Meniere's disease is a disorder of the inner ear that causes episodes in which you feel as if you're spinning (vertigo), and you have fluctuating hearing loss with a progressive, ultimately permanent loss of hearing, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear. In most cases, Meniere's disease affects only one ear.
Meniere's disease can occur at any age, but it usually starts between the ages of 20 and 50. It's considered a chronic condition, but various treatments can help relieve symptoms and minimize the long-term impact on your life.
Signs and symptoms of Meniere's disease include:
- Recurring episodes of vertigo. You have a spinning sensation that starts and stops spontaneously. Episodes of vertigo occur without warning and usually last 20 minutes to several hours, but not more than 24 hours. Severe vertigo can cause nausea and vomiting.
- Hearing loss. Hearing loss in Meniere's disease may come and go, particularly early on. Eventually, most people have some permanent hearing loss.
- Ringing in the ear (tinnitus). Tinnitus is the perception of a ringing, buzzing, roaring, whistling or hissing sound in your ear.
- Feeling of fullness in the ear. People with Meniere's disease often feel pressure in the affected ears (aural fullness) or on the side of their heads.
After an episode, signs and symptoms improve and might disappear entirely. Episodes can occur weeks to years apart.
When to see a doctor
See your doctor if you have signs or symptoms of Meniere's disease. Because any one of them can result from other illnesses, it's important to get an accurate diagnosis as soon as possible.
The cause of Meniere's disease isn't understood. One popular theory that hasn't been proved is that Meniere's disease appears to be the result of the abnormal amount of fluid (endolymph) in the inner ear. This often shows on autopsies, but it's not clear that it causes the episodes.
Factors that affect the fluid, which might contribute to Meniere's disease, include:
- Improper fluid drainage, perhaps because of a blockage or anatomic abnormality
- Abnormal immune response
- Viral infection
- Genetic predisposition
- Head trauma
Because no single cause has been identified, it's likely that Meniere's disease results from a combination of factors.
The unpredictable episodes of vertigo and the prospect of permanent hearing loss can be the most difficult problems of Meniere's disease. The disease can interrupt your life and cause fatigue, emotional stress, depression and anxiety.
Vertigo can cause you to lose balance, increasing your risk of falls and accidents while driving or operating heavy machinery.
You're likely to first see your family doctor. Your primary care doctor might refer you to an ear, nose and throat (ENT) specialist, a hearing specialist (audiologist), or a nervous system specialist (neurologist).
Here's some information to help you get ready for your appointment.
What you can do
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before a test. Make a list of:
- Your symptoms, especially those you have during an episode, how long they last and how often they occur
- Key personal information, including major stresses, recent life changes and family medical history
- All medications, vitamins or supplements you take, including the doses
- Questions to ask your doctor
Take a family member or friend along, if possible, to help you remember the information you're given.
For Meniere's disease, some basic questions to ask your doctor include:
- What's likely causing my symptoms?
- What are other possible causes for my symptoms?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What's the best course of action?
- What are the alternatives to the approach you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- Should I see a specialist?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you several questions, such as:
- When did your symptoms begin?
- How often do your symptoms occur?
- How severe are your symptoms and how long do they last?
- What, if anything, seems to trigger your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Have you had ear problems before? Does anyone in your family have a history of inner ear problems?
Your doctor will conduct an exam and take a medical history. A diagnosis of Meniere's disease requires:
- Two episodes of vertigo, each lasting 20 minutes or longer but not longer than 24 hours
- Hearing loss verified by a hearing test
- Tinnitus or a feeling of fullness in your ear
- Exclusion of other known causes of these problems
A hearing test (audiometry) assesses how well you detect sounds at different pitches and volumes and how well you distinguish between similar-sounding words. People with Meniere's disease typically have problems hearing low frequencies or combined high and low frequencies with normal hearing in the mid frequencies.
Between episodes of vertigo, the sense of balance returns to normal for most people with Meniere's disease. But you might have some ongoing balance problems.
Tests that assess function of the inner ear include:
Videonystagmography (VNG). This test evaluates balance function by assessing eye movement. Balance-related sensors in the inner ear are linked to muscles that control eye movement. This connection enables you to move your head while keeping your eyes focused on a point.
In a VNG evaluation, warm and cool water or warm and cool air are introduced into the ear canal. Measurements of involuntary eye movements in response to this stimulation are performed using a special pair of video goggles.
- Rotary-chair testing. Like a VNG, this measures inner ear function based on eye movement. You sit in a computer-controlled rotating chair, which stimulates your inner ear.
- Vestibular evoked myogenic potentials (VEMP) testing. This newer test shows promise for not only diagnosing, but also monitoring Meniere's disease. It shows characteristic changes in the affected ears of people with Meniere's disease.
- Posturography. This computerized test reveals which part of the balance system — vision, inner ear function, or sensations from the skin, muscles, tendons and joints — you rely on the most and which parts may cause problems. While wearing a safety harness, you stand in bare feet on a platform and keep your balance under various conditions.
- Video head impulse test (vHIT). This newer test uses video to measure eye reactions to abrupt movement. While you focus on a point, your head is turned quickly and unpredictably. If your eyes move off the target when your head is turned, you have an abnormal reflex.
