Choose the content to read

• What is Ménière disease?
• What are the symptoms of Ménière disease?
• What causes Ménière disease symptoms?&
• What are the complications of Ménière disease?
• How is Ménière disease diagnosed?
• What are the treatments for Ménière disease?
• How can I prevent Meniere’s disease?

Ménière Disease

Ménière disease affects the inner ear, leading to hearing and balance issues. If left untreated, this disease typically worsens over time.

What is Ménière disease?

Meniere’s disease, or idiopathic endolymphatic hydrops, arises from an inner ear abnormality impacting hearing and balance. Ménière disease, if left untreated, can worsen over time, possibly causing permanent hearing loss and ongoing balance problems. Taking prescribed medications can help relieve symptoms.

Is Ménière disease a severe condition?

Although Ménière disease is not life-threatening, it can strike haphazardly without warning, disrupting daily activities and impairing the quality of life.

What are the symptoms of Ménière disease?

• Frequent episodes of dizziness or vertigo lasting from 20 minutes to 12 hours, not exceeding 24 hours, and may be accompanied by nausea and vomiting.
• Fluctuating hearing loss starts in one ear of low-frequency sound in the early stages. Over time, hearing loss can be irreversible and permanent.
• Ringing in the ear and ear fullness

When should I see a doctor?

Seek medical attention as soon as you experience symptoms of Meniere disease.

What causes Ménière disease symptoms?

Endolymph, fluid in the inner ear, is a media crucial for transmitting signals to the hearing and balance loci in the brain. When the endolymph accumulates, it disturbs the intricate mechanism responsible for hearing and maintaining balance. Why the endolymph buildup is unclear; Ménière disease can be hereditary in certain instances.

What are the complications of Ménière disease?

• Vertigo episodes.
• Permanent hearing loss.
• Anxiety or stress from sudden onset of symptoms.
• Risk of falls and accidents.

How is Ménière disease diagnosed?

• History taking and physical exam

Your doctor will inquire about the frequency and duration of vertigo episodes, i.e., whether you have two or more vertigo attacks lasting more than 20 minutes in 24 hours, ringing in the ear, or ear compaction.

• Audiometry

Your doctor will assess your ability to hear sounds at various pitches and volumes and to distinguish similar-sounding words. If you have the disease, you will have difficulty hearing low frequencies or a combination of high and low frequencies sounds.

• Balance assessment

Most individuals with Ménière disease can regain their balance after vertigo episodes. However, some may experience lingering balance issues.

• Medical Imaging and other tests

Because some of Ménière disease symptoms can resemble other conditions, such as a brain tumor and multiple sclerosis, your doctor may order additional tests to rule out these conditions.

• Ear function assessment
  • Electronystagmogram or videonystagmography (ENG or VNG) can evaluate balance by analyzing eye movements. One component tracks eye movement following a target, while another observes eye movement during head position changes. The caloric test induces inner ear responses to temperature changes by instilling warm and cold air or water into the ear.
  • Rotary-chair testing assesses eye movements, similar to ENG and VNG.  You sit in a computer-controlled chair that rotates from side to side to elicit inner ear activity.
  • Vestibular-evoked myogenic potentials (VEMP) testing is an examination that activates parts of the inner ear with sound while recording muscle reactions. Abnormal or lack of response is detectable in patients with Ménière disease.
  • Computerized dynamic posturography (CDP) is a test that can identify how your balance system works. The balance system usually relies on vision, inner ear function, and sensation of the skin, muscles, tendons, and joints. CDP can assess which part contributes to the balance problem. You will stand barefoot on a platform while wearing a safety harness, maintaining balance under different conditions.
  • Video head impulse test (vHIT) can identify if your eyes move from the target during head movement, indicating an abnormality in the inner ear vestibular system.
  • Electrocochleography (ECoG) can detect inner ear fluid buildup.

What are the treatments for Ménière disease?

There is no cure for the disease, but treatments can relieve symptoms of vertigo and prevent a permanent hearing loss. 

Medications for vertigo

• Motion sickness medicines such as meclizine or diazepam can alleviate the spinning sensation, nausea, and vomiting.
• Anti-nausea medicines such as promethazine.
• Diuretics and betahistine can be taken together or alone to relieve vertigo. Diuretics lower the fluid in the inner ear, while betahistine improves inner ear blood flow.

In some patients, a doctor may recommend restricting sodium intake and taking a long-term course of medication to alleviate fluid retention and lessen the severity and frequency of the disease symptoms.

Other therapies

• Rehabilitation for balance problems.
• Hearing aid.

Middle ear injection of medications

• Gentamicin is an antibiotic that can damage the part of your ear that causes vertigo. Other healthy parts of the ear can take over the lost function. However, this is at the cost of additional hearing loss.
• Steroids such as dexamethasone can help manage vertigo attacks in some individuals. While dexamethasone may not be as effective as gentamicin, it poses a lower risk of causing further hearing impairment.

Surgery

If your symptoms do not improve with other treatments, your doctor may consider surgery.

• Endolymphatic sac surgery is a procedure to place a tube to drain excess fluid, relieving the pressure in the inner ear.
• Labyrinthectomy destroys the vestibular portion responsible for vertiginous symptoms but will result in complete hearing loss in that ear. The healthy ear will assume the function of sending balance and hearing neural signals to the brain. Labyrinthectomy is suitable for individuals with poor or total hearing loss in the affected ear.
• The vestibular nerve section cut the nerve to block the transmission of movement-related signals to the brain. It improves vertigo symptoms while preserving hearing in the affected ear. General anesthesia and an overnight hospital stay are usually necessary for this procedure.

How can I prevent Meniere’s disease?

Meniere’s disease is not preventable. If you have a family history of the disease, notify your doctor to schedule close monitoring.  If you have frequent dizziness and suspect that you have the disease, it is advisable to have a confirmatory diagnosis.

What can I do to minimize Ménière disease symptoms?

• Reduce your salt intake to prevent fluid retention that may exacerbate symptoms of Ménière disease.
• Limit caffeine consumption, especially from energy drinks, which may heighten the frequency of vertigo attacks from Ménière disease.
• Manage stress as it can trigger Ménière disease symptoms. Engage in stress-reducing hobbies or activities to alleviate the symptoms.
• Get adequate rest and quality sleep.
• Limit alcohol consumption.

How can I prepare myself before the doctor’s appointment?

• Write down your symptoms, duration, and frequency of the attacks.
• Write down any main stressors you have been dealing with, the medications, and dietary supplements you are taking.
• Bring a friend or family member to drive for you on the assessment day.
• Make a list of questions that you would like to ask your doctor. For instance:  
  • What causes Ménière disease?
  • Do I have to undergo any tests?
  • Is it curable?
  • What treatment option do you recommend?
  • How can I manage my preexisting health condition?
• Prepare to answer questions that your doctor may ask. For instance: 
  • When was the onset of the symptoms?
  • Did you experience dizziness or vertigo? How long did it last in minutes or hours?
  • Do you experience symptoms regularly?
  • What triggers your symptoms?
  • What improves or worsens your symptoms?
  • Does anyone in your family have Ménière disease?

A note from MedPark’s doctor

Living with Ménière disease can induce persistent anxiety due to erratic symptoms that disturb your daily life and impede your freedom and comfort. Yet, undergoing appropriate treatments from a medical expert can alleviate these symptoms and restore your quality of life.