ear.

Meniere's disease can occur at any age, but it usually starts between young and middle-aged adulthood. It's considered a chronic condition, but various treatments can help relieve symptoms and minimize the long-term impact on your life.

Signs and symptoms of Meniere's disease include:

• Recurring episodes of vertigo. You have a spinning sensation that starts and stops spontaneously. Episodes of vertigo occur without warning and usually last 20 minutes to several hours, but not more than 24 hours. Severe vertigo can cause nausea.
• Hearing loss. Hearing loss in Meniere's disease may come and go, particularly early on. Eventually, most people have some permanent hearing loss.
• Ringing in the ear (tinnitus). Tinnitus is the perception of a ringing, buzzing, roaring, whistling or hissing sound in your ear.
• Feeling of fullness in the ear. People with Meniere's disease often feel pressure in an affected ear (aural fullness).

After an episode, signs and symptoms improve and might disappear entirely for a while. Over time, the frequency of episodes may lessen.

When to see a doctor

See your doctor if you have signs or symptoms of Meniere's disease. These problems can be caused by other illnesses, and it's important to get an accurate diagnosis as soon as possible.

The cause of Meniere's disease is unknown. Symptoms of Meniere's disease appear to be the result of an abnormal amount of fluid (endolymph) in the inner ear, but it isn't clear what causes that to happen.

Factors that affect the fluid, which might contribute to Meniere's disease, include:

• Improper fluid drainage, perhaps because of a blockage or anatomic abnormality
• Abnormal immune response
• Viral infection
• Genetic predisposition

Because no single cause has been identified, it's likely that Meniere's disease results from a combination of factors.

The unpredictable episodes of vertigo and the prospect of permanent hearing loss can be the most difficult problems of Meniere's disease. The disease can unexpectedly interrupt your life, causing fatigue and stress.

Vertigo can cause you to lose balance, increasing your risk of falls and accidents.

Your doctor will conduct an exam and take a medical history. A diagnosis of Meniere's disease requires:

• Two episodes of vertigo, each lasting 20 minutes or longer but not longer than 12 hours
• Hearing loss verified by a hearing test
• Tinnitus or a feeling of fullness in your ear
• Exclusion of other known causes of these problems

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. People with Meniere's disease typically have problems hearing low frequencies or combined high and low frequencies with normal hearing in the midrange frequencies.

Balance assessment

Between episodes of vertigo, the sense of balance returns to normal for most people with Meniere's disease. But you might have some ongoing balance problems.

Tests that assess function of the inner ear include:

• Videonystagmography (VNG). This test evaluates balance function by assessing eye movement. Balance-related sensors in the inner ear are linked to muscles that control eye movement. This connection enables you to move your head while keeping your eyes focused on a point.
• Rotary-chair testing. Like a VNG, this measures inner ear function based on eye movement. You sit in a computer-controlled rotating chair, which stimulates your inner ear.
• Vestibular evoked myogenic potentials (VEMP) testing. This test shows promise for not only diagnosing, but also monitoring Meniere's disease. It shows characteristic changes in the affected ears of people with Meniere's disease.
• 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 harness, you stand in bare feet on a platform and keep your balance under various conditions.
• Video head impulse test (vHIT). This newer test uses video to measure eye reactions to abrupt movement. While you focus on a point, your head is turned quickly and unpredictably. If your eyes move off the target when your head is turned, you have an abnormal reflex.
• Electrocochleography (ECoG). This test looks at the inner ear in response to sounds. It might help to determine if there is an abnormal buildup of fluid in the inner ear, but isn't specific for Meniere's disease.

Tests to rule out other conditions

Blood tests and imaging scans such as an MRI 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.

No cure exists for Meniere's disease. A number of treatments can help reduce the severity and frequency of vertigo episodes. But, unfortunately, there aren't any treatments for the hearing loss.

Medications for vertigo

Your doctor may prescribe medications to take during a vertigo episode to lessen the severity of an attack:

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

Long-term medication use

Your doctor may prescribe a medication to reduce fluid retention (diuretic) and suggest that you limit your salt intake. For some people, this combination helps control the severity and frequency of Meniere's disease symptoms.

