What you need to know about Ménière's disease

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Although there is no cure, treatment can help manage some symptoms.

Lifestyle changes

Ménière’s disease has links with stress and anxiety. However, it is unclear whether stress and anxiety cause symptoms of Ménière’s disease, or whether the disease leads to stress and anxiety.

Either way, stress and anxiety management can help reduce the intensity of symptoms. People may find that yoga, meditation, tai chi, or mindfulness helps them relax.

Research suggests that there is a link between smoking and tinnitus, so quitting may help reduce this symptom.

Medications for vertigo

Doctors may recommend different types of drugs for vertigo. The options include:

• Motion sickness drugs: These medications include meclizine (Antivert) and diazepam (Valium). They can help with the spinning sensation that vertigo causes, as well as the nausea and vomiting.
• Drugs for nausea: Prochlorperazine (Compazine) is an effective medication for treating nausea during an episode of vertigo.
• Diuretics: These drugs reduce fluid retention in the body. For Ménière’s disease, doctors might prescribe a combination of triamterene and hydrochlorothiazide (Dyazide or Maxzide).

Reducing the amount of fluid that the body retains may improve the fluid volume and pressure in the inner ear. As a result, the severity and frequency of symptoms may decrease.

Middle ear injections

Doctors can inject some medications into the middle ear to improve symptoms of vertigo.

These drugs include the antibiotic gentamicin (Garamycin) and steroids, such as dexamethasone (Decadron).

Surgery

Surgery may be an option for people with Ménière’s disease if other treatments have not been effective, or if symptoms are severe. Surgical options include:

• Endolymphatic sac decompression: A surgeon removes a small portion of bone from around the endolymphatic sac. This membrane in the inner ear helps control water pressure in the ear. If it is not working correctly, this may contribute to vertigo.
• Labyrinthectomy: A surgeon removes a portion of the inner ear.
• Vestibular nerve section: A surgeon cuts the vestibular nerve.
• Vestibular rehabilitation therapy: People may experience balance problems between episodes of vertigo. A healthcare professional can instruct them on exercises and activities that may help their body and brain regain the ability to process balance.

People with hearing loss may benefit from a hearing aid.

Alternative treatment

Aside from making adjustments to the diet and lifestyle, there are few natural options available to manage Ménière’s disease.

Some herbs, such as ginger root and ginkgo biloba, may provide relief from vertigo symptoms in some people.

However, according to the NIDCD, no evidence supports using herbal supplements, acupuncture, or acupressure to treat Ménière’s.

Herbal supplements may also interact with existing medications. People who wish to try these remedies should check with a doctor before taking them.

Positive pressure treatment

A few years ago, the Food and Drug Administration (FDA) approved a device that can help people who have Ménière’s disease.

This device releases small pulses of air pressure into the middle ear. These pulses seem to interact with the fluid inside the ear to reduce dizziness.

The symptoms of Ménière’s disease vary from person to person. They can occur suddenly, and their frequency and duration differ.

Doctors often refer to sudden symptoms as an attack. Ménière’s attacks vary in length but typically last for between 20 minutes and 24 hours.

Common symptoms that occur during an attack include:

Vertigo

Usually the most obvious symptom of Ménière’s disease, vertigo can involve:

• a spinning sensation, even while a person is stationary
• dizziness
• vomiting
• nausea
• irregular heartbeat
• sweating

It is difficult to predict when a vertigo attack will occur. For this reason, it is important to have vertigo medication handy at all times.

Vertigo symptoms may interfere with several activities, including:

• driving
• operating heavy machinery
• climbing ladders or scaffolding
• swimming

Tinnitus

This persistent, disruptive noise in the ear may resemble the following sounds:

• ringing
• buzzing
• roaring
• whistling
• hissing

People are generally more aware of it during quiet times or when they are tired.

Hearing loss

In a person with Méniére’s disease, levels of hearing loss may fluctuate, especially early on in the disease’s progression.

The person may also be more sensitive to loud sounds. Eventually, most people with Ménière’s develop some degree of long-term hearing loss.

Anxiety, stress, and depression

These psychological symptoms can also develop due to Ménière’s disease. The condition is unpredictable and can adversely affect the individual’s ability to work, especially if they have to climb ladders or operate machinery.

As hearing gets progressively worse, people might find social interaction more challenging.

Some people with Ménière’s lose the ability to drive, further limiting their independence, job prospects, freedom, and access to friends and family. It is important for people who experience stress, anxiety, or depression to tell their doctor.

Ménière’s can also have other effects throughout the body. We explore these in more detail in the section below.

Ménière’s disease develops in two stages. Between these stages, a person might not experience symptoms for extended periods.

Early

In its early stages, Ménière’s disease causes sudden and unpredictable episodes of vertigo.

During these episodes, there will be some loss of hearing, which typically returns to normal once vertigo subsides. The ear may feel uncomfortable and blocked and have a sense of fullness or pressure. Tinnitus is also common in early stage Ménière’s disease.

After a vertigo attack due to Ménière’s disease, a person often has extreme exhaustion and feels the need to sleep for hours.

