Meniere’s disease is a condition with vertigo, tinnitus (ringing, buzzing noises in the ears) and progressive deafness. Meniere’s disease is caused by a dysfunction of the endolymphatic sac (semi-circular canals) in the inner ear – also known as the labyrinth. The labyrinth is a system of small fluid-filled channels that send signals of sound and balance to the brain. It is an unpredictable disease that requires various types of treatment.
It is estimated that approximately 1 in every 1000 people suffers from Meniere’s disease. The disease can develop at any age, but more commonly does so when the patient is aged between 40 and 60.
The disease is named after Prosper Meniere (1799-1862), a French physician who first reported that vertigo was caused by inner ear disorders in an article published in 1861.
What are the signs and symptoms of Meniere’s disease?
Symptoms very from person to person. Symptoms can occur suddenly, and their frequency and duration differ.
The principle symptoms include:
- A feeling you are spinning, even when you are stationary
- Dizziness
- Vomiting
- Nausea
- Irregular heartbeats (palpitations)
- Sweating
An episode of vertigo may last from a few minutes to a number of hours. As it is difficult to predict when a vertigo attack may occur, patients should have their vertigo medication handy at all times. Vertigo can interfere with driving, operating heavy machinery, climbing ladder/scaffolding, and swimming.
- Tinnitus – you sense noise, buzzing, roaring, whistling or hissing in your ear, which is generated from inside your body. You will be more aware of it either during quiet times or when you are tired.
- Hearing loss – hearing loss may fluctuate, especially early on in the course of the disease. The patient may also be especially sensitive to loud sounds. Eventually, most people experience some degree of long term hearing loss.
The three stages of Meniere’s disease:
- Early stage – sudden and unpredictable episodes of vertigo. Often the patient will experience nausea, dizziness and vomiting during the episodes. An episode may last from about 20 minutes to a full 24 hours. During episodes there will be some hearing loss, which returns to normal after it is over. The ear may feel uncomfortable and blocked, with a sense of fullness or pressure (aural fullness). Tinnitus is also common.
- Middle stage – vertigo episodes continue, but are usually less severe. Tinnitus and hearing loss, on the other hand, get worse. Some patients during this stage may experience periods of complete remission – symptoms just go away and seem to have gone forever. These periods of remission can last several months.
- Late stage – vertigo episodes become even less frequent, and in some cases never come back. Balance problems, though, continue. Patients will feel especially unsteady when it is dark and they have less visual input to help maintain balance. Hearing and tinnitus typically get progressively worse.
The following symptoms are also possible (known as secondary symptoms)
- Anxiety, stress, depression – because of Meniere’s disease’s unpredictability many patients become anxious, depressed and stressed. The disease can have a detrimental impact on the sufferer’s work, especially if they have to climb ladders or operate machinery. As hearing gets progressively worse the patient may find it more difficult to interact with other people. Some people cannot drive, further limiting their independence, job prospects, freedom and access to social contacts. It is important for patients who experience stress, anxiety and/or stress to tell their doctor.
What causes Meniere’s disease?
Experts believe the disease is caused by an abnormality in the composition and/or amount of fluid in the inner ear. However, they do not know what factors cause these inner-ear changes.
In the inner ear there is a cluster of connected passages and cavities – labyrinth. The outer part of the inner ear is where the bony labyrinth is. Inside there is a soft structure of membrane (membranous labyrinth), which is a smaller version of the bony labyrinth with a similar shape.
The membranous labyrinth contains endolymph – a fluid. The membranous labyrinth has hair-like sensors that respond to the fluid’s movement. The sensors create nerve impulses that travel to the brain. Different parts of the brain are actively involved in various types of sensory perception:
- Our ability to detect our own acceleration movement in any direction comes from sensors in a portion of the membrane in the vestibule (the centre section of the labyrinth).
- Three loops (semi-circular canals) branch off from one side of the vestibule. The sensors in the semi-circular canals help us to maintain balance; they sense our own rotational motion.
