Ménière’s disease is a condition of the inner ear that causes problems with hearing and balance.
On this page you can find out more about the condition that is thought to affect between 600,000 and 750,000 people in the US, which has up to 60,000 new cases diagnosed each year. In the UK, around one in 1,000 people have Ménière’s disease.If your hearing is causing you problems, or perhaps you’ve noticed that you’re unable to maintain your balance, it’s always worth speaking to a professional. We can connect you with a local audiologist to get you the help you need. Fill in our quick form and we’ll do the rest.
What is Ménière’s disease?
Ménière’s is a disease of the ear that impacts your balance. Most people with Ménière’s normally only have it in one ear or unilaterally, but both ears are affected in an estimated 15% to 40% of cases. In many cases, it starts in one ear and goes on to develop in both ears.
The symptoms of Ménière’s are caused by a build-up of fluid in part of the inner ear that’s involved with balance.
There is no cure, but Ménière’s disease treatment options include medication, dietary changes, types of therapy, surgery, and pressure pulse treatment.
Ménière’s disease is a vestibular disorder, meaning it affects the part of the inner ear called the vestibule, which is involved in balance. To understand how the symptoms of Ménière’s disease occur, it helps to know a bit more about how the vestibular system works.
The vestibular system
This sensory system sends information to the brain about motion, head position, and spatial orientation, and helps to maintain balance and keep the head and body stable when we move.
The vestibular system is part of the inner ear and it has three main structures:
- Cochlea – a hollow, snail-shaped, fluid-filled structure that converts sound vibrations into electrical impulses that are sent to the brain, where sound is interpreted.
- Semicircular canals – three loop-shaped tubes that are filled with fluid and detect movement and motion.
- Vestibule – the central part of the inner ear, situated between the cochlea and the semicircular canals, and attached to the vestibular nerve that sends motion and balance signals to the brain.
The cochlea is the organ responsible for hearing, and the semicircular canals and vestibule are the two parts of the inner ear that are involved in the state of balance, or equilibrium.
The semicircular canals are filled with fluid called endolymph, which detects when the body moves. The canals are at right angles to each other, so they each pick up movement in a different direction or along a different plane.
When we move the endolymph fluid also moves around. Signals about the body’s position and direction pass through the vestibule and along the vestibular nerve to the brain. The brain interprets these signals and, in turn, passes messages to muscles throughout the body to keep us balanced and stable.
In Ménière’s disease, there is a buildup of endolymph that interferes with the signals between the inner ear and the brain. When these signals become mixed up, the brain can’t interpret them properly or send the appropriate signals to the muscles.
This sets off problems with balance, coordination, and hearing associated with Ménière’s disease.
What causes Ménière’s disease?
The physical cause of Ménière’s symptoms is excess endolymph fluid in the inner ear, but it’s not yet known why some people get it and others don’t. However, there are several theories: constricted blood vessels, increased pressure of the endolymph fluid, viral infections, allergies, an autoimmune response, or genetics.
Most people’s Ménière’s disease is idiopathic, which means it happens spontaneously or the exact cause isn’t known. When an underlying cause can be identified – trauma, an autoimmune condition, or a genetic component – it’s called Ménière’s syndrome.
Ménière’s disease symptoms
The symptoms of Ménière’s disease come and go in episodes, or attacks, which can last anywhere between a few minutes to 24 hours.
During an attack, you experience a range of symptoms affecting your hearing, balance, and coordination.
- Vertigo – feeling dizzy, as though you or the room are spinning
- Tinnitus – ringing, buzzing, or humming in your ear
- Hearing loss – a sudden drop in your hearing in the affected ear
- Nausea – feeling sick, and sometimes vomiting
- Loss of balance – feeling unsteady on your feet
- Feeling of fullness in the ear
The reasons you experience the different symptoms are because of the different parts of the inner ear involved.
Vertigo
Balance and coordination involve the vestibular system and its structures, your vision and sensors throughout your body, as well as your brain, which coordinates the information from all three.
When the build-up of endolymph fluid in your ear scrambles motion signals between your inner ear and brain, your brain has to rely heavily on your vision and body sensors. When you get vertigo, your brain is struggling to coordinate the confusing information from the three different senses.
Tinnitus
The cochlear and the semicircular canals both contain tiny hair cells, which become damaged if you have Ménière’s disease. As a result, these hair cells trigger into action without notice and send mixed signals along the auditory nerve to your brain.
Hearing loss
Ménière’s disease is thought to be linked with a rise in pressure in part of the inner ear, which likely causes problems with hearing. When the pressure is suddenly released, that’s when you get the onset of vertigo.
