What is Ménière’s disease?
Ménière’s disease is an inner ear disorder. It causes attacks of dizziness, vertigo, ringing in the ears, and hearing loss. More than 600,000 Americans have a Ménière's disease diagnosis. Usually, only one ear is involved. However, about 15% of people have problems with both ears.
Originally named after the French physician who first described the condition, the medical name for Ménière's disease is idiopathic endolymphatic hydrops. Idiopathic means it is a condition for which the cause is unknown. Endolymphatic refers to the fluid—endolymph—that is present in the inner ear. And hydrops describes an accumulation of fluid. So, Ménière's disease is an abnormal buildup of fluid in the inner ear with an unknown cause.
Ménière's disease tends to strike young and middle-aged adults, but it can affect anyone. It is a chronic condition that does not have a cure. However, there are strategies that can help manage symptoms and control attacks. This includes following a Ménière's disease diet, which is low in salt. It can also help to identify and manage Ménière's disease triggers, such as stress or fatigue. Severe cases may require surgery.
Ménière's disease is unpredictable. People can have very different experiences with the attacks. It can range from mildly troublesome to severe and disabling. If you have symptoms of Ménière's disease, see your doctor promptly. Several other conditions have similar symptoms, so it is important to get an accurate diagnosis.
What are the symptoms of Ménière’s disease?
Ménière’s disease symptoms occur in spells or attacks. Some people experience an aura before an attack starts. This can include headache, sound sensitivity, ear pressure, balance problems, or just a vague feeling something isn’t right. Once the attack starts, it can last anywhere from 20 minutes to 24 hours.
Common symptoms of a Ménière’s disease attack
The most common symptoms of a Ménière’s disease attack are:
Dizziness or vertigo, which is a spinning sensation. This symptom can be so severe it affects a person’s ability to maintain balance. Drop attacks occur when balance problems cause people to fall during the attack. Vertigo can also result in nausea and vomiting.
Feeling of fullness, pressure or pain in the ear
Hearing loss or dullness, especially with low-toned sounds. In the beginning, hearing loss fluctuates and is usually only temporary during attacks. As the disease progresses, hearing loss also affects higher tones and can become permanent.
Tinnitus, which is ringing, roaring, buzzing or hissing sounds in the ear
Fatigue is common after an attack. Some people will be free of symptoms once they recover from an attack. Others will continue to have ongoing problems with unsteadiness, tinnitus, or other symptoms between attacks. Similarly, some people have several frequent attacks each week, while others go for years without an attack.
See your doctor if you experience any of these symptoms. Your doctor will need to rule out other causes of your symptoms. This may involve several tests, including hearing tests, blood tests, and imaging exams of your head and ear. There are also special balance and ear tests that can give your doctor information about the cause.
What causes Ménière’s disease?
The symptoms of Ménière’s disease are the result of increased fluid in the inner ear. The fluid may accumulate due to an overproduction or improper drainage. However, doctors do not exactly know why this happens. Theories include viral infections, allergies, genetics, and a faulty autoimmune response. Most likely, a combination of genetic and environmental factors is at the root of the problem.
Oftentimes, Meniere’s disease attacks are linked to triggers. These vary from person to person, but may include:
Barometric pressure changes (for example, air pressure is greater at sea level than it is at higher elevations, and it changes with weather and climate)
Certain foods and other dietary factors, such as too much salt
Physical or emotional stress
What are the risk factors for Ménière’s disease?
Ménière’s disease can happen to anyone, but it most commonly starts in adults between the ages of 20 and 50. Sometimes, Ménière’s disease runs in families. However, most people do not have a family history of the disorder.
Reducing your risk of Ménière’s disease
Currently, there is no way to prevent Ménière’s disease. You may be able to help control attacks by avoiding or minimizing triggers. Cutting out alcohol, caffeine, and smoking or other nicotine or tobacco products may also help.
How is Ménière’s disease treated?
There is no curative treatment for Ménière’s disease. Instead, treatment focuses on managing symptoms and controlling attacks. To accomplish these goals, your doctor may recommend the following treatments:
Low-salt diet along with a diuretic—or water pill—to reduce fluid and pressure in the inner ear
Medications to reduce dizziness and nausea
Positive pressure therapy using an air pressure pulse generator to deliver pressure through the ear canal. The goal is to reduce fluid buildup and relieve symptoms.
Vestibular rehabilitation therapy (VRT) to improve balance and steadiness
If these treatments fail, there are other options. The first is middle ear injections of gentamicin or a corticosteroid. Gentamicin relieves vertigo in more than 80% of people who have the treatment. However, there is risk of long-term hearing loss and imbalance. Corticosteroid injections are not as effective but carry less risk of chronic problems.
Finally, surgery may be an option for very severe cases. The main type of surgery today aims to interrupt communication between the inner ear and the brain. It does this by either destroying the inner ear or the nerve that carries balance information to the brain. Complete hearing loss occurs in the ear if the inner ear is removed. Cutting the nerve allows doctors to preserve hearing while relieving vertigo. Physical therapy is necessary after surgery to retrain the brain and compensate for loss of inner ear function.
During an attack, it’s important to focus on safety. Find somewhere safe to lie down and keep your head still. Focus on an object that isn’t moving and avoid bright lights and other visual triggers. Do not eat or drink much to reduce the risk of vomiting. Call your doctor if you are vomiting so much you can’t keep any liquids down. Rest after an attack if you feel exhausted.
What are the potential complications of Ménière’s disease?
Vertigo and hearing loss are the two symptoms that result in most complications of Ménière’s disease. Vertigo can be so severe people must lie down on the floor. It can also lead to falls and other accidents. Most people will develop some degree of permanent hearing loss. Add to this the unpredictability of the disorder, and it’s easy to see how it can also affect your quality of life. Many people with Ménière’s suffer with anxiety and fear. This, in turn, can trigger attacks. Part of coping with the disease means finding support to deal with the mental and emotional effects. Talk with your doctor to find support groups in your area.
Explaining your condition to compassionate friends and family will help you cope and provide an additional layer of safety during an episode when they are present. If you work, you may want to discuss the situation with your employer if you need certain accommodations.