Meniere’s Disease

Meniere’s disease is a disorder of the inner ear that causes sudden episodes of severe dizziness, hearing loss, ringing in the ears, and a feeling of fullness or pressure in the ear. While there is no cure, various treatments can help manage symptoms and improve quality of life.

Table of contents

• What Is Meniere’s Disease?
• Symptoms and Episodes
• Causes and Risk Factors
• How Doctors Diagnose the Condition
• Treatment Options
• Lifestyle Changes and Self-Care
• Complications and Long-Term Effects

idiopathic endolymphatic hydrops

• Inner ear
• Cochlea
• Semicircular canals
• Labyrinth

What Is Meniere’s Disease?

Meniere’s disease is an inner ear problem that causes dizzy spells, also called vertigo (a spinning sensation), and hearing loss^[1]. This condition is also known as idiopathic endolymphatic hydrops, which refers to a buildup of fluid in the inner ear^[2]. Most of the time, Meniere’s disease affects only one ear, though in 15% to 25% of people with the disorder, both ears may be affected^[3].

The condition is relatively rare. Approximately 615,000 individuals in the United States have Meniere’s disease, and about 45,500 cases are newly diagnosed each year^[3]. The incidence is estimated to be about 1-2 people per 1000, although this figure can vary depending on the diagnostic criteria used^[11].

Meniere’s disease can happen at any age, but it usually starts between the ages of 40 to 60^[1]. It’s thought to be a lifelong condition, though some treatments can help ease symptoms and lessen how it affects your life long term^[1]. Males and females appear to show a similar incidence of Meniere’s, although some studies show that females are slightly more likely to develop this condition^[2].

Symptoms and Episodes

Symptoms of Meniere’s disease come and go in episodes or attacks. These episodes start suddenly and can last anywhere between a few minutes and 24 hours^[5]. Some people have single attacks of dizziness separated by long periods of time, while others may experience many attacks close together over several days^[3].

The main symptoms of a Meniere’s disease episode include^[1]:

• Regular dizzy spells. You have a spinning feeling that starts and stops suddenly. Vertigo may start without warning and usually lasts 20 minutes to 12 hours, but not more than 24 hours. Serious vertigo can cause nausea and vomiting.
• Hearing loss. Hearing loss in Meniere’s disease may come and go, especially early on. Over time, hearing loss can be long-lasting and not get better. At first, many people have difficulty hearing lower pitches, specifically^[2].
• Ringing in the ear. This is called tinnitus. Tinnitus is the term for when you have a ringing, buzzing, roaring, whistling or hissing sound in your ear. The sound may remind you of machines whirring or the whooshing noise you hear when holding a seashell up to your ear^[2].
• Feeling of fullness in the ear. People with Meniere’s disease often feel pressure in the ear. This is called aural fullness.

Some people with Meniere’s disease have vertigo so extreme that they lose their balance and fall. These episodes are called “drop attacks” or Tumarkin attacks^[3]. While the actual attack is brief, it can cause injuries during the fall and be emotionally draining for patients. Only around 10% of people with Meniere’s disease get Tumarkin attacks^[11].

After a vertigo attack, symptoms get better and might go away for a while. Over time, how many vertigo attacks you have may lessen^[1]. However, the hearing loss can get worse without treatment^[2].

Causes and Risk Factors

Experts don’t know what causes Meniere’s disease. But many believe that a buildup of inner ear fluid called endolymph plays a role. Too much endolymph can disrupt hearing and balance signals going to your brain^[2].

The inner ear contains organs of hearing and balance within a structure called the labyrinth. This labyrinth is filled with endolymph that stimulates receptors in the balance organs as the body moves^[3]. Although the causes of Meniere’s disease remain unclear, the symptoms are associated with a fluid imbalance in this part of the inner ear^[3].

