For a quick overview of Meniere’s disease click here.
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Note: This information is sourced from the UK National Health Services Choices website.
Meniere’s disease, sometimes also referred to as Meniere’s Sydrome is a rare disorder that affects the inner ear. It can cause vertigo, tinnitus, hearing loss, and a feeling of pressure deep inside the ear.
People with Meniere’s disease usually experience some or all of these symptoms during sudden attacks, which typically last around two to three hours, although it can take a day or two for the symptoms to disappear completely.
It’s worth noting, however, that the symptoms and severity of Ménière’s disease vary widely from person to person. Some people may experience frequent attacks of vertigo along with hearing loss, while others may have severe tinnitus with minor vertigo. Other symptoms include sensitivity to sound (hyperacusis) or distorted sound.
See your GP if you experience any of the symptoms of Ménière’s disease, so they can try to identify the problem and refer you to a specialist if necessary.
Meniere’s disease often progresses through different stages. In the early stages, most people have sudden and unpredictable attacks of vertigo, accompanied by nausea, vomiting and dizziness.
The attacks of vertigo continue, but may come and go and become less severe. It’s common to experience a loss of balance or dizziness before or after these attacks. Permanent hearing loss and tinnitus continue to develop and may be worse during attacks of vertigo.
During the later stages, the episodes of vertigo tend to occur less frequently and sometimes stop altogether over time. However, the tinnitus and hearing loss often become worse and you may be left with permanent balance and hearing problems.
In Australia, it’s estimated that around one in 500 people have Ménière’s disease.
Meniere’s disease most commonly affects people aged 20-60 and it’s thought to be slightly more common in women than men.
The exact cause of Meniere’s disease is unknown, but it’s thought to be caused by a problem with pressure deep inside the ear.
Factors that can increase your risk of developing Meniere’s disease include a family history of the condition and a chemical imbalance in the fluid in your inner ear.
Treatments for Meniere’s disease can usually help people with the condition control their symptoms. However, current treatments aren’t able to cure the condition.
Possible treatments include:
A number of different surgical procedures may be used to treat Ménières disease, depending on how severe the symptoms are and whether one or both ears are affected. However, the effectiveness of surgery is unclear and research is continuing.
Some people with Meniere’s disease also find that the condition affects their mental health. The unpredictable nature of the attacks and the restrictions this can place on your activities can lead to feelings of anxiety and depression.
Your GP can offer advice and support if you’re finding it difficult to cope with the effect Meniere’s disease is having on your life.
Click here for more information about getting help
The symptoms of Meniere’s disease vary from person to person. They often begin as sudden attacks, lasting for a few hours. Some people may experience several attacks each week or they may be separated by weeks, months or even years.
See your GP if you experience any of the symptoms of Meniere’s disease, so they can try to identify the problem and refer you to a specialist, if necessary.
Click here for more information on finding a doctor.
The main symptoms of Meniere’s disease are:
These symptoms usually only affect one ear. However both ears can be affected over time.
Vertigo is one of the most common and noticeable symptoms of Meniere’s disease.
As well as a sensation of spinning, you may also experience additional symptoms during an attack of vertigo, such as dizziness, feeling or being sick, and problems with balance. You may have difficulty standing or walking. Occasionally, you may have “drop attacks”, where you suddenly fall to the ground.
During a severe attack, you may also experience sweating, diarrhoea and rapid or irregular heartbeats.
Tinnitus is usually more noticeable when you’re tired or when it’s quiet, as there’s less background noise to distract you from sounds coming from inside your body.
Examples of sounds you may hear include buzzing, humming, grinding, hissing and whistling.
Meniere’s disease is often divided into early, middle and late stages.
However, the progression of Meniere’s disease varies between individuals. You may not necessarily pass through each of these stages and the severity of the symptoms may also vary. In general, people experience more attacks during the first few years, and then as the attacks decrease in frequency over time, the hearing loss becomes progressively worse.
Some or all of the following symptoms may be experienced before an attack:
If a person is aware of these warning symptoms, it can allow them to move to a safer or more comfortable situation before an attack.
The early stage of Meniere’s disease consists of sudden and unpredictable attacks of vertigo. These are usually accompanied by nausea, vomiting and dizziness. You may lose some hearing during the attack, and you may experience tinnitus at the same time. Your ear may also feel blocked and uncomfortable, with a sense of fullness. Some people may also experience sensitivity to sound.
Attacks of vertigo at this stage can last from 20 minutes to 24 hours, but usually last around two to three hours. Your hearing and the full sensation in your ear usually returns to normal between attacks.
The middle stage of Meniere’s disease consists of continuing attacks of vertigo, with the attacks becoming less severe for some people. However, tinnitus and hearing loss often become worse.
During the middle stage, you may experience some periods of remission (where your symptoms go away), which can last for up to several months. Some people may still experience symptoms of tinnitus, sensitivity to sound or loss of balance between attacks of vertigo.
During the late stage of Meniere’s disease, the episodes of vertigo occur far less frequently. There may be months or even several years between attacks or they may stop altogether. However, you may be left with balance problems, and you may be unsteady on your feet, particularly in the dark.
