Ménière's Disease

Topic Overview

What is Ménière's disease?

Ménière's (say "men-YEERS") disease is a disorder of the inner ear that affects hearing and balance. It causes sudden attacks of vertigo (a spinning sensation), tinnitus (a loud ringing in the ears), and a loss of hearing that may become permanent.

Ménière's disease usually develops between the ages of 40 and 60 and affects both men and women. Children can also have Ménière's disease.

What causes Ménière's disease?

The cause of Ménière's disease is unknown, but it may be related to a fluid imbalance in the inner ear.

What are the symptoms?

During an attack, Ménière's disease causes symptoms that include:

• A low-pitched roaring, ringing, or hissing in the ear (tinnitus).
• Hearing loss, which may be temporary or permanent.
• Vertigo, which is the feeling that you or your surroundings are spinning or whirling.
• A feeling of pressure or fullness in the ear.

How is Ménière's disease diagnosed?

Ménière's disease can usually be diagnosed based on your medical history and a physical exam. If your doctor is uncertain, hearing tests or imaging tests, such as magnetic resonance imaging (MRI) may be done to rule out other conditions.

How is it treated?

Treatment focuses on reducing the severity of the vertigo until the attack ends. For some people, it may be possible to reduce the frequency of attacks by eating a diet low in salt, using a medicine (diuretic) to rid the body of excess fluids, and doing exercises to improve balance.

Medicines that affect the inner ear, called vestibular suppressants, may be used to reduce the whirling or spinning sensations of vertigo. Other medicines, called antiemetics, may be able to help if your vertigo causes nausea or vomiting.

Frequently Asked Questions

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Cause

The cause of Ménière's disease is not known, but it may be related to a fluid imbalance in the inner ear.

The inner ear contains a fluid called endolymph. It is thought that, in Ménière's disease, too much of this fluid builds up in the inner ear. The resulting pressure affects the sensory systems in the inner ear that help maintain balance. This leads to the symptoms of tinnitus (ringing in the ears), hearing loss, vertigo (spinning sensation), and pressure or fullness in the ear.

Little is known about the cause of endolymph fluid buildup. It may be that too much fluid is produced or that the fluid does not properly drain from the inner ear, or it may be a combination of the two.

Symptoms

Symptoms of Ménière's disease are:

• Vertigo attacks that occur suddenly and last from several minutes to hours. The spinning sensation caused by vertigo is often bad enough to cause nausea and vomiting.
• A low-pitched roaring, ringing, or hissing sound in the ear (tinnitus).
• Hearing loss (often of low-frequency sounds) that may return to normal after the attack or that may be permanent.
• A feeling of pressure or fullness in the ear.

Vertigo is not the same as feeling dizzy. Dizziness is feeling unsteady or unstable. Vertigo is a sensation of whirling or spinning. Symptoms of dizziness and vertigo may be caused by many conditions other than Ménière's disease.

Sometimes you may sense that an attack is about to occur. The signal might be:

• An increasing feeling of pressure in the ear.
• Sounds seeming louder than normal.
• Nausea. A few people have nausea before an attack. But nausea can have many causes, so nausea does not always mean that an attack is about to occur.

What Happens

An attack of Ménière's disease causes symptoms of tinnitus (ringing in the ears), hearing loss, a feeling of pressure or fullness in the ear, and vertigo (spinning sensation).

The attacks are unpredictable and vary in frequency and severity. An attack can last from hours to days. Most people have repeated attacks over a period of years. Attacks usually increase in frequency during the first few years of the disease but then decrease in frequency.

Vertigo may be severe and result in nausea and vomiting. To reduce this feeling, try lying perfectly still until the attack subsides.

Sometimes each additional attack damages the inner ear. Over time the inner ear may become so badly damaged that it may no longer function properly. The attacks will then usually stop, but you may have:

• Poor balance.
• Permanent hearing loss.
• Residual roaring or hissing in the affected ear.

Ménière's disease normally occurs in only one ear at a time. In as many as half of the people affected, the disease eventually develops in the other ear.¹

A few people with Ménière's disease experience "drop attacks." A drop attack is a sudden fall while standing or walking. The falls occur without warning, and the attacks are described as suddenly being pushed to the ground. There is usually no loss of consciousness, and complete recovery occurs in seconds or minutes.

What Increases Your Risk

Because the cause of Ménière's disease is unknown, it is difficult to predict who will get the condition. You may be at higher risk for getting Ménière's disease if you have:

• Another family member who has this condition.
• An autoimmune disease (such as diabetes, lupus, or rheumatoid arthritis), which occurs when the immune system attacks the body.
• Had a head injury, especially if it involved your ear.
• Had viral infections of the inner ear .
• Allergies. People with Ménière's disease may be more likely to have allergies than people who do not have Ménière's disease.

When To Call a Doctor

Call 911 or other emergency services immediately if you have vertigo (a spinning sensation) along with other symptoms, including:

• Headache, especially if you also have a stiff neck and fever.
• Sudden hearing loss.
• Weakness of an arm or leg.
• Blurred or double vision.
• Difficulty speaking.
• Numbness or tingling that does not go away, anywhere on your body.
• A recent head injury.

