What are the other Names for this Condition? (Also known as/Synonyms)

• Auditory Vertigo
• Endolymphatic Hydrops
• Otogenic Vertigo

What is Meniere’s Disease? (Definition/Background Information)

• Meniere’s Disease is an idiopathic disorder (meaning that the cause is unknown) of the inner ear. It is believed to be caused by accumulation of excess fluid in the inner ear (called labyrinth)
• Meniere’s Disease is characterized by tinnitus (ringing in the ears), severe dizziness/lightheadedness (vertigo), hearing loss, and a sensation of pressure, deep inside the ear
• In extreme cases, some individuals experience sudden loss of balance and they collapse/fall. These are known as ‘drop attacks’
• The condition affects only one ear in most cases, but it can involve both ears

Who gets Meniere’s Disease? (Age and Sex Distribution)

• Meniere’s Disease can affect any individual, regardless of age and gender
• People in the age group of 40-50 years are more likely to develop the disorder

What are the Risk Factors for Meniere’s Disease? (Predisposing Factors)

Meniere’s is an idiopathic disorder and as such no specific risk factors are identified. However, some predisposing factors have been proposed, which include:

• Stress
• Allergies
• Genetic predisposition
• Head injury
• Inner ear infection
• Smoking and alcoholism
• Recent viral illness
• Excessive dietary salt intake

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Meniere’s Disease? (Etiology)

The cause of Meniere’s Disease is unknown, but several hypotheses have been proposed. These include:

• Abnormal fluid volume or fluid composition and increase in fluid pressure in the labyrinth (an inner ear compartment)
• Rupture of the labyrinth, which allows fluid in different compartments to mix
• A blockage in the labyrinth that may have been caused by scar tissues or an anatomic abnormality
• Inner ear injury that occurs due to:
  • Viral infection
  • Syphilis (a sexually transmitted disease)
  • Autoimmune disorders
  • Blood vessel problems
  • Medications (antibiotics and chemotherapy agents)
• Allergies
• Genetic predisposition; maybe due to an inherited generic pattern that makes a person susceptible to a particular disease
• Head injury

What are the Signs and Symptoms of Meniere’s Disease?

Signs and symptoms of Meniere’s Disease include:

• Recurrent episodes of vertigo lasting from minutes to hours. Sensation of ‘room-spinning’ and feeling off-balance, which may be accompanied by:
  • Nausea or vomiting
  • Sweating
  • Pale appearance
  • Weakness
  • Imbalance to the extent of falling down (drop attacks)
  • Headache
• Hearing loss in a single ear or both ears, which keeps constantly fluctuating
• Tinnitus; with constant ringing, buzzing, whistling, or roaring sound in the ears
• Pressure sensation, feeling of fullness in the ears (aural fullness)

How is Meniere’s Disease Diagnosed?

Diagnostic tests performed for Meniere’s Disease include:

• Physical examination and evaluation of medical history
• Hearing tests (audiometry)
• Special tests such as: Balance assessment with electronystagmography, vestibular-evoked myogenic potentials testing, and rotary chair test
• Posturography: This is a test of balance performed by evaluating components of the human balance system which a person relies on like vision, inner ear function, sensations from skin, muscles, tendons, and joints; and understanding those that cause problems
• Use of tests (in order to rule out other causes) like MRI, CT scans, auditory brainstem response test to measure electrical activity in the hearing nerve and hearing centers of the brain

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Meniere’s Disease?

The possible complications due to Meniere’s Disease include:

• Recurring and unpredictable attacks of vertigo; a major cause of worry with Meniere’s Disease
• Recurrent falls: The sudden dizziness due to vertigo can cause a person to lose their balance and fall
• Accidents during driving, work-related accidents while operating heavy machinery
• Emotional stress causing depression, anxiety
• Permanent hearing loss

How is Meniere’s Disease Treated?

There is no definitive cure for Meniere’s Disease. The treatment is directed towards reducing the frequency of attacks and severity of symptoms.

Use of medications:

• Medications for vertigo: The physician may prescribe certain medications like meclizine (antivert) or diazepam (valium) to reduce the head-spinning sensation, control nausea and vomiting
• Anti-nausea medications (e.g. promethazine) can also help control nausea and vomiting during episodes of vertigo
• The physician may prescribe long-term medications like water pills (diuretics) to decrease fluid content in the body. This can help regulate the volume and pressure of fluids in the inner ear. Since, the water pills may deplete potassium content in the body, potassium supplements may be prescribed

Non-invasive therapies and procedures used:

• Rehabilitation: Vestibular rehabilitation therapy is performed to rectify imbalances during vertigo attacks. This therapy comprises of exercises and other activities to help body and brain to regain their ability to process ‘balance’ information correctly
• Hearing aid: Helps improve the hearing capacity in individuals affected by Meniere’s Disease. An audiologist helps in choosing suitable hearing aids
• Meniett device: During severe attacks of vertigo, a device called ‘Meniett pulse generator’ may be used to apply pressure to the ear canal through a ventilation tube. This therapy may be easily done at home and the process repeated thrice daily, for duration of 5 minutes each time

Dietary and lifestyle modifications recommended:

• Complete bed rest during vertigo attacks
• Minimize dietary sugar and salt consumption
• Avoid caffeine, aspirin, alcohol, and smoking
• Practice relaxation techniques to cope up with stress
• In case of complete hearing loss, a hearing aid may be used
• The use of masking devices are recommended to reduce the effect of tinnitus
• Adopt safety measures to avoid falling due to a sudden loss of balance

Surgical procedures: When conservative measures fail, the ENT physician may suggest surgical options

• Endolymphatic Sac Decompression procedure: This procedure helps in regulating fluid levels in the inner ear. Under this procedure a small portion of bone near the endolymphatic sac, is removed. Sometimes, this procedure is accompanied by the placement of a tube to help excess fluid drainage, from the inner ear
• Vestibular Nerve Section: In this procedure the surgeon cuts the nerve, which connects the balance and movement sensors in the inner ear to the brain center
• Labyrinthectomy: The surgeon removes a portion of, or all of the inner ear. By this method both the balance and hearing function are removed from the affected ear. This procedure is performed only when a person is already suffering from a complete loss of hearing in the affected ear

How can Meniere’s Disease be Prevented?

No specific preventive measure has been identified, but certain precautions may reduce the frequency and severity of the attacks in a person suffering from Meniere’s Disease. It can help if individuals affected by the disorder avoid the following:

• Excessive dietary salt and sugar intake
• Excess noise
• Excess alcohol, smoking
• Stress
• Certain drugs like aminoglycosides, aspirin, and quinine, which are harmful to the ear

What is the Prognosis of Meniere’s Disease? (Outcomes/Resolutions)

• A definitive cure has not been identified for Meniere’s Disease
• Some amount of permanent hearing loss seems to take place, over time
• The right combination of lifestyle, behavioral modification, and medications can minimize the effects of Meniere’s Disease and help an individual lead a normal life
• Patients with severe and complicated symptoms can opt for surgical procedures. However, there are merits and certain demerits to surgical intervention techniques

Additional and Relevant Useful Information for Meniere’s Disease:

Meniere’s Disease is sometimes confused with Ménétrier's disease (commonly known as giant hypertrophic gastritis), which is a stomach disorder.