Meniere’s Disease

Meniere’s disease was first described by French physician, Prosper Meniere, in the early 1860s. Meniere’s disease is an inner ear disorder causing the symptoms of vertigo, hearing loss, pressure in the ear, and tinnitus. These symptoms tend to occur in attacks lasting two to four hours, followed by strong fatigue. The afflicted individual may have no symptoms between attacks, though over time the hearing loss tends to get progressively worse.

Causes of Meniere’s Disease

Though much research has been done into Meniere’s disease it remains difficult to diagnose and is often misdiagnosed. It is considered to be a “diagnosis of exclusion,” meaning that other conditions need to be carefully considered and ruled out. There is no one test that is completely accurate in diagnosing Meniere’s disease. 

Research indicates that the underlying cause of Meniere’s disease is a condition called endolymphatic hydrops, an excessive buildup of the fluid in the inner ear called endolymph. The reason for this excessive buildup is not completely understood, though it is believed to result from either a defect in the endolymphatic duct, where the fluid drains from the inner ear, or overproduction of endolymph by the stria vascularis, a tissue in the inner ear. 

As this fluid builds up, it causes the membranous labyrinth, which houses the nerve endings in the inner ear for both hearing and balance, to become swollen like an overinflated water balloon. This increased pressure within the inner ear changes the mechanics of the nerve endings and the result is pressure in the ear, decrease in hearing, noise in the ear, and a strong sensation of spinning, called vertigo.

Some studies suggest that there may be a genetic component to Meniere’s disease but this remains debated. Allergies and immune system problems are also sometimes associated with this condition. There appears to be some relationship between Meniere’s disease and migraines, a connection that Prosper Meniere himself suspected.

Symptoms of Meniere’s Disease

In general, the symptoms of Meniere’s disease will affect one ear first. For some people, the other ear does not develop symptoms, but for others both will eventually be affected. It is important to remember that the specific symptoms of Meniere’s disease vary from one person to the other. The following symptoms may be more or less pronounced in some individuals and not all symptoms are necessarily present. 

Pressure in the Ear
Pressure or fullness in the ear is often the first thing an individual notices when an attack of Meniere’s is starting. This may feel like something is stuck in the ear or the way your ear feels when you go up in an airplane.

Hearing Loss
The hearing loss associated with Meniere’s disease usually affects the low frequencies and is in one ear. The hearing tends to decline during an attack and improve after an attack. In the initial stages of the disease, hearing may be normal between attacks. As the disease progresses, however, hearing is apt to be permanently decreased in the low frequencies and eventually at all frequencies.
Hearing loss associated with Meniere’s disease is a “sensorineural” hearing loss, meaning that it is the nerve endings that are affected. In most cases, a sensorineural hearing loss entails permanent loss; a fluctuating sensorineural hearing loss is unusual and a strong indicator of Meniere’s disease. 

Tinnitus
Tinnitus is defined as any noise in the ear that is unrelated to external sounds. Many people have tinnitus and tinnitus alone could be a symptom of any number of conditions. The tinnitus associated with Meniere’s disease generally fluctuates, is absent between attacks, and is very noticeable during or preceding an attack. It is often described as a “roaring” sound, though any noise that is in one ear and fluctuates may be consistent with Meniere’s disease.

Vertigo
Perhaps the most troublesome symptom associated with Meniere’s disease is vertigo. Vertigo is a strong sense of spinning, as though someone were spinning you on a barstool. During an attack, this is uncontrollable and an individual is likely to be unable to stand or walk. The individual may experience nausea, vomiting, or in extreme cases loss of control of their bladder and/or bowels. Most individuals, once an attack starts, become incapacitated. Vertigo often occurs after one or more of the other symptoms (pressure, hearing loss, tinnitus) occur, and thus individuals with Meniere’s begin to use those symptoms as a warning sign of impending vertigo.

Managing An Attack

Unfortunately, once an individual becomes symptomatic with Meniere’s disease, an attack is apt to happen at any time, be it at home, driving down the highway, or at the grocery store. Once an attack starts there is no consistently effective way to reduce symptoms.  
Certainly if an attack occurs when you are driving or doing something else that might be dangerous, STOP. Pull your car off to the side of the road as carefully as possible and turn it off. Turn off your lawnmower and sit down. Find a safe, secure place and sit or lie down. Do not eat or drink anything, as this may cause vomiting. If well-intentioned strangers come to your aid, try to explain the situation (it may be helpful to have a rehearsed explanation at the ready). You may need assistance getting home. After an attack, you will probably need to sleep for several hours.

Diagnosis of Meniere’s Disease

Do not diagnose yourself with Meniere’s disease. Remember that there are many conditions that can cause vertigo and the other symptoms associated with Meniere’s. Some of these conditions are easily treated by a knowledgeable doctor. 
If you suspect that you may have Meniere’s disease, contact your primary doctor. He or she will probably recommend that you see an otolaryngologist (ear, nose, and throat doctor) for a thorough examination. You will likely need to have several tests related to your hearing and balance systems in order to help the physician determine whether you do in fact have Meniere’s disease.

Treatments of Meniere’s Disease

Unfortunately, there is no cure for Meniere’s disease, nor is there any one treatment that is effective for all individuals with Meniere’s. 
Once a diagnosis of Meniere’s disease is made, treatment may include the following:

Dietary changes 
Usually reducing the salt in your diet and increasing how much water you drink. Also it may be suggested that you limit the amount of caffeine you consume and the amount of processed foods you eat. Items containing MSG (monosodium glutamate), a type of salt often used in prepared foods, should be avoided. Additionally it is likely that reducing the amount of alcohol and nicotine that you consume will be recommended.

Medications
Many physicians recommend the use of diuretics to treat Meniere’s disease. Vestibular suppressants such as Meclizine are often prescribed for any condition causing vertigo. Steroids, calcium channel blockers, and immune system suppressants are sometimes prescribed.

Surgery
In extreme cases where patients have not responded to dietary changes or to prescription medications, surgery may be recommended to essentially destroy the inner ear structures. This may be done by the administration of drugs that destroy the nerve endings within the inner ear or by surgically destroying these structures. Obviously this is an option that must be considered carefully and discussed thoroughly with your physician.

References: 
Hain TC, (2008). Meniere’s Disease. Accessed online at www.american-hearing.org/disorders/menieres. 
Haybach PJ, (2005). Meniere’s Disease. Accessed online at www.vestibular.org/vestibular-disorders/specific-disorders/meniere92s-disease.php
Pulec J.L., (1984). Meniere’s Disease. In: Northern JL, ed. Hearing Disorders, Austin, TX, Pro-Ed, 135-142.