Ménière's Disease

Symptoms

Ménière's disease usually affects one ear, though both can become involved over time.

• Vertigo: a strong sense that you or the room are spinning, lasting 20 minutes to 12 hours, often with nausea, vomiting and unsteadiness
• Fluctuating hearing loss: muffled hearing, especially low pitches, that worsens during attacks and may improve between them
• Tinnitus: ringing, roaring or buzzing in the affected ear
• Aural fullness: pressure or a blocked feeling in the ear, often before an attack

After attacks, people often feel tired and off-balance for a day or more. Some experience drop attacks (Tumarkin crises): sudden falls without losing consciousness.

Stages over time

• early: unpredictable vertigo attacks, hearing recovers between attacks
• middle: attacks continue, hearing loss and tinnitus become more permanent
• late: vertigo attacks often become less frequent, but hearing loss and imbalance persist

Causes

The underlying cause is not fully understood. Ménière's is associated with endolymphatic hydrops, an excess of fluid in the inner ear's membranous labyrinth. Contributing factors may include:

• abnormal fluid drainage
• genetic predisposition (about 1 in 10 have a family history)
• autoimmune processes
• migraine
• viral infections
• allergies

Possible triggers for attacks include salt, caffeine, alcohol, stress, fatigue and changes in air pressure.

Diagnosis

Diagnosis is clinical, using criteria such as those of the Bárány Society and AAO-HNS:

• 2 or more spontaneous vertigo episodes lasting 20 minutes to 12 hours
• low- to mid-frequency sensorineural hearing loss on an audiogram in the affected ear on at least one occasion
• fluctuating hearing, tinnitus or fullness in the affected ear
• no better explanation

Tests include:

• audiogram (hearing test)
• vestibular tests such as videonystagmography and video head impulse testing
• MRI to rule out an acoustic neuroma or other brain causes

Conditions with similar symptoms

Treatment

Lifestyle

• limit salt to about 1,500 to 2,000 mg sodium a day
• reduce caffeine and alcohol
• stop smoking
• manage stress and sleep
• keep a diary to identify triggers

Medicines

• during attacks: meclizine, benzodiazepines or prochlorperazine to reduce vertigo and nausea
• to prevent attacks: diuretics such as hydrochlorothiazide; betahistine is widely used outside the US, with mixed evidence

Injections

• intratympanic steroids into the middle ear, which may reduce attacks while preserving hearing
• intratympanic gentamicin, which reduces balance function in the affected ear and controls vertigo in most people, with some risk to hearing

Surgery

For disabling vertigo despite other treatment:

• endolymphatic sac decompression
• vestibular nerve section, which preserves hearing
• labyrinthectomy, which removes balance function and hearing in that ear

Rehabilitation and hearing

• vestibular rehabilitation therapy helps with ongoing imbalance between attacks
• hearing aids or cochlear implants for permanent hearing loss
• tinnitus management strategies

Living with Ménière's disease

During an attack, lie still on a firm surface and focus on a fixed object. Avoid driving or climbing if attacks are unpredictable. Many people find that attacks become less frequent with time and treatment. Support groups can help with the anxiety the unpredictability causes.

Frequently asked questions

What are the first signs of Ménière's disease?

Early signs are often a feeling of fullness or pressure in one ear, muffled hearing and ringing, followed by a sudden attack of spinning vertigo lasting from 20 minutes to several hours, frequently with nausea and vomiting.

What triggers Ménière's attacks?

Common triggers include high salt intake, caffeine, alcohol, stress, fatigue, illness and changes in air pressure. Triggers vary between people, so keeping a symptom diary helps identify your own.

Can Ménière's disease go away?

There is no cure, but vertigo attacks often become less frequent or stop over years. Hearing loss and tinnitus may persist or worsen. Treatment controls vertigo in most people and improves quality of life.

Is Ménière's disease serious?

It is not life-threatening, but it can be disabling because attacks are sudden and unpredictable. It can cause permanent hearing loss in the affected ear. Effective treatments are available to control vertigo.