Hearing problems and tinnitus tend to become progressively worse during the late stage of Meniere’s disease.
The exact cause of Meniere’s disease isn’t clear, although it’s thought to be caused by a problem with the pressure in the inner ear.
The inner ear is made up of:
The fluid inside the inner ear is called endolymph.
If the pressure of the endolymph fluid changes – for example, because there is too much fluid – it can result in symptoms such as vertigo and tinnitus.
It’s thought that this pressure change is responsible for Meniere’s disease, although it hasn’t been proven.
Although the exact cause of Meniere’s disease is unknown, the following factors may increase the risk of developing the condition:
There’s no single test for Meniere’s disease, and the condition can be difficult to distinguish from other conditions with similar symptoms.
For example, migraines and ear infections can also affect your balance and hearing. A viral infection of the balance nerve (vestibular neuronitis) or the inner ear (labyrinthitis) can also produce similar vertigo attacks.
See your GP if you experience any of the symptoms of Meniere’s disease.
They’ll ask you to describe your symptoms to find out if a pattern is emerging that could indicate Meniere’s disease.
For Meniere’sdisease to be diagnosed, you’ll need to have the following characteristic symptoms:
Your GP may also carry out a general physical examination to rule out other possible causes of your symptoms. This may involve listening to your heartbeat, checking your blood pressure and examining the inside of your ears.
If necessary, your GP can refer you to a specialist for further tests.
In most cases, you’ll probably be referred to an ear nose and throat (ENT) specialist at the ENT department of your local hospital.
You can also be referred to a specialist in audiovestibular medicine for hearing and balance assessment, although this service may not be available in every hospital.
The specialist will be able to assess the extent of your hearing loss by using hearing tests, such as an audiometry test.
During an audiometry test, you listen to sounds of different volume and pitch produced by a machine and signal when you hear a sound, either by raising your hand or pressing a button.
Videonystagmography (VNG) may be used to check for signs of uncontrollable eye movements (nystagmus) because this can indicate a problem with balance.
During this test, special goggles are placed over your eyes and you’ll be asked to look at various still and moving targets. The goggles are fitted with a video camera to record your eye movements.
A caloric test involves putting warm and cool water or air in your ear for about 30 seconds. The change in temperature stimulates the balance organ in the ear, allowing the specialist to check how well it’s working.
This test isn’t painful, although it’s normal to feel dizzy for a few minutes afterwards.
Electrocochleography is a test used to measure how your hearing nerves respond to sound.
During this test, a series of electrodes are attached to your head and a thin probe or needle is passed into your ear so it touches or passes through your eardrum. Local anaesthetic will be used to numb your eardrum before the procedure if a needle is going to be passed through it.
You will then listen to a series of loud clicks, while the activity of your nerves is picked up by the electrodes and probe or needle.
In some cases, a magnetic resonance imaging (MRI) scan of your head may be carried out to look for any abnormalities in your brain – such as an acoustic neuroma (a non-cancerous tumour) – that could be causing your symptoms.
Treatment can usually help to control the symptoms of Meniere’s disease, although there’s currently no cure.
Your ear, nose and throat (ENT) specialist and your GP can help you manage your symptoms. Possible treatments include:
Your GP and ENT specialist should provide you with advice tailored to your individual needs, and should develop a plan to help you manage your symptoms.
During an attack of Meniere’s disease, you may be prescribed medication to treat the symptoms of vertigo, nausea and vomiting.
This is usually prochlorperazine or an antihistamine. If these work, you may be given a supply to keep, so you can take them quickly during an attack.
Prochlorperazine (Compazine, Stemzine, Buccastem, Stemetil, Phenotil) can cause side effects including tremors (shaking) and involuntary body or facial movements. It can also make some people feel sleepy.
Check the patient information leaflet that comes with your medicine for the full list of possible side effects, or read more about prochlorperazine.
If you experience vomiting during your attacks, you can take a type of prochlorperazine called Buccastem. This comes as a tablet that you place between your gums and your cheek, on the inside of your mouth. The tablet dissolves and is absorbed into your body.
Antihistamines you may be prescribed include cinnarizine, cyclizine and promethazine teoclate.
Antihistamines can make you feel sleepy. Headaches and an upset stomach are also possible side effects. Check the patient information leaflet that comes with your medicine for the full list of possible side effects.
During an attack, take your medication as soon as possible and grab the nearest available support. Get into a position in which you feel most stable or comfortable, and keep as still as possible. If you need to move, do so slowly and carefully. Close your eyes or keep them fixed on objects in front of you, and don’t turn your head quickly.
Once your symptoms start to improve, it’s best to gradually try to move around, as this encourages your brain to use your vision and other senses to compensate for the problems in your inner ear.
If you suffer severe vertigo, dizziness, nausea and vomiting during an attack of Ménière’s disease, you may need to be injected with prochlorperazine by your doctor.