The more this sudden increase and release in pressure happens, the greater the cumulative damage to the inner ear structures, which can cause a gradual, long-term decline in hearing.Symptoms can vary between individuals, and whichever symptoms you experience will usually all occur at the same time during an attack.
Attacks are largely unpredictable; they can come in clusters of several in one week, or you might go for weeks, months, or even years without having an attack.
Many people feel tired and worn out after an attack, and it can take a few days for the symptoms to completely disappear.
How is Ménière’s disease diagnosed?
There are no specific tests that can confirm a Ménière’s disease diagnosis. Your healthcare professional may suspect you have Ménière’s disease based on your symptoms, and ask questions about your medical history.
You will probably be diagnosed with Ménière’s disease if you experience the following:
- Two or more attacks of vertigo that last 20 minutes or longer
- Tinnitus
- Temporary hearing loss
- A sensation of fullness or congestion in the ear
The three main symptoms – vertigo, tinnitus, and hearing loss – can also be symptoms of other conditions and illnesses, so you might also be referred for scans and other tests to rule out other causes.
Your doctor or audiologist may perform a hearing test to determine how badly your hearing is affected, and whether there might be something else causing your hearing loss.
Ménière’s disease treatment
There may be no cure for Ménière’s disease, but there are several different options you can try to treat and manage the symptoms.
Between 60% and 80% of people with Ménière’s disease find their condition improves on its own, or with medication, diet, and other non-surgical treatments.
Which particular Ménière’s disease treatments are recommended and which work for you will depend on your individual symptoms and circumstances.
Medication
In the US, some medications that are available on prescription can help ease vertigo and dizziness, which many people have reported to be the most distressing and debilitating symptoms. These types of drugs are called vestibular suppressants and fall into three drug categories:
- Benzodiazepines – like diazepam (Valium, Diastat) and lorazepam (Ativan)
- Antihistamines – like meclizine (Antivert)
- Anticholinergics – like glycopyrrolate (Robinul)
Another type of medication, an antiemetic, can also be helpful when treating nausea and vomiting associated with Ménière’s disease.
You might also benefit from taking a diuretic (a water tablet). This will increase how much you urinate and help reduce the amount of fluid that builds up in your body and, in turn, your middle ear.
Gentamicin, an antibiotic, is sometimes injected into the middle ear as it can help manage vertigo. However, it comes with a high risk of damaging the microscopic hairs in the inner ear that are involved with processing sound, so there is a significant chance of hearing loss.
An alternative is to use a corticosteroid injected into the ear, which is not associated with a risk of damaging your hearing – but it can often alleviate dizziness. Injected corticosteroids have fewer side effects than if you take steroids in tablet form.
The most commonly prescribed medications in the UK are antihistamines prochlorperazine, which help relieve severe nausea and vomiting.
Dietary changes
You may be advised to limit your salt intake – usually to around 1-2g daily – because large amounts of salt can cause your body to retain fluid. By reducing your salt intake, you might be able to reduce fluid build-up and pressure in the inner ear, which can help relieve Ménière’s symptoms.
Many people with Ménière’s avoid caffeine, chocolate, and alcohol because these stimulants seem to trigger attacks or worsen symptoms. Your healthcare professional might advise you to limit these in your diet, or to cut them out completely.
You may also find that cutting down or quitting smoking will help ease your symptoms.
Cognitive behavioral therapy
The symptoms of Ménière’s can be highly distressing, often disabling. Counseling or CBT, which involves talking about your experiences and how you interpret and react to them, may help you cope with the impact of your condition.
Relaxation therapy, including yoga and breathing techniques, can also help.
Vestibular rehabilitation
This is an individual program of exercises aimed at educating your vestibular system to help you improve your balance and stability. The exercises involve specific head, neck, and eye movements that are customized to you.
At first, the movements create problems in the balance system before retraining the system to manage these difficulties. As a result, vestibular rehabilitation will initially cause vertigo before it alleviates it.
Hearing aids
The hearing loss associated with earlier stages of Ménière’s disease is typically temporary. However, as the condition progresses, you might get fewer attacks of vertigo and dizziness, but more significant hearing loss. If this happens, you will likely need to explore hearing loss treatments, which often start with hearing aids.
Meniett device
This is a small device that fits into the outer part of your ear, which delivers pulses of air pressure intermittently through a tube to the middle ear. It is thought that the air pressure pulses act on the endolymph fluid and pressure inside the ear to help stop dizziness. Meniett devices are not frequently used.
Surgical treatment
There are a few inner ear surgical procedures that can sometimes be used if your symptoms are particularly severe and if no other treatments have worked. This is only ever a last resort and performed very rarely, because there is not much clinical evidence that it’s effective.
