Meniere's Disease (Meniere Disease)

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

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.

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.

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.

• 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.