Theories vary about the underlying causes. Some researchers believe it may develop from constricted blood vessels, which also occur with migraine headaches. Other theories suggest viral infections, allergies, or autoimmune reactions as possible causes^[3]. Conditions that may cause too much endolymph to build up include^[2]:

• Allergies
• Blockages in your inner ear that prevent endolymph drainage
• Head injuries
• Infections
• Migraine headaches

Risk factors for developing Meniere’s disease include^[2]:

• Age. Meniere’s disease typically affects people ages 40 to 60.
• Sex. Some studies show that females are slightly more likely to develop this condition.
• Genes. Genetic variations could play a role, since Meniere’s disease sometimes affects more than one family member^[3]. About 7% to 10% of people with Meniere’s disease have a family history of the disorder^[2].
• Autoimmune diseases. You may be more likely to develop Meniere’s disease if you have an autoimmune disease such as rheumatoid arthritis, lupus and ankylosing spondylitis.

How Doctors Diagnose the Condition

Otolaryngologists (ENTs, or ear, nose, and throat specialists) diagnose Meniere’s disease^[2]. Your healthcare provider does an exam and asks about your health history. A Meniere’s disease diagnosis needs to include^[8]:

• Two or more vertigo attacks, each lasting 20 minutes to 12 hours, or up to 24 hours
• Hearing loss proved by a hearing test
• Tinnitus or a feeling of fullness or pressure in the ear

Meniere’s disease can have symptoms that are similar to other illnesses. Because of this, your healthcare provider will need to rule out any other conditions you may have^[8]. There’s no test to say for sure that you have Meniere’s disease, so it is fundamentally a diagnosis of exclusion^[7].

A hearing test is called audiometry. Audiometry looks at how well you hear sounds at different pitches and volumes. People with Meniere’s disease often have trouble hearing low frequencies or combined high and low frequencies. They may have typical hearing in the midrange frequencies^[8].

Tests that study how well the inner ear is working include^[8]:

• Electronystagmogram or videonystagmography (ENG or VNG). These tests measure balance by studying eye movement. One part of the test looks at eye movement while your eyes follow a target. One part studies eye movement while your head is put in different positions. A third test, called the caloric test, follows eye movement by using temperature changes to trigger a reaction from the inner ear.
• Rotary-chair testing. Like a VNG, this test measures how well your inner ear works based on eye movement. You sit in a computer-controlled chair that spins from side to side.

Doctors sometimes do an MRI (magnetic resonance imaging) to be sure something else isn’t causing your symptoms. They’ll also usually do a hearing test^[4].

Treatment Options

There is no cure for Meniere’s disease, but treatment can prevent attacks or reduce their severity^[13]. Treatment options range from medications to procedures and, in rare cases, surgery.

Medications

Your clinician may prescribe medications to use when you have an attack. These medications provide symptom relief and include^[13]:

• Antiemetics to reduce nausea and vomiting
• Vestibular suppressants to reduce vertigo and anxiety associated with attacks. Examples include meclizine or diazepam^[17].

Medications can also help prevent and reduce the frequency of Meniere’s disease attacks. They include^[13]:

• Diuretics (water pills) to reduce fluid build-up in the inner ear
• Migraine medications, due to the overlap of migraine and Meniere’s disease

Injections

Doctors may inject medications into the middle ear to treat Meniere’s disease. Steroids may reduce dizziness and hearing loss^[13]. For severe cases, intratympanic injections of steroids or gentamicin into the middle ear may be considered. While gentamicin can reduce vertigo, it carries a risk of hearing loss^[17].

Surgical Options

Surgery is rarely recommended and should be a last resort^[17]. If you have severe dizziness and medicine doesn’t help, doctors may^[4]:

• Do surgery to get rid of some of the fluid in your inner ear (endolymphatic sac decompression)
• Inject a medicine through your ear drum
• As a last resort, cut the nerves in your ear that control balance (vestibular neurectomy) or perform a labyrinthectomy

Surgical options carry many risks such as hearing loss, vision issues, and facial paralysis^[17].

Physical Therapy

Vestibular Rehabilitation Therapy (VRT) involves exercises designed to improve balance and reduce dizziness by retraining the brain to compensate for inner ear dysfunction^[17]. However, keep in mind that it is not for everyone. Starting with lifestyle modifications first is always recommended until symptoms are better under control^[17].