People may also experience the following during the early stages of the disease:

• diarrhea
• blurry vision
• jerking eye movements
• nausea
• vomiting
• cold sweat
• palpitations or a rapid pulse
• trembling

Late

Vertigo episodes become less frequent in the late stages of the disease and, in some cases, never come back.

However, balance, hearing, and vision problems can continue. Individuals will feel especially unsteady when it is dark. Hearing and tinnitus usually get steadily worse.

A person might also experience drop attacks. These involve spontaneously losing posture or suddenly falling down while remaining conscious.

The most disruptive feature of Ménière’s disease is the sudden onset of vertigo attacks.

The individual may have to lie down and miss out on social, leisure, work, or family activities.

Vehicle licensing authorities in many countries state that people with a diagnosis of Ménière’s disease must not drive.

These authorities will not permit the individual to drive until they receive a doctor’s confirmation that their symptoms are under control.

Certain dietary changes can help reduce fluid retention. Generally, minimizing fluid retention will reduce the frequency and severity of the symptoms.

These measures may help:

• Eating more frequent but smaller meals: Evenly distributing meals throughout the day helps regulate body fluids. Rather than eating three large meals a day, try six smaller ones.
• Eating less salt: The less salt a person consumes, the less fluid their body will retain. People should avoid adding salt to meals and cut out most junk foods, as these are often high in added salt.
• Reduce alcohol intake: Alcohol can adversely affect the volume and composition of the inner ear fluid.
• Drink water regularly: Peoples with Ménière’s disease should take particular care to hydrate regularly during hot weather and intense exercise.
• Avoid tyramine: This amino acid is in a range of foods, including chicken liver, smoked meats, red wine, ripe cheeses, nuts, and yogurts. It may trigger migraine, and people with Ménière’s disease should consider avoiding foods that contain it.

Ménière’s disease may occur due to an abnormality in the structure of the inner ear or the fluid levels in it.

However, the exact reason why these changes develop is unclear.

The inner ear contains a cluster of connected passages and cavities called the labyrinth.

The outer part of the inner ear is home to the bony labyrinth. Inside, there is a soft membrane structure, which is a smaller version of the labyrinth, with a similar shape.

The membranous labyrinth contains a fluid called endolymph. It also has hair-like sensors that respond to the fluid’s movement and send messages to the brain through nerve impulses.

Different parts of the inner ear play roles in various types of sensory perception, such as:

• detecting acceleration in any direction
• rotational motion
• sound

For all of the sensors in the inner ear to function fully, the pressure, volume, and chemical composition of the fluid have to be correct.

Certain features of Ménière’s disease alter the properties of the inner ear fluid, triggering the disorienting effects of the disease.

Triggers

Certain stresses and emotional disturbances can trigger episodes of Ménière’s symptoms, including working for too long, underlying health conditions, and tiredness.

Salt in the diet is another trigger.

No single test or scan can allow a doctor to diagnose Ménière’s disease. The doctor will carry out an interview and physical examination, ask about the person’s medical and family history, and consider the signs and symptoms.

The doctor will ask about the following:

• the severity of symptoms
• how often symptoms occur
• what medications the person has been taking
• any previous problems with the ears
• general health status
• any history of infectious diseases or allergies
• any family history of inner ear problems

Several other diseases and conditions have similar symptoms, which can make it challenging to diagnose Ménière’s disease.

Hearing loss

To establish the extent of hearing loss, a doctor will perform an audiogram.

An audiometer produces tones of varying loudness and pitch. The individual listens with headphones and indicates when they hear a sound or when a sound is no longer present.

Balance assessment

Many people with Ménière’s disease experience some degree of difficulty with balance. A person’s sense of balance may seem to resolve between episodes of vertigo.

Electronystagmography

A doctor introduces warm and cool water or air into the ear canal. They then measure involuntary eye movements in response to this simulation. Unusual responses may indicate an inner ear problem.

Rotary chair testing

The individual sits on a chair in a small, dark booth. The doctor places electrodes near the person’s eyes, and a computer-guided chair gently rotates back and forth at varying speeds.

The movement stimulates the inner balance system and causes nystagmus, or eye movements. A computer and monitor records these with an infrared camera.

Vestibular evoked myogenic potentials (VEMP) testing

This test measures the function of certain sensors in the inner ear that detect acceleration.

Posturography

The individual wears a safety harness while standing barefoot on a special platform and trying to keep their balance under various conditions.

Other tests

A doctor may wish to rule out other possible diseases and conditions, such as a brain tumor or multiple sclerosis (MS). They may request the following scans to help them do this:

• MRI scan
• CT scan
• Auditory brainstem response audiometry — which measures ear and brain function in response to sounds — to rule out tumors

Ménière’s disease has a complicated range of symptoms and is difficult to diagnose and treat.

Attacks may be frequent or infrequent and cause stress, anxiety, and hearing loss. Periods of remission occur between episodes.

A person with Ménière’s disease should seek medical support, as several methods are available to manage the symptoms.