Meniere's disease

Sounds like 'men-YEERS'

Meniere's disease is an inner ear problem that affects your hearing and balance, leading to episodes of feeling as if the world is spinning (vertigo), partial hearing loss, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear (blocked ear).

  • Each episode may last from 20 minutes to several hours (the average is 2 to 4 hours).
  • Many people feel quite sleepy after an episode and slight unsteadiness may last a day or so after an episode – sometimes longer.
  • With time, hearing loss can become worse and may result in some degree of permanent hearing loss.
  • In most people, Meniere's disease affects only one ear, in others, over time it can develop in both ears.

What causes Meniere's disease?

The exact cause of Meniere's disease is not known. It is believed to related to build up of fluid in the inner ear experienced by people with Meniere's disease. When fluid builds up it creates pressure on the parts of the inner ear that control balance and hearing. 

The cause of the fluid build up is unknown – it may be that your body produces too much of the fluid, or that the fluid doesn't drain as it should from the inner ear. Or it may be both.

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Who is at risk of Meniere's disease?

Meniere's disease can occur at any age but it usually occurs in people aged over 40 years. It is considered a chronic condition (ongoing).

It's hard to predict who will get Meniere's disease. But your risk may be higher than normal if you have:

  • A family member who has it.
  • An autoimmune disease, such as diabetes, lupus, or rheumatoid arthritis.
  • Had a head injury, especially if it involved your ear.
  • Had a viral infection of the inner ear.
  • Allergies.

How is Meniere's disease diagnosed?

To diagnose Meniere's disease, your doctor will ask you to describe your symptoms and will carry out tests such as an MRI, hearing tests, and other specialised tests. You may be referred to the ear, nose and throat (ENT) specialist or audiology department of your local hospital.

How is Meniere's disease managed?

There is no cure for Meniere's disease but a combination of factors, including lifestyle changes and medication, can help reduce the severity and ease the symptoms, mainly of vertigo episodes. There are no treatments for the hearing loss that occurs with Meniere's disease.

Lifestyle changes

Meniere's disease can be hard to manage and tough to live with. Here are a few lifestyle changes that may ease the symptoms of vertigo associated with Meniere's disease:

  • Changes to your diet such as reduced salt, caffeine and alcohol intake.
  • If you smoke, quitting.
  • Reducing stress by engaging in regular exercise.
  • When you have an episode of Meniere's disease, lying down and holding your head very still until the symptoms go away may help. 

When you have an episode of vertigo, you are at increased risk of falls and injury. You can take steps to help protect yourself, such as:

  • Do exercises to improve your balance. This can reduce your risk of falling and hurting yourself or others.
  • Make changes to reduce your risk of injury during a vertigo episode. For example, install grab bars in your washroom. Wear shoes with low heels and non-slip soles. And don't drive during an episode.

Medications

Your doctor may prescribe medications to take during a vertigo episode to lessen the severity of your symptoms:

  • Medications that control nausea and vomiting during an episode of vertigo (called anti-nausea medications) such as prochloperazine, promethazine or cyclizine.
  • Medications to reduce inflammation in the inner ear, such as prednisone. Your doctor may start you on a high dose and reduce the dose slowly over a few days.

Your doctor may prescribe medication to prevent further episodes such as betahistine.

  • Betahistine is thought to increase the blood flow around the inner ear.
  • It is unlikely to stop all episodes but may reduce the severity and frequency of the attacks.
  • It does not work in all cases. Your doctor may offer you a trial of betahistine for 6 to 12 months to see if it helps to reduce symptoms. If it does, it can be continued.

Other treatments 

Depending on the severity of your condition and its impact on your daily living, your doctor may recommend other treatment options for different problems caused by Meniere's.   

  • Hearing aids for hearing loss
    • If you develop permanent hearing loss, you may benefit from a hearing aid.
    • If loud sounds become distressing then an audiologist or hearing therapist can provide you with advice on compression hearing aids which may help to ease this symptom.  
  • Sound therapy for tinnitus
    • If you develop permanent noises in the ear (tinnitus) then various strategies may be advised.
    • For example, an audiologist or hearing therapist may advise on sound therapy.
    • This is often a CD or on an MP3 player which plays soothing and relaxing sounds, helping to distract you from the sound of tinnitus.
    • Some people have found coping strategies, relaxation training, counselling, and other such techniques, useful to combat tinnitus.
  • Physiotherapy for loss of balance 
    • A physiotherapist may be involved if your balance becomes permanently affected (in severe cases).

What is the outlook (prognosis)?

Meniere's disease affects different people differently. When you are first diagnosed, it is not possible to predict how badly it will affect you in the coming years.

In many people, months or years go by between episodes. In some people, the episodes are more frequent. Some episodes are minor and don't last long. Others can be very distressing with severe sickness (vomiting) and dizziness.

Fortunately, treatments that can ease symptoms have improved in recent years.

There is also a good chance that eventually (typically after 5-10 years) the episodes stop occurring altogether. However, some degree of permanent hearing loss or permanent noises in the ear (tinnitus) may have developed in the affected ear or ears by this time. 

Learn more

The following link provide further information on Meniere's disease. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Meniere's disease Patient Info, UK 

References

  1. Da Cruz M. Ménière’s disease A stepwise approach. MedicineToday 2014; 15(3): 18-26