Lifestyle Changes and Self-Care

Making lifestyle changes can help prevent or reduce attacks. Lowering the fluid volume in your inner ear can help prevent attacks. Excess salt in your diet causes your body to retain fluid, which can build up in your inner ear^[13].

Dietary Changes

Eating a low-salt (sodium) diet helps reduce the fluid pressure in your inner ear. This can help control symptoms of Meniere’s disease. Your provider may recommend cutting back to 1000 to 1500 mg of sodium per day. This is about ½ to ¾ teaspoon (2.5 to 4 grams) of salt^[15].

Tips to cut salt from your diet include^[15]:

• Start by taking the salt shaker off your table, and do not add any extra salt to foods
• When shopping, look for healthy choices that are naturally low in salt, including fresh or frozen vegetables and fruits, and fresh or frozen beef, chicken, turkey, and fish
• Learn to read labels and check how much salt is in each serving. A product with less than 100 mg of salt per serving is good
• Avoid most canned foods unless the label says low or no sodium
• Avoid processed foods such as cured or smoked meats, bacon, hot dogs, sausage, bologna, ham, and salami
• Replace salt with other seasonings such as pepper, garlic, herbs, and lemon

Some people find that limiting or avoiding caffeine and alcohol helps reduce symptoms^[13]. Both substances can affect inner ear fluid dynamics and exacerbate symptoms. If you smoke, quitting may help reduce symptoms^[17].

Try to eat the same amount of food and drink the same amount of fluid at about the same time every day. This can help reduce changes in the fluid balance in your ear^[15]. Stay hydrated by drinking sufficient water throughout the day. Try to get half of your body weight in ounces per day^[17].

Daily Living Strategies

Practical tips for managing symptoms day-to-day include^[20]:

• In the morning, get up slowly and give your senses time to adjust to being upright
• Plan your day with a short, realistic list which includes time for breaks
• Stay active – regular exercise is important for maintaining flexibility and strength which can help you balance
• While shopping, take your time. Focus on single items at regular intervals to give your eyes and brain a break
• Rest when you feel tired
• Carry your medication with you
• Use night lights in places you are likely to go during the night

Managing Triggers and Stress

Some people report reduced episodes by recognizing triggers such as emotional stress, fatigue, illness, or allergies. By avoiding your triggers and maintaining good overall health, you may have better disease control^[13]. Stress can trigger or worsen symptoms. Incorporating relaxation techniques such as yoga, meditation, or deep breathing exercises can be beneficial^[17].

Keeping a symptom diary can help identify potential triggers and assess the effectiveness of management strategies^[17].

Safety Precautions

You must tell the Driver and Vehicle Licensing Agency (DVLA) if you have dizziness that comes on suddenly or happens often^[5]. Do not drive if you feel dizzy or symptoms of vertigo are coming on^[5]. During episodes, using a cane or walker can provide stability^[17].

Complications and Long-Term Effects

Severe vertigo attacks related to Meniere’s disease can lead to serious falls. They can make everyday activities (like climbing a ladder or driving a car) too risky to attempt^[2]. Over time (usually after eight to 10 years), the condition can lead to permanent hearing loss^[2]. Doctors can’t stop your hearing from getting worse with time. You may need a hearing aid^[4].

Meniere’s disease can take a toll on your mental health, too. Worrying about the long-term impacts can lead to anxiety and depression^[2]. The unpredictability and intensity of what people call attacks makes Meniere’s an incapacitating disorder for many^[6]. Many people lose confidence about going out in public^[11].

Talk with your healthcare provider about both the physical and mental impacts of this condition, so they can help^[2]. Having a loved one with a chronic illness can be challenging. Communicate openly about your feelings and concerns, offer support, and learn as much as you can about the condition^[18].

In most cases, Meniere’s disease is slowly progressive and significantly impacts the social functioning of the individual affected^[7]. However, some treatments can help ease symptoms and lessen how it affects your life long term. Working with a healthcare provider to find the right treatments can help manage the condition^[2].