Meniere’s Disease

Meniere’s Disease is an inner ear disorder which affects hearing and balance. Individuals who suffer from Meniere’s Disease also generally experience recurring episodes of dizziness, tinnitus, and progressive hearing loss. Meniere’s Disease usually affects only one ear and is caused by an increase in volume and pressure of the fluid (endolymph) in the inner ear. In 15% of patients, both ears may be affected.

Not all individuals who suffer from Meniere’s Disease experience the same symptoms. Classic Meniere’s Disease is considered to consist of the following four symptoms:

• Sporadic episodes of vertigo or dizziness. This can range from motion sickness to vertigo so severe that the patient has completely lost all control of their vestibular (balance) system;

• Fluctuating, progressive, unilateral (in one ear) or bilateral (in both ears) sensorineural hearing loss, often initially beginning in the lower frequency ranges;

• Unilateral or bilateral tinnitus, the sensation of noise even in a quiet environment, often consisting of a high pitched squeal or ringing;

• A sensation of fullness or pressure in one or both ears.

Attacks of vertigo can be incapacitating and severe. Episodes of vertigo can last for hours, and may be accompanied by an increase in the loudness of tinnitus and a greater sense of hearing loss. Vertigo can cause nausea, vomiting and occasionally “drop attacks” which is a sudden onset of severe vertigo so severe that it causes the patient to fall. Drop attacks are a medical emergency and must be treated immediately to prevent injury to the patient and/or others.

Loss of hearing acuity can be coupled with sounds that seem distorted or unusually loud. Some individuals experience nystagmus, which is an uncontrollable jerking movement of the eye. Other individuals report short term memory loss, forgetfulness and confusion. In addition to these symptoms, other individuals report exhaustion, drowsiness, headaches, vision problems and depression.

Meniere’s Disease is related to Endolymphatic Hydrops (excess fluid in the inner ear). As fluid pressure builds, patients experience a sense of fullness in the ear associated with increasing tinnitus. If severe enough levels of fluid pressure are reached, delicate membranes of the inner ear may rupture producing the abrupt onset of vertigo. Many causes of elevated fluid pressure exists and may include, among others, immune system related causes, otosclerosis, viral infections, chronic infections of the ear or other body systems, etc. In most cases of Meniere’s Disease the cause is unknown.

A Meniere’s Disease diagnosis is usually established by an individual’s medical history coupled with a detailed otoneurological examination, audiometric testing and magnetic resonance imaging (MRI).  There remains no perfect, objective diagnostic test for Meniere’s Disease.

Treatment

The treatment for Meniere’s Disease differs from patient to patient.  In many patients, dietary modifications in the form of low salt diets plus diuretic therapy to lower inner ear fluid pressure can reduce symptoms. Additionally, Meniere’s symptoms can also be improved by the treatment of exacerbating medical conditions (such as treatment of environmental allergies, migraines, chronic medical conditions, middle ear conditions and many others), and vestibular suppressant therapy using medications . 

In others, second line therapy in the form of the Menniett Device, Intratympanic Steroids, Intratympanic Gentamicin, or Endolymphatic Shunt Surgery are needed to control symptoms. If other methods fail, surgery to eliminate the ability of the balance nerve to send signals to the brain is needed. These surgeries include labyrinthectomy and vestibular nerve section.  Hearing loss associated with Meniere’s Disease can be ameliorated through the use of hearing aids, BAHA implantation, or in the case of individuals with bilateral Meniere’s Disease, cochlear implants. 

The progression of Meniere’s Disease is unpredictable. Symptoms may become more severe, remain the same, or disappear completely. Treatment is very individualized and begins with a thorough work up and evaluation followed by a treatment plan.

If you or a loved one are concerned you may be suffering from Meniere's Disease, please contact us today to schedule an initial consultation.