Meniere’s Disease

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by Joon Nah BScPT
Certified Vestibular Physiotherapist
Updated: Dec 24, 2021

 

What is Meniere’s Disease?

Meniere’s Disease is a chronic condition affecting the inner ear (vestibular-cochlear organ) that causes episodes of vertigo, tinnitus (ringing or buzzing sounds in the ear) and hearing loss. It is related to increased inner ear fluid pressure which disrupts your ability to balance and sense motion properly and impairs the way your hearing organ detects sound.

Meniere’s Disease was named after the French physician Prosper Ménière who first identified the disorder in 1861 as being a peripheral vestibular condition.

 

Meniere’s Disease Symptoms

Meniere’s disease is characterized by episodes or attacks. These usually appear suddenly and last seconds to minutes to hours with minimal symptoms in-between attacks.

Primary symptoms include:

• Vertigo (a false sense of motion, often as if the room is spinning or you’re spinning)
• Tinnitus – the sound of ringing, buzzing, whooshing the affected ear
• Hearing loss in the affected ear (usually the lower frequencies)
• Aural fullness or the feeling of fullness or pressure in the affected ear

However, many patients develop secondary symptoms with their Meniere’s disease, particularly as it progresses. These include:

• Nausea, motion sickness, vomiting, diarrhea
• Clumsiness and unsteadiness
• Lightheadedness
• Headache, heavy head sensation
• Fatigue and sleepiness
• Anger, anxiety, fear, worry
• Brain fog, difficulty concentrating, mild memory lapses
• Stiff neck or neck pain
• Heart palpitations, rapid pulse, cold sweat
• Sensitivity to sounds / noise
• Vision problems

 

What Causes Meniere’s Disease?

Meniere’s disease is thought caused by a condition called endolymphatic hydrops (excessive fluid buildup). Your inner ear organ for balance and hearing has a compartment filled with fluid called Endolymph. With Meniere’s, there is a break in the lining of this compartment creating an imbalance of fluid and ions. This increased pressure of fluid (hydrops) overstimulates your vestibular organ causing you to feel vertigo and overstimulates your hearing organ creating tinnitus.

What actually causes this break in the compartment’s membrane? The research hasn’t quite figured this out yet, but some studies suggests it may be due to factors such as:

• hormonal imbalances
• inner ear trauma
• infections such as a virus (e.g. otosyphilis and Cogan’s syndrome)
• compression of blood vessels
• autoimmune disorders (e.g. lupus and rheumatoid arthritis)

 

What triggers Meniere’s Disease attacks?

Common triggers for this vestibular dysfunction includes:

• weather changes, particularly rapid changes in barometric pressure
• poor diet and lifestyle (see below under Treatment)
• anxiety and poor stress coping skills

 

Who Gets Meniere’s Disease?

• Though people of any age can get Meniere’s Disease, it usually occurs in adults between the ages of 40-60 years old
• It affects females more than males
• Those who already have other vestibular conditions such as vestibular migraine
• (your vestibular system are the parts of your brain and inner ear that allow you to detect and react to changes in head position and motion)
• More common in the Caucasian population
• 10% of patients with Meniere’s Disease can have it affecting both ears, however as the disease progresses up to 40% find it affects both ears.

Is Meniere’s Disease Hereditary?

Studies show that approximately 50% of cases have a family history of the condition.

 

How is Meniere’s Disease Diagnosed?

There is no one specific test to diagnosis Meniere’s Disease. Rather an accurate diagnosis is determined by a detailed subjective history from the individual, vestibular and hearing testing, as well as ruling out other similar causes.

Here are the 4 main requirements for a diagnosis of Meniere’s Disease:

1) Vertigo attacks lasting more than 20 minutes, with uncontrolled reflexive eye movements called Nystagmus
2) At least one documented case of hearing loss
3) Either tinnitus or ear fullness (pressure)
4) All other possible causes have been ruled out

Diagnostic Tests for Meniere’s Disease

Blood Tests

Blood work does not specifically test for Ménière disease. However, it is often ordered to rule out metabolic issues (e.g. diabetes), infections, or hormonal imbalances

Head Scans such as MRI or CT Scans

Though these tests are often prescribed, they have little value in diagnosing Meniere’s disease other than to help exclude related conditions such as acoustic neuroma, multiple sclerosis, Arnold Chiari, dehiscence, congenital abnormalities, widened cochlear and vestibular aqueducts, and hemorrhage.

Electrocochleography (ECoG)

This testing method uses sound stimulation to detect changes in pressure inside of the inner ear organ. However the patient needs to be in the midst of an attack in order to properly detect an increase in hydrops ear pressure. And these test results should be combined with the 4 requirements listed above.

Dizziness symptoms are related to many other diagnoses and Meniere’s Disease is only one option. Click here for the 10 most common causes of dizziness.

Meniere’s Disease vs BPPV (benign paroxysmal positional vertigo)

Meniere’s disease is often mistaken for BPPV and the confusion is understandable. They are both inner ear, peripheral vestibular conditions that involve episodes of vertigo and in some cases can both be positional in nature (i.e. spinning sensation brought on by specific head positions). However, some key differences include:

• BPPV is always positionally provoked, where Meniere’s can often occur without any change in head position.
• The vertigo with BPPV usually lasts for less than 30 seconds, whereas with Meniere’s Disease it can commonly last up to a few hours.
• BPPV does NOT typically cause tinnitus, hearing loss or ear fullness.
• BPPV is usually not a chronic condition that occurs for months or years, whereas Meniere’s Disease is often progressive and long-lasting.

