Meniere's disease, also called idiopathic endolymphatic hydrops, is a disorder of the inner ear. Although the cause is unknown, it probably results from an abnormality in the fluids of the inner ear. Meniere's disease is one of the most common causes of dizziness originating in the inner ear. In most cases only one ear is involved, but both ears may be affected in about 15% of patients. Meniere's disease typically starts between the ages of 20 and 50 years. Men and women are affected in equal numbers.
Symptoms of Meniere’s Disease
The symptoms of Meniere's disease are episodic rotational vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Vertigo is usually the most troublesome symptom of Meniere's disease, and is often debilitating. The patient feels that either she or the room is moving, and may experience severe nausea and vomiting. Attacks may vary considerably from one patient to another and from episode to episode. Sleepiness may follow for several hours, and the off-balance sensation may last for days.
There may be an intermittent hearing loss early in the disease, especially in the low pitches, but a fixed hearing loss involving tones of all pitches commonly develops in time. Loud sounds may be uncomfortable and appear distorted in the affected ear. The tinnitus and fullness of the ear in Meniere's disease may come and go with changes in hearing, occur during or just before attacks, or be constant. The symptoms of Meniere's disease may be only a minor nuisance, or can become disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning.
Diagnosing Meniere’s Disease
The physician will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. You may be asked whether there is a history of syphilis, mumps, or other serious infections in the past, inflammations of the eye, an autoimmune disorder or allergy, or ear surgery in the past. You may be asked questions about your general health, such as whether you have diabetes, high blood pressure, high blood cholesterol, thyroid, neurologic or emotional disorders. Tests may be ordered to look for these problems in certain cases. The physical examination of the ears, and other structures of the head and neck is usually normal, except during an attack.
An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in the affected ear. Speech discrimination (the patient's ability to distinguish between words like "sit" and "fit") is often diminished in the affected ear. An ENG (electronystagmograph) may be performed to evaluate balance function. This is done in a darkened room. Recording electrodes are placed near the eyes. Wires from the electrodes are attached to a machine similar to a heart monitor. Warm and cool water or air are gently introduced into each ear canal. Since the eyes and ears work in a coordinated manner through the nervous system, measurement of eye movements can be used to test the balance system. In about 50% of patients, the balance function is reduced in the affected ear. Other balance tests, such as rotational testing or balance platform, may also be performed to evaluate the balance system.
Other tests may be done as well. Electrocochleography (ECoG) may indicate increased inner ear fluid pressure in some cases of Meniere's disease. The auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computed tomography (CT) or, magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing and balance nerve. Such tumors are rare, but they can cause symptoms similar to Meniere's disease.
Treatments for Meniere’s Disease
Diet and Medications for Meniere’s Disease
Drug therapy usually can provide only symptomatic relief. Vertigo can be eased by anticholinergic agents, such as atropine or scopolamine, by antihistamines such as diphenhydramine or meclizine, or by barbiturate drugs such as pentobarbital that provide general sedation.
A low salt diet and a diuretic (water pill) may reduce the frequency of attacks of Meniere's disease in some patients. In order to receive the full benefit of the diuretic, it is important that you restrict your intake of salt and take the medication regularly as directed.
For patients with bilateral Ménière's disease, treatment is more difficult. Sometimes surgical intervention on the most problematic ear will stop the majority of attacks. In the past, the antibiotic streptomycin was sometimes used in exceptionally large doses, which had the effect of destroying the balance mechanism while not affecting the hearing. Some patients are willing to endure having to use their tendon reflexes and their eyes to achieve balance (meaning they have no sense of balance in a completely dark room) in order to stop the attacks of vertigo.
Other medical treatments for Meniere’s disease include intratympanic injection of steroid or gentamycin. These treatments are relatively safe and shown to be effective in about 80% of patients. Ear tube insertion is an integral part of the procedures. These procedures are rarely associated with worsening of hearing, tinnitus, vertigo, and ear drum perforation.
Surgery for Meniere’s Disease
If vertigo attacks are not controlled by conservative measures and are disabling, one of the following surgical procedures may be recommended. Although there is no cure for Meniere's disease, surgery can control the attacks of vertigo in nearly all cases.
Labyrinthectomy and eighth nerve section are procedures in which the balance and hearing mechanism in the inner ear is destroyed on one side. This is considered when the patient with Meniere's disease has poor hearing in the affected ear. Labyrinthectomy and eighth nerve section result in the highest rates for control of vertigo attacks.
Selective vestibular neurectomy is a procedure in which the balance nerve is cut as it leaves the inner ear and goes to the brain. Vertigo attacks are permanently cured in a high percentage of cases, and hearing is preserved in most cases.
The endolymphatic shunt or decompression procedure is an ear operation that usually preserves hearing. Attacks of vertigo are controlled in one half to two-thirds of cases, but control is not permanent in all cases. Recovery time after this procedure is short compared to the other procedures.
Other operations or treatments may be advised in some cases. For example, a prosthesis may be implanted to help drain the excess fluid that accumulates in the ear as an attack begins.
Lifestyle Changes to Help Meniere’s Disease
Avoid caffeine, smoking, and alcohol. Quitting smoking can help decrease the frequency and severity of Meniere’s attacks. Get regular sleep and eat properly. Remain physically active, but avoid excessive fatigue. Stress may aggravate the vertigo and tinnitus of Meniere's disease. Stress avoidance or counseling may be advised.
Safety Precautions for Meniere’s Patients
If you experience vertigo without warning, you should not drive, because failure to control the vehicle may be hazardous to yourself and others. Safety considerations may require you to forego ladders, scaffolds, and swimming.
