Meniere’s Disease

Definition

Meniere's disease is an inner ear disorder that affects balance and hearing.

See also: Vertigo

Alternative Names

Hydrops; Endolymphatic hydrops

Causes, incidence, and risk factors

The inner ear has fluid-filled tubes called semicircular canals, or labyrinths. The canals, along with a nerve in your skull, help interpret your body's position and maintain your balance.

Meniere's disease occurs when a part of the canal, called the endolymphatic sac, becomes swollen. This sac helps filter and remove fluid in the semicircular canals.

The exact cause of Meniere's disease is unknown. In some cases, it may be related to:

• Head injury
• Middle ear infection
• Syphilis

Other risk factors include:

• Allergies
• Alcohol use
• Fatigue
• Recent viral illness
• Respiratory infection
• Smoking
• Stress
• Use of certain medications, including aspirin

Genetics may also play a role.

About 100,000 people a year develop Meniere's disease.

Symptoms

Symptoms include:

• Abnormal sensations of movement (vertigo)
  • Gets worse with sudden movement
  • Lasts for a few minuts to several hours
  • May come and go
• Dizziness
• Hearing loss in one or both ears
  • Low frequency noises lost first
  • Extent of hearing loss may change
• Noises or ringing in the ear (tinnitus)
• Sudden episodes of complete disorientation that causes the person to fall down
• Sweating (may be heavy)
• Uncontrollable eye movements
• Vomiting and nausea

The feeling of dizziness and being off balance generally come in attacks that last from minutes to hours. Other symptoms can last for longer.

Signs and tests

A neurological examination may show problems with hearing, balance, or eye movement.

A procedure called caloric stimulation tests eye reflexes by warming and cooling the inner ear with water. Abnormal results on this test can be a sign of Meniere's disease.

Additional tests done to distinguish Meniere's disease from other causes of vertigo may include:

• Evoked potential studies
• Electronystagmography
• Head CT scan or head MRI scan
• Hearing tests (audiology/audiometry)

Treatment

There is no known cure for Meniere's disease. The goal of treatment is to reduce pressure in the inner ear and relieve symptoms.

Medications such as antihistamines, anticholinergics, are used but are rarely effective.

Water pills (diuretics) may help relieve fluid pressure in the inner ear. A low-salt diet to reduce fluid retention may also help (See: Sodium in diet)

Medicines called antiemetics may be prescribed for nausea and vomiting. Symptoms such as dizziness, and vertigo may respond to sedative/hypnotics and benzodiazepines such as diazepam.

Ear surgery may be required if symptoms are severe and do not respond to other treatment.

Hearing aids may be needed for severe hearing loss.

Avoid sudden movements that may aggravate symptoms. You may need help walking due to loss of balance during attacks.

Avoid bright lights, TV, and reading during attacks, which may make symptoms worse. Rest during severe episodes, and gradually increase activity.

Avoid hazardous activities such as driving, operating heavy machinery, climbing, and similar activities until 1 week after symptoms disappear.

Expectations (prognosis)

The outcome varies. Meniere's disease can often be controlled with treatment. Recovery may occur spontaneously. However, the disorder may be chronic or disabling.

Complications

• Inability to walk or function due to uncontrollable vertigo
• Hearing loss on the affected side

Calling your health care provider

Call for an appointment with your health care provider if symptoms of Meniere's disease, such as hearing loss, ringing in the ears, or dizziness, occur or worsen.

Prevention

There is no known prevention for Meniere's disease, but prompt treatment of ear infection and other related disorders may be helpful.