Call your doctor now or seek immediate care if:

• You have an attack of vertigo that is different from those you have had before or from what your doctor told you to expect.
• You need medicine to control nausea and vomiting caused by severe vertigo.

If you have been diagnosed with Ménière's disease, watch closely for changes in your health, and be sure to contact your doctor if:

• You have frequent or severe episodes of vertigo that interfere with your normal activities.
• You do not get better as expected.
• You have any new symptoms.
• You have problems with your medicine.
• You have questions or concerns.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting is not appropriate if you think you may have Ménière's disease-see a doctor right away. Attacks of Ménière's disease can cause permanent hearing loss. Prompt diagnosis and steps to prevent further attacks may reduce both the discomfort of attacks and the risk of hearing loss.

Who To See

Health professionals who can diagnose and treat Ménière's disease include:

• Family medicine physicians.
• General practitioners.
• Internists.

You may be referred to a specialist:

• Otolaryngologist
• Neurologist

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Your doctor can usually diagnose Ménière's disease by taking your medical history and doing a physical exam.

If the cause of your vertigo is unclear, your doctor may want to do more tests to determine whether your symptoms are caused by problems in the inner ear or in the brain. Brain-related causes of vertigo (such as stroke, head injury, brain tumors, or multiple sclerosis) are less common.

Other tests that may be done to rule out other causes of your symptoms and to confirm a diagnosis of Ménière's disease include:

• Electronystagmography, which uses electrodes to measure eye movements. It looks for characteristic eye movements that occur when the inner ear is stimulated. The pattern of eye movements can indicate the location of the cause of the vertigo, such as the inner ear or the central nervous system.
• Imaging tests, such as magnetic resonance imaging of the head (MRI) or computed tomography of the head (CT scan), which may be done if symptoms could be caused by a brain problem.
• Hearing tests, to detect hearing loss. A specific type of hearing test, called a brain stem auditory evoked response (BAER) study, may be done to find out whether the nerve from the inner ear to the brain is working correctly. Hearing loss supports a diagnosis of Ménière's disease.

Treatment Overview

Although Ménière's disease cannot be cured, treatment is available to control symptoms and reduce the frequency of attacks. During an attack, medicines may be used to reduce vertigo and control nausea and vomiting.

No treatment is available to prevent the hearing loss that may eventually occur with progressive attacks of Ménière's disease.

Initial and ongoing treatment

Early and ongoing treatment of Ménière's disease focuses on controlling the symptoms-especially vertigo, a spinning sensation-and reducing the frequency of attacks. Changing your diet may reduce the number and frequency of future attacks.

Treatment most often used to reduce the frequency and severity of attacks of Ménière's disease includes:

• Taking medicines such as diuretics to reduce the accumulation of fluid (endolymph) in the inner ears .
• Avoiding caffeine, alcohol, tobacco, and stress or any substances or conditions that trigger an attack.
• Taking vestibular suppressant medicines (such as antihistamines or sedatives) to calm the inner ear. Don't give antihistamines to your child unless you've checked with the doctor first.
• Eating a low-salt diet to reduce fluid buildup in the inner ears. For more information, see:

  Ménière's disease: Eating a low-salt diet.

It is important to minimize the personal safety risks posed by Ménière's disease. For more information, see:

Vertigo: Staying safe when you have balance problems.

Vertigo: Balance exercises.

Vertigo may be easier to tolerate if you lie down and hold your head very still until the attack passes. Medicines such as antihistamines may be used to reduce vertigo. Antiemetic medicines may be used to control nausea and vomiting.

Treatment if the condition gets worse

If symptoms of Ménière's disease do not respond to treatment, surgery is an option. The goal of surgery is to eliminate the symptoms of Ménière's disease without destroying hearing in the affected ear.

In rare cases, severe, persistent vertigo caused by Ménière's disease may be treated by destroying the balance center in the inner ear (labyrinth) through surgery (labyrinthectomy) or with an antibiotic injected into the ear (chemical ablation) to destroy the labyrinth. Because these treatments may cause hearing loss in that ear, they are generally used only as a last resort.

Prevention

In most cases, Ménière's disease cannot be prevented. But some cases of Ménière's disease may be caused by head injuries. Wearing a helmet when bicycling, motorcycle riding, playing baseball, in-line skating, or during other sports activities can protect you from head injuries that could lead to Ménière's disease.

You may be able to reduce the frequency of vertigo attacks by limiting the amount of salt in your diet and avoiding caffeine, alcohol, tobacco, and stress, which can help reduce stimulation to the inner ear. For more information on reducing salt intake, see:

Ménière's disease: Eating a low-salt diet.

Ménière's disease may be connected to allergies. Treating allergies with desensitization shots and eliminating suspected food allergens may reduce the frequency of attacks.² For more information, see the topic Food Allergies.

Home Treatment

The vertigo (spinning sensation) of Ménière's disease may be easier to tolerate if you lie down and hold your head very still during an attack.

