Meniere’s Disease is a condition of the inner ear that causes episodes of vertigo, tinnitus (ringing or buzzing in the ear), and hearing loss. Overtime, the disease can progress resulting in more frequent episodes of vertigo and progressive hearing loss. Tinnitus may also become more intense, or more constant. In later stages of the condition, individuals can also experience balance difficulties between episodes.
SIGNS AND SYMPTOMS
• Tinnitus – the sound of ringing and/or buzzing in the affected ear
• Feeling of fullness or pressure in the affected ear
• Hearing – progressive and fluctuating loss of hearing that occurs in the affected ear
• Vertigo – the false perception of the room moving or the individual moving
Meniere’s disease is thought to be due to endolymphatic hydrops, which is an excess of fluid in the inner ear that can cause damage to the vestibular apparatus. However, the presence of endolymphatic hydrops does not always lead to the development of the disease. The cause for this excess fluid is generally unknown, but some research suggests it may be due to compression of blood vessels, autoimmune disorders, genetics, or a virus.
WHO GETS IT?
• Onset between 20-60 years old
• More common in the Caucasian population
An accurate diagnosis is determined by a detailed subjective history from the individual, as well as ruling out other causes. A hearing test is also an important piece of information to determine if hearing loss has occurred. As the disease progresses, objective tests using infrared goggles can also detect deficits of the vestibular system.
1. Medications – are often used to help control symptoms and may include:
• Vestibular Suppressants – to assist in decreasing the frequency and intensity of vertigo episodes. In Canada, the most common medication is Serc (betahistine dihydrochloride). This has been shown to help manage Meniere’s disease with long-term use. Although it does not “cure” the disease, it can help with symptoms. Anti-depressants and anti-anxiety medications may be used as well, if stress and anxiety are present.
• Antiemetic Medications – are often prescribed to manage symptoms of nausea during acute attacks (i.e. Gravol).
• Diuretics – have been shown to assist in symptom management by controlling fluid balance.
2. Diet Modifications – A low-sodium diet and the avoidance of CATS (coffee, alcohol, tobacco, and stress) have been demonstrated to help reduce the severity of symptoms. Many people with Meniere’s also find that limiting intake of monosodium glutamate (MSG) and sugar can reduce symptoms. Individuals can keep a dietary journal to assist in determining what foods may influence their symptoms.
3. Physiotherapy – Between episodes of vertigo, individuals may notice feelings of imbalance or dizziness. By working with a vestibular physiotherapist, impairments that are present between vertiginous episodes can be identified and vestibular exercises can be prescribed to improve symptoms. Although vestibular rehabilitation will not prevent an episode of vertigo, it greatly helps manage the symptoms that may be present between attacks.
At this time, there is no cure for Meniere’s Disease; therefore treatment consists of symptom management. Vestibular Rehabilitation Therapy (VRT) can assist in managing dizziness and imbalance between episodes. Our vestibular physiotherapists can also assist with lifestyle changes that may assist your management of the condition. To have medications prescribed, you should discuss this condition with your family physician or ENT that is monitoring your care.
For more information contact our Toronto Dizziness Clinic.
Thai-van H, Bounaix M-J, Fraysse B. Menière’s Disease: Pathophysiology and Treatment. Drugs. 2001; 61: 1089-1102.
Matlick D, Richman S. Ménière’s Disease. CINAHL Rehabilitation Guide, EBSCO Publishing, 2014 Dec 26 (Clinical Review).
Ekvall Hansson E, Brattmo M. Balance performance and self-perceived handicap among patients with Meniere’s disease – A comparison with healthy controls. European Journal of Physiotherapy. 2013; 15: 221-224.