Meniere’s Disease: Symptoms, Causes & Effective Treatment

Meniere's disease, otherwise known as idiopathic endolymphatic hydrops, is an uncommon disorder that develops within the inner ear. As a result of this disorder, individuals will experience episodes of vertigo and hearing loss. These episodes can occur spontaneously and without any prior warning signs. Although symptoms can disappear after each episode, as Meniere's progresses, symptoms of Meniere's disease tend to deteriorate, potentially leading to irreversible hearing loss and persistent balance disorders. Meniere's disease has been shown to cause a high level of psychological distress among sufferers, including anxiety and depression resulting from dealing with an unpredictable illness.

Each episode associated with Meniere's disease includes the following four primary symptoms:

• Vertigo: Vertigo is a strong sensation of spinning and/or movement in space, even when sitting or lying flat. The sensation can be so severe that it may cause sudden falls due to loss of coordination and/or balance.
• Hearing loss: Hearing loss is usually limited to one ear. Hearing difficulty starts with pitch difficulty.
• Tinnitus: Tinnitus is a ringing, roaring, or whirling noise in the affected ear.
• Ear pressure: Ear pressure is a feeling of fullness or pressure inside the ear.

In addition to the above symptoms, nausea and vomiting are typical. The duration of these episodes varies widely (from as short as 20 minutes to as long as 24 hours); therefore, some people may quickly experience multiple episodes, while others may experience periods of time before experiencing Meniere's episodes.

The exact cause of Meniere's disease remains unknown. Most experts agree that excessive amounts of a fluid called endolymph accumulating in the inner ear play a major role in the development of Meniere's disease. Endolymph surrounds structures in the inner ear responsible for transmitting information regarding hearing and balance to the brain. Excess fluid prevents normal functioning of these structures, resulting in abnormal signal transmission to the brain.

Possible contributing factors to excessive accumulation of endolymph include:

• allergic reactions
• endolymph drainage blockage
• head trauma
• infection
• migraines

Additional research is required to better understand the relationship between these potential contributing factors and Meniere's.

A variety of factors increase your likelihood of developing Meniere's disease, including:

• Age: Meniere's disease primarily affects people aged 40-60.
• Sex: Studies indicate women may be more susceptible than men.
• Genetics: Approximately 10% of people with Meniere's disease have a family history of the condition, indicating possible genetic involvement.
• Other autoimmune disorders: People suffering from rheumatoid arthritis, lupus, or ankylosing spondylitis are at a higher risk for developing Meniere's disease.

Meniere's disease generally follows a predictable course.

Stage one involves predominant episodes of vertigo accompanying transient tinnitus and hearing loss. Between episodes, symptoms tend to resolve themselves.

Stage two represents more recurrent episodes that occur for longer periods. During stage two, hearing loss tends to be more persistent and less reversible than previously experienced.

In stage three, although vertigo episodes remain present, episodes tend to decrease in frequency; permanent hearing loss becomes permanent, and balance issues persist more noticeably.

An otolaryngologist (nose and ear specialist, or ear, nose, and throat specialist) diagnoses Meniere's disease based upon your reported symptoms, along with findings from both a general physical examination and a neurological examination. Various diagnostic tests may be ordered to support diagnosis and exclude other diseases that could produce similar symptoms. These include:

• a hearing test
• vestibular test battery
• brain tumour contrast imaging

There is no cure for Meniere's disease. However, various forms of treatment can reduce the frequency and severity of episodes caused by Meniere's disease.

Medication options include diuretics and betahistine to lower ear pressure in the inner ear and motion sickness or anti-nausea medication such as diazepam or meclizine to alleviate vertigo. Oral medications alone may fail to provide sufficient relief; thus, intratympanic steroid injections via the eardrum into the inner ear may be administered additionally for future episodes. Additionally, gentamicin injections are occasionally given; however, gentamicin may potentially exacerbate existing hearing loss.

Dietary habits are key in controlling Meniere's disease. Reducing daily sodium consumption is suggested as one method for helping control endolymphatic hydrops in the inner ear. A healthcare provider recommends limiting daily sodium consumption to approximately 1500 mg/day, or about 75% of a standard teaspoonful. You should attempt to limit your exposure to or avoidance of:

• Caffeine: Caffeine can contribute to tinnitus and trigger vertigo episodes.
• Alcohol: Alcohol affects fluid balances within the inner ear.
• Food products containing monosodium glutamate (MSG)

Once a vertigo episode begins, you need to be mindful of your safety. Therefore, your priority is to sit or lie down immediately to minimise risks for injury-related falls. Remain perfectly still and stabilise your gaze to allow stabilisation of your vision. Be sure to have your prescription medications available for immediate use, as early intervention has proven to shorten durations and reduce the severity of vertigo episodes. Avoid bright lighting and rapid movements until the episode ends.

Consult with your doctor if you suffer recurring episodes of vertigo, unexplained hearing loss, tinnitus in one ear, persistent tinnitus, or sensations of pressure in the ears. Contact emergency services if vertigo or equilibrium issues cause you to lose balance, resulting in unexpected falls, or if it severely impairs your ability to function normally. Also, inform your physician if Meniere's disease has negatively impacted your mental health, since anxiety and depression are common complications associated with the condition and can be treated.

Living with an unpredictable illness like Meniere's disease presents challenges; however, the condition can be managed using strategies such as identifying your triggers, reducing sodium intake in your diet, using prescribed medications as directed, and collaborating with a medical professional. If you experience hearing episodes of tinnitus or hearing changes, contact your doctor as early as possible for evaluation. Early diagnosis combined with continuous treatment offers the greatest opportunity for improving the quality of life for those afflicted with Meniere's disease.