The Low-Down on Meniere’s Disease

Female suffering with Meniere's disease

 

You spin me right ’round, baby
Right ’round, like a record, baby
Right ’round, ’round, ’round
You spin me right ’round, baby
Right ’round, like a record, baby
Right ’round, ’round, ’round

 

If these lyrics by artist Dead or Alive feel like they apply to you in sudden dizzying episodes that last between 20 minutes to 12 hours, you might have Meniere’s disease. Alternatively, you might just be infatuated with some stranger you just met. Let’s, for now, pretend that it’s more likely Meniere’s disease. Here’s what you should know about this dizzying condition.

What is Meniere’s Disease?

Meniere’s disease is a disorder of the inner ear, which plays a significant part in both hearing and balance. In the US, it is thought that around 45,500 new cases are diagnosed every year. It’s possible to develop Meniere’s at any age, but it’s more common for it to begin in adults between 40 and 60 years of age, and it affects females more than males.

Meniere’s occurs due to the accumulation of fluid, known as endolymph, in the labyrinth of the inner ear. This fluid build-up interferes with the proper function of the labyrinth, meaning that both balance and hearing can be thrown off.

It’s not fully understood what causes Meniere’s disease in the first place. As the condition appears to run in families, there may be a genetic predisposition to abnormal endolymph production or regulation. Some doctors also suspect that Meniere’s may be triggered by certain viruses, allergies, or autoimmune conditions.

 

The Symptoms of Meniere’s Disease

In addition to recurring episodes of severe dizziness, known as vertigo, there are a few other symptoms that may point to Meniere’s as the cause. They include:

  • Hearing loss. Hearing loss in this case usually only affects one ear and can come and go. However, eventually the hearing loss in the afflicted ear can become permanent.
  • Tinnitus. Tinnitus is the sensation of sound without any external sound actually being present. You may experience this as ringing, buzzing, whining, roaring, hissing, or some other persistent noise.
  • Aural fullness. Aural fullness refers to the sensation of the ear being full or blocked.
  • Loss of balance. Some people with Meniere’s experience such severe vertigo that they have a fall. Such extreme episodes are termed “drop attacks.”
  • Nausea and vomiting. Not surprisingly, severe dizziness and vertigo can bring on nausea, with or without vomiting.

In order to diagnose Meniere’s disease, you will need to exhibit measurable hearing loss on a hearing test, tinnitus or aural fullness, as well as at least two episodes of vertigo lasting between 20 minutes to 12 hours. However, there is no single test or symptom that can be used to definitively diagnose you with Meniere’s. In addition to considering your general health and medical history, your doctor needs to exclude any other possible causes of these symptoms. Differential diagnoses can include brain tumors, multiple sclerosis, or labyrinthitis. To rule out these other conditions, your doctor may request imaging tests, such as MRI or CT scans. You may also be put through hearing tests (known as audiometry) and various balance assessments.

 

Treatment for Meniere’s Disease

At this point in time, there is no absolute cure for Meniere’s disease. However, it can be managed.

  • Medications. Oral medications for motion sickness or to dampen your nausea can help soften the effects of a vertigo attack. Some medications may also help to shorten the duration of the episode. Diuretic drugs can reduce fluid retention in the body, helping to minimize endolymph build-up in the inner ear.
  • Ear injections. An ENT (ear, nose, throat) specialist may perform an injection of medication into the middle ear, which then can be absorbed into the inner ear. These medications aim to control vertigo attacks, however, they may carry risks to your hearing. Two drugs are typically used for this treatment, gentamicin and dexamethasone. Gentamicin carries a higher risk of further hearing damage. While dexamethasone is safer for your hearing, it may be slightly less effective at controlling dizziness.
  • Cognitive therapy. Although cognitive therapy doesn’t prevent or lessen vertigo attacks, it can help you manage them better. Your therapist can equip you with strategies that help you to cope with the anxiety associated with the sudden vertigo attacks.
  • Pressure pulse treatment. This is an FDA-approved device that is fitted to the outer ear. The device delivers pulses of positive pressure to the middle ear, which helps to reduce endolymph accumulation.

 

Lifestyle Changes You Can Make

In addition to those prescribed treatments, some people with Meniere’s find that relatively simple lifestyle changes can help to control the frequency or duration of vertigo episodes. Limiting your salt intake can reduce fluid retention in the body, similar to the effects of diuretic medication. You may also find that limiting or eliminating caffeine, chocolate, or alcohol from your diet can lessen your symptoms.

If all these therapies fail, and your Meniere’s symptoms continue to be severe and debilitating, your doctor may consider surgery. Surgical procedures include:

  • Endolymphatic sac surgery. Decompressing the endolymphatic sac in the inner ear can help to relieve excess fluid. You may also have a drainage shunt implanted at the same time, to help drain away the endolymph excess.
  • Vestibular nerve section. By surgically severing the vestibular nerve, you no longer receive vertigo-inducing neural signals from your inner ear to your brain. This typically alleviates vertigo episodes without affecting hearing.
  • Labyrinthectomy. Removal of the labyrinth of the inner ear is known as a labyrinthectomy. As the labyrinth is involved in both hearing and balance, while your vertigo episodes will be improved, this procedure also removes the hearing function from the affected ear. For this reason, labyrinthectomies are only offered if your ear already has profound hearing loss.

 

Living with Meniere’s Disease

Research has found that Meniere’s disease can have a significant impact on a person’s quality of life, both physically and psychosocially. Studies suggest that people living with Meniere’s may restrict or avoid certain activities in order to dodge vertigo triggers, or the embarrassment and inconvenience that comes with experiencing an attack in public. Additionally, tinnitus and hearing loss both independently can have negative impacts on daily functioning and social interactions, which further adds to the challenge of coping with a condition like Meniere’s.

Apart from clinical management strategies, such as medications or pressure pulse therapy, if you’re living with Meniere’s, you may find it beneficial to reach out for social support. Support groups may be found online or there may even be one that meets locally. Speak to your doctor about the options available to you.