Meniere’s disease can cause vertigo (a feeling that your head is spinning) and hearing loss. It also causes a ringing in your ear (tinnitus). These symptoms come and go. They can last from a few minutes to 24 hours.
Your doctor can diagnose Meniere’s disease by talking with you, doing a physical exam, and ordering tests. These include a computerized dynamic posturography test and an audiogram.
Symptoms
The cause of Meniere’s disease isn’t known, but it probably results from an abnormality in the fluids of the inner ear. These fluids move over sensory cells that send information to the brain about your head position and sound. They contain specific concentrations of’salts’ such as sodium, potassium and chloride. In people with Meniere’s disease, the concentration of this fluid fluctuates. This can interfere with the ability of these cells to function and cause vertigo, hearing loss and tinnitus.
An attack of Meniere’s disease usually involves episodes of vertigo that last from 20 minutes up to several hours, and may be accompanied by nausea or vomiting. The tinnitus in Meniere’s disease is a noise (ringing, buzzing, hissing or whistling) in the ear that does not occur with external sounds and can vary in frequency and intensity. Over time, these attacks of vertigo lead to hearing loss that is usually focused on low frequencies but can affect both high and low frequencies.
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To diagnose Meniere’s disease, your healthcare professional will perform a complete physical and review your symptoms. The healthcare professional may order an audiometric test to look at how well you hear sounds of different pitches and volumes, as well as to check your ability to tell the difference between words that sound alike.
The audiologist may also order a vestibular test battery and MRI to look for any abnormalities in the inner ear balance system and the eye muscles used to control balance. Your healthcare professional will suggest you eat a low salt diet to help reduce fluid retention and may recommend medications like diuretics or betahistine to improve your symptoms. Medicines for motion sickness can ease the spinning feeling and antiemetics can control nausea and vomiting during an episode of Meniere’s disease. In some cases, your healthcare professional might inject you with medication directly into the endolymphatic sac or labyrinth to reduce the frequency of your vertigo attacks. Vestibular rehabilitation therapy may help your body and brain regain the ability to process balance information correctly between Meniere’s disease episodes. You might also benefit from a hearing aid in the affected ear.
Diagnosis
The symptoms of Meniere’s disease include episodes of severe dizziness (vertigo), a ringing in the ears called tinnitus, and hearing loss that comes and goes. The attacks of vertigo usually affect one ear and can last for hours at a time. Between vertigo episodes, your balance returns to normal, but you may continue to have some ongoing balance problems.
The cause of Meniere’s disease is unknown, but it’s likely that an abnormal increase or decrease in inner ear fluid levels causes the disorder. Fluid changes may be triggered by certain activities, including traveling, changing elevations, exercise, stress, or eating foods that are high in salt.
Your doctor can tell if you have Meniere’s disease from your description of your symptoms and the results of medical tests. A caloric stimulation test of your eye reflexes may be done, and an MRI or electronystagmography scan might also be recommended. These tests look at eye movement when your head is placed in different positions or when air and warm water are introduced into the ear canal to see how your inner ear reacts.
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If you have a history of Meniere’s disease and an abnormal balance test result, your doctor can recommend treatments to help reduce the severity of your symptoms and lessen how often you experience them. Treatments may include medicine, vestibular rehabilitation therapy, and dietary or lifestyle changes. If you don’t get relief from these, your doctor may recommend gentamicin injections or surgery to decompress the endolymphatic sac.
Some alternative therapies, such as acupuncture or acupressure, tai chi, and herbal supplements like gingko biloba or niacin, have been shown to reduce some of the symptoms of Meniere’s disease. However, you should talk to your doctor about these before trying them. They might interfere with your treatment or cause adverse side effects. Your doctor can also advise you on how to manage your symptoms, such as avoiding triggers and limiting your sodium intake. Managing your symptoms will help improve your quality of life and reduce how frequently you have vertigo attacks. It will also help prevent the tinnitus and hearing loss from getting worse over time.
Treatment
A person with Meniere’s disease has episodes of vertigo (a feeling that the room is spinning), ringing in the ears (tinnitus) and hearing loss, usually in only one ear. It’s not clear what causes the condition, but experts believe that abnormal fluid pressure in the inner ear plays a role. The pressure buildup interrupts the flow of balance and hearing signals to the brain.
An MRI scan may help determine whether or not you have Meniere’s disease. During an MRI, a small amount of fluid is injected into the head and the results are recorded. The images may show an abnormal structure in the inner ear or other problems in the vestibular system.
Other tests may include an audiometry exam, in which your doctor listens to sounds at different pitches and volumes to check how well you can hear. You may also have a speech discrimination test, which measures your ability to distinguish words that sound the same, like “fit” and “sit.”
Medicines that reduce fluid retention can improve vertigo in some people with Meniere’s disease. Some examples are diuretics and betahistine. They work by lowering how much fluid is in the body, which in turn lowers the pressure in the inner ear.
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Injections of the antibiotic gentamicin can control vertigo in some people with Meniere’s, but they increase your risk for permanent hearing loss by damaging microscopic hair cells that help you hear. Your doctor may recommend corticosteroid injections instead, which are less likely to damage your hearing.
If the medicines don’t help, your doctor might recommend more-intense treatments. These can include surgery to correct a problem in the inner ear that contributes to vertigo. Two procedures are available: endolymphatic sac decompression and labyrinthectomy. They involve removing bone around the endolymphatic sac, a membrane in the inner ear that helps control water pressure. The surgeon can also cut the vestibular nerve, which also controls balance function in some people with Meniere’s disease.
Other treatments might include vestibular rehabilitation therapy, in which a physical therapist helps you practice exercises that can improve your balance between vertigo attacks. A hearing aid might also be useful, although the tinnitus and imbalance that can occur with Meniere’s might interfere with its effectiveness.
Prevention
The cause of Meniere’s disease isn’t known, but it is thought that the symptoms are caused by a buildup of fluid in the inner ear called endolymph. This causes the perception of ringing in the ears, vertigo (spinning or rocking sensation) and pressure in the ears. The fluid may build up because of a blockage or because of an abnormal shape in the ear. Symptoms occur in episodes and vary from person to person.
Some people may experience a single attack or cluster of attacks that come and go over months to years. Others have constant dizziness. In either case, the symptoms interfere with daily activities and are very disruptive. The most serious problems occur during attacks of vertigo, when the feeling of movement can lead to falling and even trouble driving.
During an attack, the dizziness, ringing in the ears and pressure or fullness in the ears make it difficult to focus and concentrate on tasks. Some people have anxiety and depression due to the unpredictable nature of the attacks. The vertigo often lasts for several hours and is sometimes accompanied by nausea and vomiting. Some people also have a loss of hearing, which is usually temporary but can be permanent in some cases.
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There is no cure for Meniere’s disease, but treatments can help control the symptoms and improve quality of life. Your doctor will likely recommend changes in diet and habits to reduce the amount of fluid your body stores. Your doctor may prescribe medications that reduce motion sickness and other symptoms during an attack. They can also inject medication into your middle ear to reduce vertigo symptoms.
It’s important to see your healthcare provider as soon as you begin to notice symptoms of Meniere’s disease. Your healthcare professional can perform a thorough examination and give you a complete medical history. They will also give you a series of tests to check your balance and hearing. These may include audiometry, a caloric stimulation test and x-rays. The test results will help your doctor determine if the problem is Meniere’s disease or another illness that can cause similar symptoms.
