Ménière's disease

What is it?

In Ménière's disease, fluid collects in the inner ear. Pressure from the buildup of fluid and damage to some of the delicate structures in the inner ear can cause a variety of symptoms that appear suddenly, without warning, and can last minutes to hours. Many people have only mild symptoms, but in others the symptoms are severe enough to be disabling. Hearing loss comes and goes, but over time some degree of hearing loss may become permanent.

Symptoms

The cause of Ménière's disease is unknown. It tends to strike men and women equally, and although it can occur at any age, it usually begins between the ages of 30 and 50. In most cases, only one ear is affected. Only about 15 percent of people with Ménière's disease lose hearing in both ears.

The symptoms of Meniere's disease vary considerably from person to person. Some patients experience a cluster of attacks for a few weeks followed by years of relief, and other patients experience symptoms regularly for years.

A person with Ménière's disease may experience any or all of these symptoms:

• vertigo and dizziness, often so severe that it is temporarily disabling. There may be a sense that the room is spinning, twisting or rocking. Balance can be severely affected. The sensation can last from a few minutes to several hours. After the vertigo goes away, a sense of imbalance can remain for hours or days.
• nausea and vomiting during an episode of vertigo
• a feeling of pressure or fullness in the affected ear
• ringing, buzzing or other noises in the affected ear (tinnitus). This ringing is often low-pitched and may distort normal sounds.
• hearing loss that comes and goes, but gets progressively worse over time. Low-pitched hearing often is affected earlier in the disease.

Diagnosis

Diagnosing Ménière's disease can be difficult. Your doctor cannot examine the inner ear directly, so there is no simple way to tell if fluid has built up. Usually, your doctor will diagnose Ménière's disease if you experience the typical symptoms and other possible causes of the symptoms have been ruled out.

Your doctor will start by taking a medical history, including information about past or current medical problems and medications that you take. He or she will ask you detailed questions about your symptoms, including when they started, how often and for how long they occur, and how disabling they are. Your doctor then will examine you, with a special focus on your ears, nose, throat and balance system.

Tests that may be used to aid in diagnosis include:

• A hearing test, also called audiometry — This simple test can tell whether you are experiencing hearing problems, how much hearing you have lost, and what type of hearing problems you have. People with Ménière's disease have a particular type of damage to nerves important for normal hearing, which may make it difficult to tell the difference between similar-sounding words such as "boat" and "moat."
• Computed tomography (CT) or magnetic resonance imaging (MRI), scans that allow physicians to see the brain, middle ear and other structures inside the head — These scans can check for tumors and other problems that can cause symptoms that are similar to Ménière's.
• Electronystagmography or rotational testing — These tests use the nerve connection between the ears and the eyes to examine your body's balance system. In a darkened room, electrodes are placed near the eyes. Then, the ear canal is stimulated with water, air or changes in position. The electrodes measure how the inner ear responds. In Ménière's disease, your doctor can spot typical changes caused by the buildup of fluid in the inner ear.

If the diagnosis remains uncertain, you may be referred to an otolaryngologist (ear, nose and throat specialist) or neurologist.

Expected duration

There is no cure for Ménière's disease. Once the condition is diagnosed, it will remain for life. However, the symptoms typically come and go, and only some people with Ménière's disease will go on to develop permanent disabilities.

Prevention

Because no one knows what causes Ménière's disease, there is no way to prevent it.

Treatment

There is no cure for Ménière's disease, so treatment focuses on managing symptoms.

Different types of medications may be used to control various symptoms, including

• anti-vertigo medications, such as meclizine (Antivert or Bonine) or betahistine, to relieve or prevent vertigo and dizziness
• antinausea medications, such as prochlorperazine (Compazine), to relieve nausea and vomiting
• diuretics, such as hydrochlorothiazide (HydroDIURIL), to reduce the amount of fluid that builds in the inner ear.

Many physicians also recommend avoiding caffeine, alcohol, salt and nicotine to reduce the frequency or severity of attacks. These lifestyle changes may or may not help, but they are worth trying.

In severe cases, your doctor may recommend injections of gentamicin into the middle ear. A side effect of gentamicin (a potent intravenous antibiotic) is damage to the balance mechanism inside the ear. By selectively destroying the balance part of the ear, the condition may actually improve. Single to multiple injections may be necessary to damage the inner ear enough to stop the vertigo episodes. The injections can be performed in the office.

Your doctor may recommend surgery if symptoms of vertigo are severe or frequent. Different surgical procedures are available, each with pros and cons. For example, some types of surgery require your doctor to destroy parts of the inner ear, which can cause permanent hearing loss. If you are considering surgery, be sure to talk to your doctor about the possible risks and benefits. Surgical procedures that may be recommended in severe cases include:

• selective vestibular neurectomy, in which the nerve that runs from the inner ear to the brain is cut
• endolymphatic shunt, in which a tiny hole is cut in the inner ear to help clear out some of the accumulated fluid.

No treatment can prevent the hearing loss that occurs in Ménière's disease.

When to call a professional

It is usually difficult to ignore an attack of Ménière's disease. See your health care professional if you experience an unexplained spinning or dizzy sensation or if you experience hearing loss.

Prognosis

There is no cure for Ménière's disease. Over time, some degree of permanent hearing loss is common.

However, the worst symptoms of vertigo, nausea and vomiting often can be controlled. By working closely with their physicians, people with Ménière's disease often can find the right combination of lifestyle changes and medication to reduce the frequency and severity of attacks. Patients with severe, disabling symptoms may get relief with surgery, but the risks and benefits need to be weighed carefully.

Additional Info

American Academy of Otolaryngology - Head and Neck Surgery
https://www.entnet.org/

National Institute on Deafness and Other Communication Disorders
https://www.nidcd.nih.gov/