What to know about Ménière’s disease, and how to treat it

Symptoms of Ménière’s disease

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.

Some people find certain triggers cause their symptoms, such as stress, working for too long, eating too much salt, underlying health conditions, and tiredness.

Common symptoms that can occur during an attack include:

Vertigo

Vertigo is a spinning sensation that a person experiences even when standing still. This may also cause:

• dizziness
• nausea
• vomiting
• irregular heartbeat
• sweating

It is difficult to predict when a vertigo attack will occur. For this reason, it is essential to have vertigo medication readily available 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

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

Living with Ménière’s disease can be challenging. The condition is unpredictable and can adversely affect the individual’s ability to work or drive, potentially limiting their independence, job prospects, freedom, and access to friends and family.

As hearing gets progressively worse, people might find social interaction more difficult, which can lead to feelings of isolation.

It is important for people who experience stress, anxiety, or depression to speak with their doctor.

Stages of Ménière’s disease

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 usual 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:

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

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.

Causes

Ménière’s disease may occur due to a problem with the inner ear’s structure or fluid levels. However, the exact reason why these changes develop is unclear.

The inner ear contains a cluster of connected passages and cavities. The outer part is home to the bony labyrinth. Inside 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 disease’s disorienting effects.

Diagnosis

No single test or scan can definitively 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.

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

A doctor may order tests, such as:

• an audiogram to assess hearing
• a balance assessment
• electronystagmography, which measures involuntary eye movements and can indicate problems with the vestibular system
• rotary chair testing, which also assesses eye movement in response to spinning motion
• vestibular evoked myogenic potentials testing, which measures the function of certain sensors in the inner ear that detect acceleration
• posturography, which assesses balance and posture control

Other tests

To rule out other possible conditions, such as a brain tumor or multiple sclerosis, they may also request:

• an MRI scan
• a CT scan
• an auditory brainstem response audiometry, which measures ear and brain function in response to sounds

Medical treatments

Although no cure exists for Ménière’s disease, treatment can help manage some symptoms.

Medications for vertigo

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

• Motion sickness drugs: These medications include meclizine (Antivert) and dimenhydrinate (Dramamine). 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: According to Ménière’s and Vestibular UK, during this procedure surgeon removes a small portion of bone from around the endolymphatic sac. This membrane in the inner ear helps control water pressure. If it is not working correctly, it 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.

Positive pressure therapy

Positive pressure therapy releases small pulses of air pressure into the middle ear via a tube. These pulses seem to interact with the fluid inside the ear to reduce dizziness.

Researchers are still investigating if this treatment works. A 2023 Cochrane review found there was a lack of high quality evidence supporting positive pressure therapy, so more research is necessary.

Diet and lifestyle changes

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

It may help to:

• Eat 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.
• Eat less salt: A diet high in salt may increase fluid retention in the ear.
• Reduce alcohol intake: Alcohol can adversely affect the volume and composition of the inner ear fluid.
• Drink water regularly: People with Ménière’s disease should take particular care to hydrate regularly during hot weather and intense exercise.
• Avoid tyramine: This amino acid occurs naturally in various foods, including chicken liver, smoked meats, red wine, ripe cheeses, nuts, and yogurts. It may trigger vestibular migraine in some people, though not everyone gets vestibular migraine.

Research from 2018 suggests that there is a link between smoking and tinnitus, so quitting may help reduce this symptom.

If stress or anxiety triggers symptoms, addressing these may help to reduce attacks. Yoga, meditation, tai chi, or mindfulness help people relax.

Summary

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 consider seeking medical support, as several methods are available to manage the symptoms.