Ménière's Disease: Symptoms and Treatment

• Ménière's disease is a disorder of the inner ear that can cause episodes of vertigo, tinnitus, a feeling of fullness in the ear, and fluctuating hearing loss.
• It usually only affects one ear but can affect both.
• The disease can start at any age but is most likely to occur between the ages of 40 and 60 years.
• It is a chronic condition but various treatments can help relieve symptoms and minimize the long-term impact on one's life.

Symptoms

• Symptoms include recurring episodes of vertigo, hearing loss, tinnitus, and aural fullness.
• The frequency of episodes varies among individuals.
• After an episode, symptoms improve and may disappear entirely, however, over time, the symptoms return.

Vertigo

• Individuals experience a spinning sensation that starts and stops spontaneously.
• Vertigo episodes occur without warning and usually last 20 minutes to several hours, but not more than 24 hours.
• Severe vertigo can cause nausea, vomiting and sweating.

Hearing loss

• Hearing loss in Ménière's disease may come and go, particularly early on.
• Eventually, most people experience some permanent hearing loss.

Tinnitus

• Tinnitus involves perceiving a sound in the ear that isn't there.
• People with Ménière's disease may experience tinnitus that comes and goes.
• Tinnitus may be heard as a ringing, roaring, whistling or hissing sound.

Aural fullness

• People with Ménière's disease often experience fullness in the ear.
• Aural fullness is the feeling of pressure in the affected ear.

Causes

• The cause of Ménière's disease is not well understood.
• It is thought that Ménière's disease is a result of an abnormal amount of fluid in the inner ear.
• Factors that may affect inner ear fluid include improper fluid drainage, abnormal immune response, viral infection or genetic predisposition.
• It is unlikely that Ménière's disease has a single cause.

Risk factors

• Family history, as having a family member with Ménière's disease may increase the risk of developing it.
• Autoimmune disorder.
• Allergies.
• Viral infection.

Complications

• Unexpected episodes of vertigo and hearing loss.
• Loss of productivity.
• Permanent hearing loss.
• Problems with balance.
• Depression and anxiety.

Diagnosis

• A diagnosis of Ménière's disease requires a medical history, physical examination, and hearing tests.
• Hearing assessment (audiometry) determines if there is hearing loss.
• People with Ménière's disease may have issues discerning between similar sounds.
• Balance assessment evaluates inner ear function for balance.
• Videonystagmography (VNG) assesses eye movement to evaluate balance function.
• Rotary chair testing assesses inner ear function based on eye movements.
• Vestibular evoked myogenic potentials (VEMP) testing assesses the function of the balance organs.
• Electrocochleography (EcochG) tests inner ear response to sounds.
• Other tests can rule out conditions with similar symptoms to Ménière's disease.
• An MRI can identify if the symptoms are due to a brain tumor or multiple sclerosis.

Treatment

• There is no cure for Ménière's disease.
• A variety of treatments can help reduce the severity and frequency of vertigo episodes.
• Medications and lifestyle adjustments are often used as first-line treatments.
• Some people with severe Ménière's disease may require more invasive treatments, such as surgery.

Medications for vertigo

• Medications can help control vertigo, including motion sickness medications, such as meclizine or dimenhydrinate.
• Anti-nausea medications, such as promethazine, can control nausea and vomiting during an episode of vertigo.

Medications to reduce fluid retention

• Diuretics, such as hydrochlorothiazide or triamterene, can reduce fluid retention.
• Diuretics are often prescribed with a low-salt diet.
• For some people, this combination can help control the severity of Ménière's disease symptoms.

Noninvasive therapies

• Vestibular rehabilitation therapy helps improve balance.
• A therapist teaches exercises to help cope with vertigo.
• Hearing aids can improve hearing.

Middle ear injections

• Injections include:
  • Gentamicin, an antibiotic that is toxic to the inner ear, reduces the balance function in the ear, and the other ear takes over that function.
  • Corticosteroids can help reduce vertigo symptoms.
• Both injections carry a risk of further hearing loss.

Surgery

• A surgery is recommended when other treatments haven't worked.
• Endolymphatic sac procedure alleviates fluid buildup in the inner ear.
• Vestibular nerve section cuts the nerve that connects balance and movement sensors in the inner ear to the brain.
• Labyrinthectomy removes the balance portion of the inner ear, and is performed if hearing is severely affected.

Lifestyle and home remedies

• Rest during vertigo episodes.
• Avoid sudden movements, which can worsen vertigo.
• Reduce salt intake.
• Limit caffeine and alcohol intake.
• Quit smoking.
• Manage stress and get regular sleep.