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by Alan R

Definition

Meniere disease is a disorder of the labyrinth in the inner ear that causes vertigo , tinnitus (ringing in the ears), and hearing problems. The labyrinth is a system of cavities and canals in the inner ear that affects hearing, balance, and eye movement.

The Inner Ear
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Causes

The cause of Meniere disease is unknown, but it is thought to be a combination of factors. Possible causes include:

  • Rupture in part of the labyrinth, which allows fluid in different compartments to mix
  • Scar tissue, which may cause a blockage in the labyrinth and build-up of fluid
  • Inner ear injury

Risk Factors

Meniere disease is more common in adults aged 30-60 years, and in Caucasians. Other factors that may increase your chance of Meniere disease include:

  • Family history
  • Viral infection
  • Autoimmune disorders
  • Barometric pressure change
  • Stress
  • Hormonal disorders
  • Allergies
  • Excess salt in the diet

Symptoms

Meniere disease may cause fluctuating symptoms, which may come on suddenly. They typically involve only one ear, but may involve both. Symptoms include:

  • Episodes of vertigo, a spinning sensation while standing still. Episodes may last 20 minutes to 3 hours. Vertigo may be accompanied by:
    • Nausea or vomiting
    • Sweating
    • Paleness of the skin
    • Weakness or falling
    • In some cases, headache or diarrhea
  • Fluctuating hearing loss
  • Ringing in one or both ears—tinnitus
  • Feeling of fullness or pressure in the ear
  • Poor sense of balance
  • A tendency for symptoms to worsen with movement

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. This will include an examination of your ears and a neurologic exam to evaluate for possible nerve damage.

Tests may include:

  • Blood tests—to rule out other causes of the symptoms
  • Hearing test
  • Electronystagmogram—looks for abnormal eye movements
  • Auditory brainstem response
  • Electrocochleogram—to check function of the hearing organ in the inner ear
  • MRI scan —to look at internal structures of the ear

Treatment

There is no cure for Meniere disease. Treatment focuses on managing your symptoms. Talk with your doctor about the best treatment plan for you. Options may include one or more of the following:

Dietary and Lifestyle Changes

Dietary changes include:

  • Avoid foods that are high in salt
  • Avoid caffeine
  • Drink adequate fluids
  • Reduce alcohol intake

Lifestyle changes include:

  • Bed-rest during acute attacks of vertigo
  • Promptly begin replacing fluids lost to heat or exercise
  • Minimize stress
  • Avoid medications that seem to bring on or worsen symptoms
  • Consider a hearing aid, if necessary
  • Consider masking devices (white noise) to limit the effects of tinnitus
  • If you smoke, talk to your doctor about how you can quit
  • Take safety measures to avoid falling

Vestibular Rehabilitation

Your doctor may suggest specific vestibular exercises. These exercises use a series of eye, head, and body movements to get the body used to moving without dizziness. You may work with a physical therapist to learn these.

Therapy

Consider working with a therapist or joining a support group . These can help you to cope with your symptoms.

Medications

Your doctor may recommend:

  • Medications to treat vertigo
  • Antiemetics to control nausea
  • Medications that may improve hearing, control inner ear swelling, or limit overall symptoms, including:
    • Antihistamines
    • Diuretics
    • Antidepressants or anti-anxiety medications
    • Cortisone drugs for a short time
  • Aminoglycoside injected into middle ear
  • Destroys the part of the inner ear that deals with balance
  • May increase hearing loss

Surgery

Ask your doctor if a Meniett device would be helpful to you. This device provides low-pressure pulses to the middle ear.

Surgical procedures are not always helpful, but include:

  • Endolymphatic sac decompression—removal of a portion of inner ear bone and placing a tube in the inner ear to drain excess fluid
  • Labyrinthectomy—destruction or removal of the entire inner ear, which controls balance and hearing
  • Vestibular nerve section

Prevention

There are no current guidelines to prevent Meniere disease. However, to help reduce your risk, avoid:

  • High-salt diets
  • Excess alcohol
  • Stress
  • Smoking
  • Avoid medications that can be toxic to the ear

RESOURCES

American Academy of Otolaryngology—Head and Neck Surgery  http://www.entnet.org 

Meniere's  http://www.menieres.org 

CANADIAN RESOURCES

The College of Family Physicians of Canada  http://www.cfpc.ca 

Meniere's Disease  http://www.menieres-disease.ca 

References

Meniere disease. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T113932/Meniere-disease  . Updated December 5, 2016. Accessed August 22, 2017.

Meniere's disease. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/menieres-disease. Updated March 2014. Accessed August 22, 2017.

Meniere's disease. National Institute of Deafness and Other Communication Disorders (NIDCD) website. Available at: https://www.nidcd.nih.gov/health/menieres-disease. Updated February 13, 2017. Accessed August 22, 2017.

12/3/2010 DynaMed Plus Systematic Literature Surveillance  https://www.dynamed.com/topics/dmp~AN~T113932/Meniere-disease  : Hillier S, McDonnell M. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2010;(10):CD005397.

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