Ménière's Disease

What is Ménière's disease?

Ménière's disease is a problem in the inner ear. It can cause severe dizziness (vertigo) and hearing loss. It usually affects just one ear, but it can happen in both ears. The symptoms can be mild or severe. Although the dizziness can be very disabling, it can usually be controlled. There can be a significant hearing loss, but complete deafness is rare.

How does it occur?

Deep inside the skull lies the inner ear, made up of the fluid-filled tubes of the hearing and balance organs. If there is too much pressure inside these tubes, your hearing or sense of balance can be affected.

What causes the build-up of fluid and pressure is not known, but it is known to happen after some infections, such as syphilis, and after head injuries.

What are the symptoms?

The most common symptoms are:

• pressure or fullness in the ear
• ringing in the ear
• dizziness
• difficulty hearing.

These symptoms may come and go. They usually last for hours or days. There may be times when you do not have any symptoms for weeks, months, or years.

How is it diagnosed?

Your healthcare provider will ask you about your medical history. You will have a physical exam of your eyes, ears, and nervous system. A simple test of your hearing, called an audiogram, will probably be done. Because there is no single test for diagnosing Ménière's, your provider may have you try different medicines to see if any of them help your symptoms improve or go away.

You may need special tests to check the hearing and balance mechanisms in your ear. These tests measure how well your brain and nervous system react when your nerve centers for balance and hearing are stimulated. These tests are called electronystagmography (ENG), electrocochleography, oto-acoustic emission (OAE), and auditory brainstem evoked response (ABR). For these tests, you are usually reclining in a quiet room with a thermometer-like probe resting in your ear canal. These tests do not require needles or injections. You may also need an MRI scan of your ear and brain to make sure there are no tumors causing your symptoms.

What is the treatment?

Usually the first step is to avoid possible triggers of an attack. Your healthcare provider may ask you to eat a low-salt diet. A low-salt diet can help prevent your body from storing too much water. You may be asked to stop using caffeine or nicotine.

The most common medicines used to treat Ménière's are diuretics, also called water pills. An example is hydrochlorothiazide (HCTZ). It can help decrease the fluid pressure in the inner ear by causing your body to get rid of salt and water through your kidneys. Another commonly used medicine is niacin. It can improve blood flow to the inner ear by making the small blood vessels widen (dilate).

Your provider may give you an anti-dizziness medicine such as meclizine (Antivert) to help with the symptoms. It helps with the nausea and vomiting that often happen with dizziness, but it may make you sleepy.

Allergies can trigger Ménière's symptoms, so your provider may recommend allergy testing and treatment.

Physical therapy may help you learn how to keep your balance better when you are dizzy.

Your provider may recommend hearing aids to help you hear better.

In severe cases you may need surgery to control the dizziness. One type of surgery involves making an opening to try to drain excess fluid out of the inner ear. In another type of surgery, the abnormal inner ear structures are removed so that the normal ones in the other ear can work without interference.

How long will the effects of Ménière's disease last?

An attack typically lasts several hours. Attacks may come every few days or every few years. Often Ménière's disease is a mild illness and occurs just once. Sometimes symptoms last all your life. In these cases the dizziness or hearing loss can be very disabling, making work or everyday tasks quite difficult.

How can I take care of myself?

• Follow your healthcare provider's instructions for medicine, physical therapy, diet, and activity.
• Lie down and rest during an attack of Ménière's.
• Protect your hearing from loud noises such as loud equipment on the job and loud music.
• Keep your follow-up appointments with your healthcare provider.
• Call your provider if you are having new symptoms or your symptoms are getting worse.

How can I prevent Ménière's disease?

If you and your healthcare provider can figure out what triggers your attacks, avoiding these triggers may help prevent attacks.