If you suffer severe vertigo with or without nausea during an attack, your doctor may also prescribe you a tablet of Buccastem that dissolves very quickly in your mouth (see above).
In particularly severe cases, you may need to be admitted to hospital to receive intravenous fluids (through a vein) to keep you hydrated.
Your GP can prescribe a medication called betahistine to help reduce the frequency and severity of attacks of Meniere’s disease, or you may be advised to change your diet.
Although it has not been proven to be consistently effective, following a diet without added salt can help some people to control their symptoms. It’s possible that this type of diet might alter the fluids in your inner ear.
Avoiding excessive caffeine, found in drinks such as tea and coffee, is also usually recommended.
Click here for more information on dietary and lifestyle changes.
Betahistine is thought to reduce the pressure of the fluid in your inner ear, relieving the symptoms of Meniere’s disease. Your GP may recommend trying them to see if they help.
Betahistines are usually available as tablets to be taken three times a day. Your GP will discuss how long you need to take them for, which could be a few weeks, or up to a year. Possible side effects include a headache, upset stomach and a rash.
A number of different treatments can be used to treat tinnitus caused by Meniere’s disease. Some possibilities include:
You may experience permanent hearing loss if Meniere’s disease is in the middle or end stages. Meniere’s disease tends to make you more sensitive to loud sounds, and also makes it more difficult for you to distinguish low-pitched sounds.
There are a variety of hearing aids available. Hearing therapists and organisations, such as Action on Hearing Loss, can provide you with helpful advice for dealing with hearing loss.
Vestibular rehabilitation (VRT) is usually provided by a hearing specialist or physiotherapist. Your GP may be able to refer you for VRT, although it will depend on the availability in your area.
A vestibular therapist or specially trained physiotherapist can help improve your balance by teaching you vestibular rehabilitation techniques. These exercises teach you how to cope with the disorientating signals coming from your inner ear. You’re taught to use alternative signals from your eyes, ankles, legs and neck, to keep you balanced.
Vestibular therapy is usually used in the middle or late stages of Meniere’s disease, after the severe attacks of vertigo have stopped, but when balance problems may remain.
In some cases, it may be possible to use VRT without specialist help. Research has shown that some people can improve their symptoms by using self-help VRT booklets. However, you should discuss this with your doctor first. If it’s likely to be useful, you can download a copy of these booklets from the Meniere’s Society UK.
In severe cases, surgery can be performed to control the attacks of vertigo. However, surgical procedures are usually only used if other treatments have failed.
The type of surgery you have will depend on your symptoms, and whether both ears are affected. You could have:
Non-destructive surgery may be used if your hearing in the affected ear is “socially adequate” (you can hear sounds that are below 50 decibels). This type of surgery aims to change the progression of Ménière’s disease by reducing the severity and frequency of your symptoms.
Types of non-destructive surgery include:
In selectively destructive surgery, the balance part of the inner ear is destroyed with a medicine called gentamicin. This is injected through the ear drum (the thin layer of tissue separating the outer ear from the middle ear) and enters the labyrinth (the system of tubes in the inner ear).
Gentamicin should mainly damage the balance part of your ear, but there’s a risk it could damage your hearing as well.
Some surgeons prefer to apply the gentamicin directly to the inner ear during a minor operation. This means they can control the exact dose of gentamicin that enters your ear.
Destructive surgery may be considered if only one ear is affected by Ménière’s disease. The hearing in the affected ear must be considered to be “socially inadequate” (you can’t hear enough to function in social situations). As an approximate guide, if you can’t hear sounds below 50 decibels, this may count as socially inadequate.
Destructive surgery is used to destroy the part of your inner ear causing your vertigo attacks. However, these operations can cause permanent hearing loss in the treated ear, so will only be considered if you already have permanently reduced hearing in the affected ear.
Destructive surgery can be done by:
After surgery, your other ear will take over your hearing and balance functions.
There are very few clinical trials looking into the effectiveness of surgery for Ménière’s disease, which is why surgery is rarely considered. If your ENT specialist thinks you may benefit from having surgery, they’ll discuss the procedure and any risks in more detail with you.
The placebo effect is the unusual psychological effect that can occur when a person is given a “dummy” medication, such as a sugar pill. They feel better after taking the pill, because they think they’re being given real medication.
Although there’s limited scientific evidence to suggest that many of the self-help measures and treatments used for Meniere’s disease are consistently effective, they can help some people to control their symptoms because of the placebo effect.
Living with Meniere’s disease can be difficult and frustrating. Your balance and hearing may be significantly impaired during an attack, meaning that certain activities can be dangerous.
The unpredictable nature of the condition means you may need to change your daily activities so you don’t place yourself, or others, in danger. Situations you may need to avoid include:
You may also need to make sure that someone is with you most of the time, in case you need help during an attack.
These restrictions may leave you feeling stressed, anxious, or depressed. Speak to your GP if you’re finding it difficult to come to terms with the effect that Ménière’s disease is having on your life. They can offer advice and support.
If you experience sudden episodes of vertigo and dizziness, you may need to inform your state’s Road Traffic Authority about your condition before driving.