What you need to know about Ménière's disease
According to the National Institute on Deafness and Other Communication Disorders, approximately 615,000 people in the United States have Ménière's. The disease can develop at any age, but most commonly appears between the age of 40 and 60 years and normally only affects one ear.
Ménière's disease is caused by a dysfunction in the inner ear. The labyrinth is a system of small fluid-filled channels that send sound and balance signals to the brain. It is an unpredictable disease that requires various types of treatment.
This MNT Knowledge Center article will look at the symptoms, causes, natural and conventional treatments, diet options for reducing symptoms, and the triggers of Ménière's disease.
Here are some key points about Ménière's disease. More detail and supporting information is in the main article.
- Ménière's disease involves dysfunction in the inner ear.
- Attacks can last an average of 2 to 4 hours.
- Symptoms include vertigo, dizziness, nausea, and a progressive loss of hearing.
- The exact causes of Ménière's disease are not known.
Although there is no cure, treatment can help manage some of the symptoms.
There appears to be a link between smoking and tinnitus, so quitting may help to reduce symptoms and soothe the effects.
There are links between Ménière's disease, stress, and anxiety. However, it is not known whether stress and anxiety cause symptoms or whether Ménière's disease leads to stress and anxiety. However, some studies indicate that good stress and anxiety management can help reduce the intensity of symptoms.
Medications for vertigo
Certain medications can ease the symptoms of Meniere's.
These may include:
- motion sickness drugs, such as meclizine (Antivert) or diazepam (Valium). They can help with the spinning sensation, as well as nausea and vomiting.
- drugs for nausea, such Prochlorperazine is effective in the treatment of nausea during a vertigo episode.
- diuretics, for example, a combination of triamterene and hydrochlorothiazide (Dyazide, Maxzide) to reduce fluid retention.
By reducing the amount of fluid the body retains, the fluid volume and pressure in the inner ear may improve, resulting in less severe and less frequent symptoms.
Middle ear injections
Some injections into the middle ear may improve symptoms of vertigo.
They include gentamicin, an antibiotic, and steroids, including dexamethasone.
Surgery may be an option if other treatments have not worked or if symptoms are severe. Surgery options include:
- endolymphatic sac decompression, in which a small portion of bone is removed from over the endolymphatic sac
- labyrinthectomy, where a portion of the inner ear is surgically removed
- vestibular nerve section, in which the vestibular nerve is cut
- vestibular rehabilitation therapy, in which people who have problems with their balance between episodes of vertigo may benefit from exercises and activities aimed at helping the body and the brain regain the ability to process balance data properly
People with hearing loss may benefit from a hearing aid.
Vertigo is one of the most obvious symptoms of Ménière's disease.
Symptoms vary from person to person; they can occur suddenly, and their frequency and duration differ.
They are often referred to as an "attack." These attacks vary in length but are an average of 2 to 4 hours long.
Common symptoms that occur during an attack include:
Vertigo: This is usually the most obvious symptom of Ménières disease, which includes:
- a feeling that you are spinning, even when you are not moving
- irregular heartbeat
An episode of vertigo may last from a few minutes to a number of hours. As it is difficult to predict when a vertigo attack will occur, it is important to have vertigo medication handy at all times. Vertigo can interfere with driving, operating heavy machinery, climbing ladders/scaffolding, and swimming.
Tinnitus: This is a ringing, buzzing, roaring, whistling, or hissing in the ear. People are generally more aware of it during quiet times, or when they are tired.
Hearing loss: Hearing loss can fluctuate, especially early on in the disease. There may also be a sensitivity to loud sounds. Eventually, most people experience some degree of long-term hearing loss.
Ménière's disease develops in three stages.
1) Early: This involves sudden and unpredictable episodes of vertigo. Episodes last from 20 minutes to 24 hours. During episodes, there will be some hearing loss, which returns to normal after it is over. The ear may feel uncomfortable and blocked, with a sense of fullness or pressure. Tinnitus is also common.
2) Middle: Vertigo episodes continue but are usually less severe. Tinnitus and hearing loss get worse. During this stage, some people will experience periods of complete remission where symptoms disappear. These periods of remission can last several months.
3) Late: Vertigo episodes become even less frequent, and in some cases never come back. Balance problems, though, can continue. Individuals will feel especially unsteady when it is dark. Hearing and tinnitus normally get steadily worse.
The following symptoms are also possible. These are known as secondary symptoms:
Anxiety, stress, depression: These can result because Ménière's disease is unpredictable, many individuals become anxious, depressed, and stressed. The disease can have an impact on the individual's work, especially if they have to climb ladders or operate machinery. As hearing gets progressively worse, they may find it more difficult to interact with other people.
Some people cannot drive, further limiting their independence, job prospects, freedom, and access to friends and family. It is important for people who experience stress, anxiety, and depression to tell their doctor.