Noninvasive therapies and procedures

Some people with Meniere's disease may benefit from other noninvasive therapies and procedures, such as:

• Rehabilitation. If you have balance problems between episodes of vertigo, vestibular rehabilitation therapy might improve your balance.
• Hearing aid. A hearing aid in the ear affected by Meniere's disease might improve your hearing. Your doctor can refer you to an audiologist to discuss what hearing aid options would be best for you.

• Positive pressure therapy. For vertigo that's hard to treat, this therapy involves applying pressure to the middle ear to lessen fluid buildup. A device called a Meniett pulse generator applies pulses of pressure to the ear canal through a ventilation tube. You do the treatment at home, usually three times a day for five minutes at a time.

  Positive pressure therapy has shown improvement in symptoms of vertigo, tinnitus and aural pressure in some studies, but not in others. Its long-term effectiveness hasn't been determined yet.

If the conservative treatments listed above aren't successful, your doctor might recommend some of these more-aggressive treatments.

Middle ear injections

Medications injected into the middle ear, and then absorbed into the inner ear, may improve vertigo symptoms. This treatment is done in the doctor's office. Injections available include:

• 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. There is a risk, however, of further hearing loss.
• Steroids, such as dexamethasone, also may help control vertigo attacks in some people. Although dexamethasone may be slightly less effective than gentamicin, it's 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 might be an option. Procedures include:

• Endolymphatic sac procedure. The endolymphatic sac plays a role in regulating inner ear fluid levels. During the procedure, the endolymphatic sac is decompressed, which can alleviate excess fluid levels. 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 the balance portion of the inner ear, thereby removing both balance and hearing function from the affected ear. This procedure is performed only 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. It requires general anesthesia and an overnight hospital stay.

Certain self-care tactics can help reduce the impact of Meniere's disease. Consider these tips for use during an episode:

• Sit or lie down when you feel dizzy. During an episode of vertigo, avoid things that can make your signs and symptoms worse, such as sudden movement, bright lights, watching television or reading. Try to focus on an object that isn't moving.
• Rest during and after attacks. Don't rush to return to your normal activities.
• Be aware you might lose your balance. Falling could lead to serious injury. Use good lighting if you get up in the night. A cane for walking might help with stability if you have chronic balance problems.

Lifestyle changes

To avoid triggering a vertigo attack, try the following.

• Limit salt. Consuming foods and beverages high in salt can increase fluid retention. For overall health, aim for less than 2,300 milligrams of sodium each day. Experts also recommend spreading your salt intake evenly throughout the day.
• Limit caffeine, alcohol and tobacco. These substances can affect the fluid balance in your ears.

Meniere's disease can affect your social life, your productivity and the overall quality of your life. Learn all you can about your condition.

Talk to people who share the condition, possibly in a support group. Group members can provide information, resources, support and coping strategies. Ask your doctor or therapist about groups in your area or look for information from the Vestibular Disorders Association.

You're likely to first see your family doctor. Your primary care doctor might refer you to an ear, nose and throat (ENT) specialist, a hearing specialist (audiologist), or a nervous system specialist (neurologist).

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before a test. Make a list of:

• Your symptoms, especially those you have during an episode, how long they last and how often they occur
• Key personal information, including major stresses, recent life changes and family medical history
• All medications, vitamins or supplements you take, including the doses
• Take a family member or friend along, if possible, to help you remember the information you're given.
• Questions to ask your doctor

For Meniere's disease, some basic questions to ask your doctor include:

• What's likely causing my symptoms?
• What are other possible causes for my symptoms?
• What tests do I need?
• Is my condition likely temporary or chronic?
• What's the best course of action?
• What are the alternatives to the approach you're suggesting?
• I have other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• Should I see a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you several questions, such as:

• When did your symptoms begin?
• How often do your symptoms occur?
• How severe are your symptoms and how long do they last?
• What, if anything, seems to trigger your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have you had ear problems before? Does anyone in your family have a history of inner ear problems?

Last Updated:

December 22nd, 2020