Ménière’s Disease

What is Ménière’s disease?

Ménière’s disease is a condition that affects an area of the inner ear. The area contains structures and nerves that control your balance and hearing.

Ménière’s disease can suddenly make you very dizzy (vertigo), hear ringing in the ear (tinnitus), lose your hearing, or feel an uncomfortable fullness in your ear. Usually, it affects only one ear, though it can affect both ears.

There is no medical cure. Sometimes it goes away on its own. But for most people it is chronic and the focus is on treating the symptoms. In some cases, surgery or procedures in a clinic can help.

What does a Ménière attack feel like?

People with Ménière’s disease usually experience episodes of vertigo, ringing in the ear, feeling of fullness in the ear, or hearing loss. These symptoms last hours to days.

As the disease continues over time, the attacks of vertigo don’t happen as often or they go away completely. But hearing loss will usually get worse. In some cases, it can cause permanent deafness.

Main symptoms

Vertigo (severe dizziness)

• The room or world feels like it is spinning around you.
• Attacks often happen suddenly without warning.
• Attacks can last for a few minutes or up to a few hours.
• Often causes a loss of balance. It can get so bad that you fall to your knees or fall over, especially when trying to move around.

Tinnitus (ringing in the ears)

• Sounds like buzzing, ringing, or roaring.
• Might only happen during attacks of vertigo, or might happen all the time.
• Usually worse in the affected ear.

Fullness or stuffiness of the ear

• Can feel like there’s a blockage of the ear, like you’re hearing underwater, or your hearing is muffled.
• Can feel like a pressure in your ear.

Hearing loss

• Early in the disease, this only happens during vertigo attacks.
• Eventually, hearing loss even when not dizzy.
• Gets worse over time.

Other symptoms you may have

• Nausea and vomiting
• Falling

Causes of Ménière’s disease

The disease is caused by a buildup of fluid in the innermost part of the ear. This buildup of fluid disrupts your hearing and sense of balance, which leads to the symptoms.

It is not known why the fluid builds up in the first place. Some theories include abnormal blood vessels in the inner ear, a previous viral infection, or some type of atypical immune response.

Though the exact cause of Ménière’s disease is unknown, certain factors are known to increase the risk.

• It is more common in women.
• The average age of developing it is between the ages of 40 and 50, though children can also develop Ménière’s disease.
• Having someone else in your family with Ménière’s disease can increase the risk of developing it, but most cases occur randomly in people who don’t have any family history.

What is the best treatment for Ménière's disease?

Ménière’s disease is a life-long condition. There is no cure but doctors can help you treat the symptoms.

Specialists include either an otolaryngologist (also known as an ear, nose, and throat doctor, or ENT) or a neurotologist (a specially trained ENT who focuses specifically on disorders of the ear).

The symptoms may go back and forth between getting better and becoming worse. Most people who have it experience some symptoms their whole life. Medication and, in some situations, surgery can help. Usually, the hearing loss does not lead to total deafness. Hearing aids sometimes help.

Medication

To treat the dizziness, doctors may prescribe medications that also help with motion sickness. These include meclizine, promethazine, or dimenhydrinate. Benzodiazepines like diazepam, clonazepam, and lorazepam may also help.

For the buildup of fluid in your inner ear, your doctors might give you a diuretic like furosemide, hydrochlorothiazide, or acetazolamide. Diuretics help your body get rid of extra fluid.

Rehabilitation

Your doctor may recommend vestibular rehabilitation therapy. (The vestibular system includes parts of the inner ear that control balance.) It’s an exercise-based program led by a specially trained physical therapist. The therapy shows your brain how to use other senses to maintain your sense of balance.

Procedures

If medication and physical therapy do not work, an ENT may try injecting certain medications, like steroids and antibiotics, into the eardrum to reduce dizziness.

Antibiotics like gentamicin and streptomycin selectively destroy the balance organ (and the chaotic signals it sends to the brain) while preserving hearing.

Surgery

Surgery is usually the last option. Your doctor might suggest it to reduce the amount of fluid in the inner ear. Or to cut the nerve that senses balance. Both surgeries can lessen or stop the dizziness. But they can also cause permanent or severe hearing loss.

The most successful operations destroy structures in the ear (which results in total deafness) in order to stop vertigo. These surgeries are usually performed only on people who experience severe dizziness and have little or no hearing in the affected ear.

In an operation called selective vestibular nerve section, the surgeon cuts the nerve in the inner ear that sends information about balance to the brain.

Endolymphatic shunt is another surgical procedure. A small hole is made in the inner ear so fluid can drain out.