What is Ménière’s Disease?

Ménière’s disease, also called idiopathic endolymphatic hydrops, is a disorder of the inner ear. Although the cause is unknown, research suggests it is a result of an abnormality in the fluids of the inner ear. Ménière’s disease is one of the most common causes of dizziness originating in the inner ear. In most cases only one ear is involved, but both ears may be affected in about 15 percent of patients. Ménière’s disease typically starts between the ages of 20 and 50 years. Men and women are affected in equal numbers.

What are the Symptoms?

The symptoms of Ménière’s disease are episodic rotational vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Tinnitus and fullness of the ear in Ménière’s disease may come and go with changes in hearing, occur during or just before attacks, or be constant. There may also be an intermittent hearing loss early in the disease, especially in the low pitches, but a fixed hearing loss involving tones of all pitches commonly develops in time. Loud sounds may be uncomfortable and seem distorted in the affected ear.

Out of all of the Ménière’s disease’s symptoms, vertigo is usually the most troublesome. It is commonly produced by disorders of the inner ear, but may also occur in central nervous system disorders. Vertigo may last from 20 minutes to two hours or longer. During attacks, patients are usually unable to perform activities normal to their work or home life. Sleepiness may follow for several hours, and the off-balance sensation may continue for days. The symptoms of Ménière’s disease may be a minor nuisance, or can become disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning.

How is a Diagnosis Made?

An otolaryngologist/ENT physician will record a history of the frequency, duration, severity, and character of your attacks. One of our physicians will also measure the duration of hearing loss or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. You may be asked whether there is history of syphilis, mumps, inflammations of the eye, an autoimmune disorder or allergy, ear surgery, or other serious infections in the past. You may be asked questions about your general health, such as whether you have diabetes, high blood pressure, high blood cholesterol, thyroid, neurologic or emotional disorders. Your physician may order tests to look for these problems in certain cases. When the history has been completed, your physician will run diagnostic tests, which check your hearing and balance functions.

These may include:

For Hearing

  • An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in the affected ear. Speech discrimination (the patient’s ability to distinguish between words like “sit” and “fit”) is often diminished in the affected ear

For Balance

  • An VNG (electronystagmograph) may be performed so that your physician may evaluate balance function. In a darkened room, recording electrodes are placed near the eyes. Warm and cool air or water are gently introduced into each ear canal. Since the eyes and ears work in coordination through the nervous system, measurement of eye movements can be used to test the balance system. In about 50 percent of patients, the balance function is reduced in the affected ear

Other Tests

  • Electrocochleography (ECoG) may indicate increased inner ear fluid pressure in some cases of Ménière’s disease
  • The auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computed tomography (CT), or magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing and balance nerve. Such tumors are rare, but they can cause symptoms similar to Ménière’s disease

Adult Lifestyle Changes to Reduce the Frequency of Ménière’s Disease Episodes:

  • Avoid alcohol, caffeine, excessive fatigue, smoking, and stress
  • Eat properly
  • Get plenty of sleep
  • Remain physically active

Diagnosing And Treating Ménière’s Disease

Adjusting to a low salt diet and a diuretic (water pill) may reduce the frequency of attacks of Ménière’s disease in some patients. In order to receive the full benefit of the diuretic, it is important that you restrict your intake of salt and take the medication regularly as directed. Anti-vertigo medications, e.g., Antivert® (meclizine generic), or Valium® (diazepam generic), may provide temporary relief. Anti-nausea medication is sometimes prescribed. Anti-vertigo and anti-nausea medications may cause drowsiness. Avoid caffeine, smoking, and alcohol. Get regular sleep and eat properly. Remain physically active, but avoid excessive fatigue. Stress may aggravate the vertigo and tinnitus of Ménière’s disease. Stress avoidance or counseling may be advised. If you have vertigo without warning, you should not drive, because failure to control the vehicle may be hazardous to yourself and others. Safety may require you to forego ladders, scaffolds, and swimming.