Learn all about BPPV here.

 

Meniere’s Disease Treatment

1. Medications for Meniere’s

Medications can be a common and useful tool for many Meniere’s Disease sufferers.

Vestibular Suppressants
These are medications that reduce the sensitivity of your vestibular system to stimulation which can dull sensations of vertigo and dizziness. Examples are: Valium, Atavan, Xanax

Diuretics
Some diuretics are prescribed to try to decrease fluid pressure in the inner ear. These medications may help prevent attacks but do not help after the attack is triggered.

Steroids
Steroids may also been helpful in treating endolymphatic hydrops because of their anti-inflammatory properties. Steroids may possibly temporarily reverse vertigo, tinnitus, and hearing loss, probably by reducing endolymphatic pressure.

Aminoglycosides
Aminoglycosides are potent antibiotics that were discovered to have a toxic effect on the vestibular organ (ototoxicity). The most common one used to treat Meniere’s Disease is Gentamicin which can be injected through the tympanic membrane (ear drum) to the inner ear. This is considered a “last resort” treatment as this antibiotic destroys balance and hearing functions in the injected ear. Though left with no balance/motion sense and hearing on that side, the other “good” ear can eventually compensate with vestibular physiotherapy.

Histamine Agonists
Antihistamines are the most commonly prescribed medications to attempt to treat dizziness. This included Meclizine (Antivert) and Betahistine (Serc) in Canada. These are thought to act by suppressing vestibular over-activity and increasing blood flow to the vestibular organ.

Antimetic (Anti-nausea) Medications
Medications such as Gravol and Zofran can be used to decrease the nausea and vomiting that can occur with Meniere’s attacks.

2. Meniere’s Disease Diet Changes

A low-sodium diet and the avoidance of CAT (coffee, alcohol, tobacco) are almost universally recommended for those who suffer from this condition. However, the research is unclear as to how helpful these dietary changes can be. In our clinical experience, our patients do find these restrictions worthwhile in helping to manage their symptoms. Other similar suggestions include:

• avoiding monosodium glutamate (MSG)
• reducing sugar intake (chocolate in particular)
• limiting food with high cholesterol and carbohydrate content
• keeping a dietary journal to better track the foods that could relate to the triggers

3. Vestibular Rehabilitation for Meniere’s Disease

Vestibular physiotherapy is delivered by physiotherapists with specialized training in vestibular rehabilitation. It is a series of progressive vestibular exercises that target the impairments that can be caused by Meniere’s and helps to reduce symptoms and improve overall function. This type of treatment will generally not prevent Meniere’s episodes, rather the goals are 1) to improve or eliminate the symptoms that occur in-between attacks and 2) to reduce the disability that occurs during attacks.

Learn more about how vestibular rehabilitation therapy works here.

4. Surgery for Meniere’s Disease

Surgery should only be considered for severe cases of Meniere’s Disease when patients are unable to function in many of their basic activities of daily living. These include the following procedures:

Decompression of the Endolymphatic Sac
Vestibular Nerve Section
Surgical Labrinthectomy

5. Cochlear Implants

Cochlear implants may be used to help restore some of the hearing loss associated with Meniere’s Disease. It is an electronic device that is fitted behind the ear that sends sound impulses directly to the hearing nerve bypassing the damaged cochlea (inner ear hearing organ).

What about the Meniett Device for treating Meniere’s Disease?

This popular device was introduced as a new technique for treating Meniere’s by stimulating the inner ear via pulse of pressure through a small tube. Unfortunately more recent medical reviews and studies did NOT support this type of treatment; (Syed et al, 2015); Cochrane review (von Sonsbeek et al, 2015); Russo et al (2016); Devantier et al (2019).

 

Can Meniere’s Disease be cured?

Does Meniere’s Disease ever go away? At this time, there is no cure for Meniere’s Disease; therefore treatment mainly consists of symptom management. Vestibular Rehabilitation Therapy (VRT) can assist in managing dizziness and imbalance between episodes.

The way in which Meniere’s presents in patients is highly varied and each person’s complaints are unique. In most patients, the early phases of the disease have attacks that are infrequent and short (seconds to minutes). Patients generally feel fine in-between these episodes.

Hearing changes such as tinnitus can occur before the vertiginous complaints or can start after the dizziness. In many cases, they occur simultaneously which helps to confirm Meniere’s Disease diagnosis.

Over time, this disease can worsen resulting in more frequent episodes of vertigo and progressive hearing loss. Tinnitus sounds may also become more intense, or appear more consistently. In later stages of the condition, individuals can also experience balance difficulties between episodes.

The pattern of disease progression can be unpredictable. Many patients experience active periods with repeated attacks, then long periods of remissions. In some cases, the disease can simply stay in permanent remission. Spontaneous remission occurs in over 50% of patients within 2 years and over 70% after 8 years. 5-10% of patients require surgery to manage their condition.

 

Meniere’s Disease Treatment Near Me

Cornerstone Dizziness clinics have experienced vestibular physiotherapists that can help assess your dizziness condition, provide advice on management, recommend referrals for additional tests and provide treatment and exercise therapy to help you feel better.

For more information on the treatment of Meniere’s and other dizziness conditions, visit our Vestibular Rehabilitation Page or contact one of our Cornerstone Dizziness Clinics located in Toronto, North York, Markham and Burlington.