Ménière’s disease is thought to be due to a buildup of excess fluid in the inner ear. The excess fluid leads to increased pressure that distorts (and occasionally ruptures) the labyrinth, or inner ear, membranes, causing episodes of severe vertigo (the sensation of spinning), ringing in the ears, and fluctuating hearing loss. The disorder is characterized by spells of symptoms in one ear, but in about a third of cases symptoms may occur in the other ear as well.
Symptoms arise in periodic acute attacks, which may last from several minutes to several days. Attacks may occur as often as every few weeks or as infrequently as every few years. In most cases, the disorder is mild and will disappear spontaneously; in other cases, attacks may become increasingly frequent and severe. Over time, hearing loss and ringing in the ears may persist between attacks. In rare cases, deafness in one or both ears may occur. Ménière’s disease usually strikes between ages 30 and 60 and affects men slightly more than women.
What Causes Ménière's Disease?
- Ménière’s disease may result from the overproduction or decreased absorption of endolymph, a fluid produced naturally in the ear. Why this occurs, however, remains unclear.
- In some women with the disease, premenstrual retention of fluid may precipitate an attack.
- Individuals who suffer from immune disorders like severe Rheumatoid Arthritis and Lupus or who has certain thyroid disorders like Hashimoto's Thyroiditis and Grave's Disease are at higher risk for developing Meniere's Disease.
- Allergies may play a role in developing Ménière’s disease.
Symptoms of Ménière's Disease
- A sudden attack of vertigo or dizziness. These spells frequently trigger nausea and vomiting as well.
- Hearing impairment or loss
- Ringing or buzzing in the ears (tinnitus)
- Pressure, fullness, or a feeling of blockage in the affected ear
- Severe imbalance
- In “classic” Ménière’s disease, fullness, hearing loss, tinnitus, and vertigo cluster together. Clearly, however, there are many atypical forms of the disease in which only some of these symptoms occur on a periodic basis.
Prevention of Ménière's Disease
There are no known ways to prevent Ménière’s disease entirely. However, many patients find that the frequency and severity of symptoms can be lessened by lifestyle changes, such as limiting salt and caffeine intake, maintaining a healthy weight, and exercising regularly.
Diagnosis of Ménière's Disease
- Patient history and physical examination
- Audiometry (measurement of hearing ability)
- X-rays to rule out other disorders that may cause similar symptoms
- A caloric stimulation test, in which water of different temperatures is instilled into the ear canals, causing the eyes to reflexively flicker in a predictable way (nystagmus). This indicates whether or not there is nerve damage in the ear.
- Blood tests
- MRI (Magnetic Resonance Imaging) with Gadolinium
- CT (Computed Tomography) Scan
- Electronystagmography (ENG) can be performed to evaluate the nerve of balance.
- Electrocochleography (ECOG) can be done to measure the excess fluid accumulation in the inner ear and confirm increased pressure caused by excess fluids in the inner ear.
- Brainstem evoked response audiometry (BSER)
- Rotational or balance platform testing, can also be performed to measure the balance system.
How to Treat Ménière's Disease
- Most cases of Ménière’s disease can be managed with medications and dietary changes.
- Lie still during an acute attack. Avoid reading and bright lights, as these may exacerbate dizziness and nausea.
- Drugs such as atropine may be prescribed to control nausea and vomiting and to reduce vertigo.
- Antihistamines such as diphenhydramine may help to ease symptoms during a severe attack.
- Mild sedatives may be prescribed for those who suffer anxiety during a severe attack.
- Diuretics and a low-sodium diet may be recommended to reduce the overall amount of fluid in the body, and thus reduce the accumulation of endolymph fluid in the ear.
- If the disorder persists and causes very severe or frequent attacks, several surgical options are available, including severing the nerve involved or removing the affected portion of the labyrinth. Such methods are effective but may result in irreversible hearing loss.
When to Call a Doctor
Call your doctor or an otolaryngologist (ear, nose, and throat specialist) if you have persistent dizziness, ringing in the ears, or fluctuating hearing loss.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media