CONDITIONS
Meniere's disease
What is Meniere's disease
Meniere’s disease is a condition of the inner ear characterized by intense dizziness, ringing in the ears, hearing loss, and a sensation of fullness or congestion in the ear. Typically, it impacts only one ear. Dizziness can happen suddenly or after hearing problems. Some people have occasional dizzy spells with long breaks in between, while others experience frequent attacks over several days. In severe cases, the vertigo can be so intense that people lose their balance and fall.
Meniere’s disease can occur at any age, but it is more common in adults aged between 40 to 60 years.
What are the symptoms of Meniere’s disease?
Symptoms of Meniere’s disease include:
- Regular dizzy spells, where everything feels like it is spinning suddenly. This dizziness can last from 20 minutes to 12 hours but usually not more than 24 hours. Severe dizziness can make a person feel sick.
- Hearing loss may come and go, especially in the beginning. Over time, hearing loss can become permanent and cannot improve.
- Ringing in the ear, known as tinnitus, which causes noises like ringing, buzzing, roaring, whistling, or hissing.
- Feeling like the ear is full or under pressure.
What causes the symptoms of Meniere’s disease?
The symptoms of Meniere’s disease happen because fluid builds up in the inner ear’s compartments, called the labyrinth.
The labyrinth contains balance organs (the semicircular canals and otolith organs) and hearing organs (the cochlea). There are two parts: the bony labyrinth and the membranous labyrinth. The membranous labyrinth is filled with a fluid called endolymph. This fluid helps receptors in the balance organs send signals to the brain about body movements. In the cochlea, fluid moves in response to sound vibrations, stimulating sensory cells that send signals to the brain.
In Meniere’s disease, the buildup of endolymph in the labyrinth disrupts the normal balance and hearing signals between the inner ear and the brain. This causes vertigo and other symptoms of the disease.
How does the doctor diagnose Meniere’s disease?
Meniere’s disease is often diagnosed and treated by an ear, nose, and throat doctor (ENT) doctor. No single test or symptom can confirm the diagnosis.
Diagnosis is based on the medical history and the presence of symptoms including:
- Two or more episodes of vertigo lasting at least 20 minutes each
- Tinnitus
- Temporary hearing loss
- Feeling of fullness in the ear
Some doctors may do a hearing test to check the extent of hearing loss caused by Meniere’s disease.
To rule out other conditions, a doctor may also request magnetic resonance imaging (MRI) or computed tomography (CT) scans of the brain.
How is Meniere’s disease treated?
Meniere’s disease does not have a cure yet, but some treatments mentioned below may help to manage it:
- Medications:
- Motion sickness medications like meclizine or diazepam can help reduce dizziness during an attack.
- Anti-nausea medications like promethazine controls nausea and vomiting during a vertigo attack.
- Diuretics and betahistine can be used alone or together to help with vertigo. Diuretics reduce the amount of fluid in the body, which also reduces extra fluid in the inner ear. Betahistine helps relieve vertigo symptoms by enhancing blood flow to the inner ear.
- Salt restriction: Reducing salt can help some people control dizziness by reducing fluid retention in the body, which may lower fluid volume and pressure in the inner ear.
- Dietary and behavioral changes: Some people find avoiding or limiting caffeine, chocolate, and alcohol helps reduce symptoms. Not smoking may also help.
- Injections: Injecting the antibiotic gentamicin into the middle ear can control vertigo but may cause hearing loss. Some doctors use corticosteroid injections instead, which can reduce dizziness without the risk of hearing loss.
- Surgery: If other treatments do not work, surgery might be an option.
- Endolymphatic sac procedure: The endolymphatic sac helps control inner ear fluid levels. In this procedure, the surgeon releases pressure around the endolymphatic sac, which can improve fluid levels. They might also place a small tube (stent) in the sac to keep the fluid draining.
- Vestibular nerve section: The vestibular nerve sends balance signals to the brain. This procedure involves cutting the vestibular nerve to prevent vertigo attacks while keeping hearing intact.
- Labyrinthectomy: This surgery removes the labyrinth, the part of the inner ear that controls balance. However, it also causes hearing loss in the affected ear. The ENT surgeons usually perform this surgery only after a hearing loss has already occurred in that ear.
In conclusion, Meniere’s disease is a disorder of the inner ear characterized by recurring episodes of vertigo, hearing loss, tinnitus (ringing in the ears), and a feeling of fullness or pressure in the ear. These symptoms can vary in severity and duration, significantly impacting daily life and activities. Meniere’s disease usually affects only one ear and can occur at any age, although it is more common in adults aged between 40 and 60. While the exact cause of Meniere’s disease is not fully understood, it is believed to involve a buildup of fluid in the inner ear, leading to disturbances in balance and hearing function. Although there is currently no cure for Meniere’s disease, various treatments and management strategies, such as medications, dietary changes, and surgical procedures, can help alleviate symptoms and improve the quality of life for individuals affected.
References
- National Institute on Deafness and Other Communication Disorders. NIDCD Fact Sheet | Hearing and Balance. Meniere’s disease. Available from: https://www.nidcd.nih.gov/sites/default/files/Documents/health/hearing/MenieresDisease.pdf Accessed on 30th April 2024
- Cleveland Clinic. Meniere’s disease. Available from: https://my.clevelandclinic.org/health/diseases/15167-menieres-disease. Accessed on 30th April 2024
- Mayo Clinic. Meniere’s disease. Available from: https://www.mayoclinic.org/diseases-conditions/menieres-disease/symptoms-causes/syc-20374910. Accessed on 30th April 2024
- Mayo Clinic. Meniere’s disease. Diagnosis and treatment. Available from: https://www.mayoclinic.org/diseases-conditions/menieres-disease/diagnosis-treatment/drc-20374916. Accessed on 30th April 2024