Changing your diet may reduce the chance of having another attack of Ménière's disease. Eating a diet low in salt and limiting the use of caffeine and alcohol may reduce the frequency of attacks. But diet changes will not reduce the intensity or duration of a vertigo attack that has already begun. For more information, see:

Ménière's disease: Eating a low-salt diet.

Doing balance exercises and taking safety precautions for attacks of vertigo may help. For more information, see:

Vertigo: Staying safe when you have balance problems.

Vertigo: Balance exercises.

Medications

Medicines do not cure Ménière's disease, but they can reduce the severity of some symptoms, such as nausea, vomiting, and the spinning sensation of vertigo. Also, medicines can help you feel more comfortable during an attack.

Medicines that reduce the spinning sensation of vertigo by calming the activity in the inner ear are called vestibular suppressants. These include:

• Antihistamines, such as dimenhydrinate (Dramamine), meclizine hydrochloride (Antivert), and diphenhydramine hydrochloride (Benadryl). Don't give antihistamines to your child unless you've checked with the doctor first.
• Scopolamine (Transderm-Scop), which is a patch placed on the skin behind your ear.
• Sedatives, such as diazepam (Valium) and clonazepam (Klonopin).

Antiemetic medicines may be used to reduce nausea and vomiting that can occur with vertigo.

Diuretics and a low-salt diet may be used to reduce excess fluid and prevent future attacks of vertigo.

Surgery

Surgery for Ménière's disease can cause permanent damage to your hearing. Talk with your doctor about surgical options if repeated attempts at less invasive treatment methods have failed to relieve your symptoms. Surgery may be considered for people with Ménière's disease who:

• Have persistent or frequent attacks of severe vertigo (a spinning sensation) that do not improve after using medicine.
• Have symptoms that are so debilitating that it becomes difficult to get through the events of daily life.
• Are affected in only one ear.

Surgeries that may be used to treat Ménière's disease include:

• Endolymphatic sac decompression, which removes some of the bone surrounding the inner ear .
• Endolymphatic shunt, which inserts a tube to drain excess fluid from the inner ear.
• Vestibular nerve section, which cuts the nerve that controls hearing and balance from the affected inner ear.
• Labyrinthectomy, which removes the balance center of the inner ear (labyrinth). This nearly always stops vertigo but also results in total hearing loss in that ear. It is most commonly used for people who have already lost most of their hearing.

The goal of surgery is to eliminate the symptoms while keeping as much hearing in the ear as possible. But the most extreme forms of surgery (vestibular nerve section and labyrinthectomy) always result in complete hearing loss in that ear. The possibility of losing your hearing in the treated ear is a major consideration when deciding whether to have surgery to treat Ménière's disease. In some cases, the disease may have already greatly damaged your hearing, which makes the risk of being deaf in that ear less important.

Other Treatment

Ménière's disease can be treated with a process called chemical ablation, in which a toxic chemical is absorbed into the balance center of the inner ear (labyrinth). The chemical makes it so that the affected ear is no longer involved with balance, and symptoms no longer occur. Hearing may be damaged by this procedure. Chemical ablation may successfully control vertigo associated with Ménière's disease.³

The Meniett device is a portable earpiece that sends little pulses of pressure through a small tube into your middle ear . The result is the elimination of fluid buildup in your inner ear, which restores your sense of balance. Initial studies show that using this device successfully reduces symptoms of severe vertigo in some people.^{4, 5}

You may want to ask your doctor whether the Meniett device is available or is an option for treating your symptoms of severe vertigo. You still need surgery to use a Meniett device (to put in the tubes), but it is considered safer than other surgeries for Ménière's disease.

Other Places To Get Help

Organizations

Related Information

• Benign Paroxysmal Positional Vertigo (BPPV)
• Dizziness: Lightheadedness and Vertigo
• Labyrinthitis
• Vestibular Neuritis

References

Citations

1. James A, Thorp M (2007). Menière's disease, search date January 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

2. Johnson J, Lalwani AK (2008). Meniere disease section of Vestibular disorders. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology-Head and Neck Surgery, pp. 716-720. New York: McGraw-Hill Medical.

3. Perez N, et al. (2003). Intratympanic gentamicin for intractable Ménière's disease. Laryngoscope, 113: 456-464.

4. Gates GA, et al. (2004). The effects of transtympanic micropressure treatment in people with unilateral Ménière's disease. Archives of Otolaryngoly, Head, and Neck Surgery, 130: 718-725.

5. Gates GA, et al. (2006). Meniett clinical trial: Long-term follow-up. Archives of Otolaryngology-Head and Neck Surgery, 132(12): 1311-1316.

Other Works Consulted

• Fife TD, et al. (2008). Practice parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 70(22): 2067-2074.

• Solomon D, Frohman EM (2005). The dizzy patient. In DC Dale, DD Federman, eds., ACP Medicine, section 11, chap. 1. New York: WebMD.

• Storper IS (2005). Ménière disease. In LP Rowland, ed., Merritt's Neurology, 11th ed., pp. 1018-1022. Philadelphia: Lippincott Williams and Wilkins.

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