The biggest problem of Ménière's disease is not knowing when episodes of vertigo will occur. The individual may have to lie down and miss out on social, leisure, work, or family activities. People with Ménière's also have a higher risk of falling, having accidents while driving a vehicle or operating heavy machinery, as well as developing depression or suffering from high levels of anxiety.
Vehicle licensing authorities in many countries state that if you have been diagnosed with Ménière's disease, you must cease driving. Driving is not allowed until symptoms are under control — this will need to be confirmed by a doctor.
There are some dietary changes that can help reduce fluid retention. Generally, the less fluid retention a person experiences, the less severe and frequent the symptoms will be.
These measures are known to help:
Eat smaller meals, more often: Evenly distributing meals throughout the day helps regulate body fluids. Rather than three large meals a day, try six smaller ones.
Eat less salt: The less salt you consume, the less fluid your body will retain. Do not add any salt to meals. Cut out most junk foods, as salt is added to these in processing.
Reduce alcohol intake: Alcohol can affect the volumes of inner ear fluid in harmful ways.
Drink water regularly: Be sure to regularly hydrate during hot weather and intense exercise.
Avoid tyramine: Tyramine is an amino acid contained in a range of foods, including chicken liver, smoked meats, red wine, ripe cheeses, nuts, and yogurts. It has been known to trigger migraines and is best excluded from the diet.
The inner ear has a complex anatomy.
Experts believe Ménière's disease is caused by an abnormality in the structure and/or the amount of fluid in the inner ear.
However, they do not know what factors cause these changes.
In the inner ear, there is a cluster of connected passages and cavities — a labyrinth.
The outer part of the inner ear is home to the bony labyrinth. Inside, there is a soft structure of membrane, which is a smaller version of the bony labyrinth with a similar shape.
The membranous labyrinth contains a fluid called endolymph, and 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 are involved in various types of sensory perception:
- detecting acceleration in any direction
- rotational motion
- sound is detected by the cochlea
For all of the sensors in the inner ear to work properly, the fluid has to be at the right pressure, volume, and chemical composition.
Certain factors present in Ménière's disease alter the properties of the inner ear fluid, triggering the disorienting effects of the disease.
The symptoms of Ménière's can be set off by certain stresses, emotional disturbances, working for too long, other conditions, and tiredness. These are known as triggers.
Salt in the diet is an additional trigger.
Aside from adjustments to the diet and lifestyle, there are few natural options available to treat Ménière's disease.
Gingko baloba can interact with anticoagulant medicine to increase the risk of bleeding, and taking gingko baloba and thiazides at the same time may increase blood pressure.
Homeopathy may provide a few solutions. The Internet Journal of Otorhinolaryngology suggests that nux vomica and salicylicum acidum are two options that have been effective, and that a plant called Cocculus indicus was equally as effective for reducing Ménière's disease as betahistine, a conventional treatment for vertigo.
However, caution is advised. Always seek the advice of a medical professional and attempt a conventional course of treatment before relying on natural or alternative medicine, and be aware of possible interactions with drugs you may also be taking.
Unfortunately, no single test exists for a quick diagnosis. The doctor will carry out an interview and physical examination, ask about their medical and family history, and consider the signs and symptoms.
The doctor will ask questions regarding:
- how severe the symptoms are
- how often symptoms occur
- what medications they have been taking
- past ear problems
- general health
- any history of infectious diseases or allergies
- any family history of inner ear problems
Several other diseases and conditions have similar symptoms, which makes it hard to diagnose Ménière's disease.
To establish the extent of hearing loss, a doctor will perform an audiogram.
This exam determines the extent of hearing loss caused by the disease. 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.
Many people with Ménière's disease have some degree of balance problems, even when their sense of balance appears to return to normal between episodes of vertigo.
Electronystagmography (ENG): Warm and cool water or air is introduced into the ear canal. Involuntary eye movements in response to this simulation are measured. Abnormalities may indicate an inner ear problem.
Rotary-chair testing: The individual sits in a chair in a small, dark booth. Electrodes are placed near the eyes, and a computer-guided chair rotates gently back and forth at varying speeds. The movement stimulates the inner balance system and causes nystagmus, or eye movements, that are recorded by a computer and monitored 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, stands barefoot on a special platform, and has to keep their balance under various conditions.
- MRI scan
- CT scan
- Auditory brainstem response audiometry: A computerized measure of auditory function using responses produced by the auditory nerve at the brainstem. This test can determine whether a tumor is disrupting the function of the auditory nerves.
Ménière's disease has a complicated range of symptoms and is difficult to treat. Attacks may be frequent or infrequent and cause stress and upset to an individual. The most important thing for someone with Ménière's is to seek support.