- Electrocochleography (ECoG). This test looks at the inner ear in response to sounds. It might help to determine if there is an abnormal buildup of fluid in the inner ear, but isn't specific for Meniere's disease.
Tests to rule out other conditions
Blood tests and others may be used to rule out disorders that can cause problems similar to those of Meniere's disease, such as a tumor in the brain or multiple sclerosis. An imaging test, such as an MRI, also might be used.
No cure exists for Meniere's disease, but a number of treatments can help reduce the severity and frequency of vertigo episodes. There are no treatments for the hearing loss that occurs with Meniere's disease. All of the treatments — some conservative, some aggressive — are to stop the spells of vertigo.
Medications for vertigo
Your doctor may prescribe medications to take during a vertigo episode to lessen the severity of an attack:
- Motion sickness medications, such as meclizine or diazepam (Valium), may reduce the spinning sensation and help control nausea and vomiting.
- Anti-nausea medications, such as promethazine, might control nausea and vomiting during an episode of vertigo.
Long-term medication use
Your doctor may prescribe a medication to reduce fluid retention (diuretic). For some people, a diuretic helps control the severity and frequency of Meniere's disease symptoms. A diuretic is usually combined with limiting dietary salt intake.
Noninvasive therapies and procedures
Some people with Meniere's may benefit from other noninvasive therapies and procedures, such as:
- Rehabilitation. If you have balance problems between episodes of vertigo, vestibular rehabilitation therapy might improve your balance.
- Hearing aid. A hearing aid in the ear affected by Meniere's disease might improve your hearing. Your doctor can refer you to an audiologist to discuss what hearing aid options would be best for you.
Meniett device. For vertigo that's hard to treat, this therapy involves applying pressure to the middle ear to improve fluid exchange. A device called a Meniett pulse generator applies pulses of pressure to the ear canal through a ventilation tube.
You do the treatment at home, usually three times a day for five minutes at a time. Initial reports on the Meniett device show improvement in symptoms of vertigo, tinnitus and aural pressure, but its long-term effectiveness has not been determined.
If the conservative treatments listed above aren't successful, your doctor might recommend some of these more aggressive treatments.
Middle ear injections
Medications injected into the middle ear, and then absorbed into the inner ear, may improve vertigo symptoms:
- Gentamicin, an antibiotic that's toxic to your inner ear, reduces the balancing function of your ear, and your other ear assumes responsibility for balance. The procedure, which can be performed during local anesthesia in your doctor's office, often reduces the frequency and severity of vertigo attacks. There is a risk, however, of further hearing loss.
- Steroids, such as dexamethasone, also may help control vertigo attacks in some people. This procedure can also be performed with local anesthesia applied by your doctor. Although dexamethasone may be slightly less effective than gentamicin, dexamethasone is less likely than gentamicin to cause further hearing loss.
If vertigo attacks associated with Meniere's disease are severe and debilitating and other treatments don't help, surgery might be an option. Procedures include:
Endolymphatic sac procedure. The endolymphatic sac plays a role in regulating inner ear fluid levels. These surgical procedures may alleviate vertigo by decreasing fluid production or increasing fluid absorption.
In endolymphatic sac decompression, a small portion of bone is removed from over the endolymphatic sac. In some cases, this procedure is coupled with the placement of a shunt, a tube that drains excess fluid from your inner ear.
- Vestibular nerve section. This procedure involves cutting the nerve that connects balance and movement sensors in your inner ear to the brain (vestibular nerve). This procedure usually corrects problems with vertigo while attempting to preserve hearing in the affected ear. It requires general anesthesia and an overnight hospital stay.
- Labyrinthectomy. With this procedure, the surgeon removes the balance portion of the inner ear, thereby removing both balance and hearing function from the affected ear. This procedure is performed only if you already have near-total or total hearing loss in your affected ear.
Certain self-care tactics can help reduce the impact of Meniere's disease. Consider these tips for use during an episode:
- Sit or lie down when you feel dizzy. During an episode of vertigo, avoid things that can make your signs and symptoms worse, such as sudden movement, bright lights, watching television or reading.
- Rest during and after attacks. Don't rush to return to your normal activities.
- Be aware you might lose your balance. Falling could lead to serious injury. Use good lighting if you get up in the night. Consider walking with a cane for stability if you have chronic balance problems.
- Avoid driving a car or operating heavy machinery if you have frequent episodes of vertigo. Doing so could lead to an accident and injury.
Salt and stress can affect hearing and balance. To avoid triggering a vertigo attack, try the following.
- Limit salt. Consuming foods and beverages high in salt can increase fluid retention. Aim for 1,500 to 2,000 milligrams of sodium each day and spread your salt intake evenly throughout the day.
- Manage stress. Managing stress might lessen the severity of symptoms and help you cope with Meniere's disease. Psychotherapy can help you identify stressors and develop strategies for coping with your condition.
Meniere's disease can affect your social life, your productivity and the overall quality of your life. Learn all you can about your condition. Talk to people who share the condition, possibly in a support group. Group members can provide information, resources, support and coping strategies. Ask your doctor or therapist about groups in your area or look for information from the Vestibular Disorders Association.