Meniere's Disease (Meniere Disease)

  • Medical Author:
    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Tips for Treating Ear Infections

Meniere's disease facts

  • Meniere's disease is a disorder of the flow of fluids of the inner ear.
  • Symptoms of Meniere's disease often fluctuate and include ringing, ear fullness, hearing loss, and poor equilibrium.
  • Diagnosis of Meniere's disease is usually based on history and exam, though other tests can be used.
  • Treatments for Meniere's disease may include diet and life style changes, medications, and surgery.

What is Meniere's disease?

Meniere's disease is a disorder of the flow of fluids of the inner ear.

What causes Meniere's disease?

Although the cause of Meniere's disease is unknown, it probably results from an abnormality in the way fluid of the inner ear is regulated. 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 of age (although it has been reported in nearly all age groups). Men and women are equally affected. The symptoms may be only a minor nuisance, or can become disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning. Meniere's disease is also called idiopathic endolymphatic hydrops.

What are the symptoms of Meniere's disease?

The symptoms of Meniere's disease typically include at least several of the following:

  • Episodic rotational vertigo: Attacks of a spinning sensation accompanied by disequilibrium (an off-balanced sensation), nausea, and sometimes vomiting. This is usually the most troublesome symptom. The vertigo usually last 20 minutes to four hours or longer. During attacks, patients are very disabled, and sleepiness may follow. An off-balanced sensation may last for several days.
  • Tinnitus: A roaring, buzzing, machine-like, or ringing sound in the ear. It may be episodic with an attack of vertigo or it may be constant. Usually the tinnitus gets worse or will appear just before the onset of the vertigo.
  • Hearing loss: It may be intermittent early in the onset of the disease, but overtime it may become a fixed hearing loss. It may involve all frequencies, but most commonly occurs in the lower frequencies. Loud sounds may be uncomfortable and appear distorted in the affected ear.
  • Ear fullness: Usually this full feeling occurs just before the onset of an attack of vertigo.

Quick GuideTinnitus: Why Are My Ears Ringing?

Tinnitus: Why Are My Ears Ringing?

Meniere's Disease Treatment

What Are Some of the Treatment Options for Meniere's Disease?

Meniere's disease does not have a cure yet, but your doctor might recommend some of the treatments below to help you cope with the condition.

  • Medications. The most disabling symptom of an attack of Meniere's disease is dizziness. Prescription drugs such as meclizine, diazepam, glycopyrrolate, and lorazepam can help relieve dizziness and shorten the attack.
  • Salt restriction and diuretics. Limiting dietary salt and taking diuretics (water pills) help some people control dizziness by reducing the amount of fluid the body retains, which may help lower fluid volume and pressure in the inner ear.
  • Other dietary and behavioral changes. Some people claim that caffeine, chocolate, and alcohol make their symptoms worse and either avoid or limit them in their diet. Not smoking also may help lessen the symptoms.
  • Cognitive therapy. Cognitive therapy is a type of talk therapy that helps people focus on how they interpret and react to life experiences. Some people find that cognitive therapy helps them cope better with the unexpected nature of attacks and reduces their anxiety about future attacks.
  • Injections. Injecting the antibiotic gentamicin into the middle ear helps control vertigo but significantly raises the risk of hearing loss because gentamicin can damage the microscopic hair cells in the inner ear that help us hear. Some doctors inject a corticosteroid instead, which often helps reduce dizziness and has no risk of hearing loss.

SOURCE: National Institute on Deafness and Other Communication Disorders, National Institutes of Health. Meniere's Disease.

How is Meniere's disease diagnosed?

The diagnosis of Meniere's disease is primarily made from the history and physical examination. Tinnitus or ear fullness (aural fullness) need to be present to make the diagnosis An audiogram is helpful to show a hearing loss, and to rule-out other abnormalities. It is often helpful, if it can be done safely, to have an audiogram during or immediately following an attack of vertigo. This may show the characteristic low frequency hearing loss. As the disease progresses hearing loss usually worsens.

Other tests such as the auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computer tomography (CT scan) or, magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing or balance nerve. These tumors are rare, but they can cause symptoms similar to Meniere's disease. A full neurological evaluation is performed to exclude other causes of vertigo.

How can Meniere's disease be treated?

  • Medications: A diuretic (water pill) such as triamterene (Dyazide, Maxzide) combined with a low salt diet, is the primary treatment of Meniere's disease. Anti-vertigo medications such as meclizine (Antivert, Bonine, Meni-D, Antrizine) mask the symptoms, providing relief, or diazepam (Valium) may provide temporary relief during more severe attacks of vertigo. Anti-nausea medications [for example, promethazine (Phenergan)] sometimes also are prescribed. In some cases, steroids and certain antibiotic medications (gentamicin) injected into the middle ear may provide some relief from vertigo symptoms. Both anti-vertigo and anti-nausea medications may cause drowsiness. Because the nausea can be so severe at times, medications may be prescribed in the form of a suppository
  • Air pulse generator: in some patients, periodic delivery of small air pulses transmitted through a tube placed in the ear drum has had some variable success.
  • Surgery: If vertigo attacks are not controlled medically and are disabling, for a minority of patients, one of the following surgical procedures may be recommended depending on the individual patient's situation:
    • endolymphatic shunt (A surgical procedure in which a shunt (tube) is placed in the endolymphatic sac that drains excess fluid from the ear.)
    • selective vestibular neurectomy
    • labyrinthectomy (surgical removal of the labyrinth of the ear) and eighth nerve section.

Although there is no real cure for Meniere's disease, the attacks of vertigo can be controlled in nearly all cases. If you have vertigo without warning, you should not drive, because failure to control the vehicle may be hazardous to yourself and to others. Safety may require you to forego ladders, scaffolds, and swimming.

Medically reviewed by Peter O'Connor, MD; American Board of Otolaryngology with subspecialty in sleep medicine

REFERENCES:

Moskowitz, Howard S., M.D., Ph.D. "Meniere disease." UptoDate.com. Updated Mar. 22, 2016

Last Editorial Review: 9/6/2016

Reviewed on 9/6/2016
References
Medically reviewed by Peter O'Connor, MD; American Board of Otolaryngology with subspecialty in sleep medicine

REFERENCES:

Moskowitz, Howard S., M.D., Ph.D. "Meniere disease." UptoDate.com. Updated Mar. 22, 2016

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