- On the other side of the vestibule is the cochlea (a structure shaped like a snail) – this is the hearing part of the inner ear. Bones in the middle ear vibrate and create waves in the inner ear fluid – the sensors in cochlea interpret these waves and translate them into impulses which are sent to the brain.
For all of the sensors in the inner ear to work properly, the fluid has to be at the right pressure, volume and chemical composition. Certain factors present in Meniere’s disease alter the properties of the inner ear fluid, which cause the disease’s symptoms.
Meniere’s disease very rarely affects both ears.
How is Meniere’s disease diagnosed?
Unfortunately, no single test exists for a quick Meniere’s disease diagnosis. The GP will interview and examine the patient, ask about their medical and family history and consider the signs and symptoms.
The doctor will ask questions regarding:
- How severe the symptoms are
- How often they occur
- What medications the patient has been taking
- Past ear problems
- The patient’s general health
- The patient’s history of infectious disease of allergies
- Any family history of inner ear problems
All three primary symptoms must be present for a diagnosis of Meniere’s disease to be possible:
- Vertigo – two or more episodes, at least 20 minutes long, within a single attack
- Tinnitus – and/or aural fullness
- Hearing loss – the patient should be referred to an ENT specialist to determine the extent of the hearing loss before diagnosis can be established.
Several other diseases and conditions have similar symptoms, making it harder to diagnose Meniere’s disease, including ear infections and some migraines. Usually, diagnosis is established after some time has passed and a pattern of recurrent attacks develops and is observed.
Establishing extent of hearing loss
- Audiogram– this exam determines the extent of hearing loss caused by the disease. An audiometer produces tones of varying loudness and pith. The patient listens with headphones and indicates when he/she hears a sound, or when a sound is no longer present. The test only works if the patient has normal hearing in one ear – the specialist can then make a comparison. An audiogram may not be so effective during the early stage because the hearing loss is usually temporary. The test may also determine whether the hearing problem is in the inner ear or the nerve that connects the inner ear to the brain.
- Balance assessment – Many people with Meniere’s disease have some degree of on-going balance problems, even when their sense of balance appears to return to normal between episodes of vertigo.
What are the treatment options for Meniere’s disease?
Although there is no cure, there is treatment that can help the patient manage some of the symptoms.
Medications for vertigo – the individual may be prescribed medication to be taken during an episode of vertigo to reduce the intensity of an attack. These may include motion sickness drugs which may help with the spinning sensation, as well as nausea and vomiting.
Diuretics – by reducing the amount of fluid that body retains the patient’s fluid volume and pressure in the inner ear may improve, resulting in less severe and less frequent symptoms. Long term diuretic medication may deplete the body levels of minerals, such as potassium. Patients should supplement their diet with potassium-rich foods such as, bananas, spinach, sweet potatoes and oranges.
Dietary changes – there are some dietary changes which can help reduce fluid retention. Generally, the less fluid retention a patient has the less severe and frequent his/her symptoms will be. These measures are known to help:
- Many smaller meals evenly distributed throughout the day helps regulate body fluids. Rather than three large meals a day, try to go for six smaller ones.
- Eat less salt – the less salt you consume the less fluid your body will retain. Do not add any salt to your meals. Cut out most junk foods.
- Cut out MSG – any foods with MSG added should be struck off your shopping list
Caffeine – this has been should to make tinnitus louder. If you avoid caffeine completely you may find symptoms improve.
Smoking – a significant number of patients report improved symptoms after they give up smoking.
Stress, anxiety – experts are not sure whether stress/anxiety cause symptoms or whether they are caused by the disease. However, some studies indicate that good stress and anxiety management may help lessen the intensity of symptoms.
Middle ear injections – some middle ear injections (injected into the middle ear) may improve symptoms of vertigo.
Surgery – this may be an option if the patient did not respond to other treatments, or if symptoms are very severe
Vestibular rehabilitation therapy – patients who have problems with their balance between episodes of vertigo may benefit from exercises and activities aimed at helping the body and the brain regain the ability to process balance data properly.
Hearing aid – a patient with Meniere’s disease who has suffered hearing loss from the affected ear may benefit from a hearing aid.
Written by Christian Nordqvist
