Meniere’s Disease

There are usually 4 major symptoms of Meniere’s disease:

Vertigo

A feeling of movement when you are still. This is similar to the sensation you experience if you spin around quickly several times and suddenly stop. You feel as though the room is still spinning and you lose your balance. Episodes of vertigo can occur without any warning and usually last 20 minutes to 2 hours or more. You may also experience severe nausea, vomiting, and sweating.

Tinnitus

A ringing, buzzing, whistling, hissing or roaring sound in the ear. This sound is not heard by others. Tinnitus may get louder as the disease progresses.

Aural Fullness

A “full” feeling or pressure in the affected ear.

Hearing Loss

This tends to come and go in the early stages of Meniere’s disease but some people may experience a degree of permanent loss.

Other less common symptoms of the disease may include headaches, stomach discomfort, and diarrhea.

Meniere’s disease is caused when 2 different fluids mix together inside your inner ear. To understand this better, you should know that there are 3 canals in each of your ears that are sensitive to movement.

Each of these ear canals have 2 separate chambers. The outer bony chamber contains perilymphatic fluid and the inner membranous chamber contains endolymphatic fluid.

These 2 fluids are very different from one another. During a Meniere’s attack, the amount of endolymphatic fluid in the inner chamber increases causing the pressure within your balance and hearing systems to rise.

When the pressure becomes too high, it causes the inner and outer chambers to rupture or burst. The two fluids in the chambers then mix and cause an attack of vertigo. This is known as a Meniere’s “attack.”

The chamber membranes eventually heal themselves and the fluid balance in your ear canal restores. However, this mixing of fluid can happen again, causing more attacks.

The cause of this disorder is not known.

Your doctor will diagnose Meniere’s disease based upon your symptoms, your clinical examination, and your medical history. For your doctor to diagnose you as having Meniere’s disease, you will have had:

• 2 spontaneous episodes of vertigo, each one lasting 20 minutes or longer.
• Hearing loss, proven by a hearing test, at least once.
• Tinnitus or aural fullness.
• Your doctor has found no other causes for your sensory problems or symptoms.

You will also need a series of tests:

• Hearing and balance tests may be arranged for you. You may need to have a hearing test, Electrocochlography (EcochG), Electronystagmography (ENG/VNG), Vestibular Evoked Myogenic Potentials (VEMP), and/or Video Head Impulse Test (vHIT).
• Since vestibular nerve tumors can cause symptoms that are similar to Meniere’s disease, a Magnetic Resonance Imaging (MRI) scan may also be arranged to make sure that a tumor is not causing your problems.

• There is no cure for Meniere’s disease, but there are a number of things that can be done to help your symptoms.
• Your doctor may recommend taking diuretics or “water pills” to help reduce your inner ear fluid pressure.
• Your doctor may recommend that you take medications to help with the vertigo, nausea and vomiting.
• You may be offered vestibular rehabilitation exercises that are sometimes used to help you manage the imbalance you may have between attacks. This therapy includes exercises and activities that you perform during therapy sessions and at home, to help your body and brain regain the ability to process balance information correctly.
• Making a few of the following lifestyle changes, living with Meniere’s disease may become a little easier for you:
• Follow a “low salt” or “salt-free” diet. This will help to reduce your inner ear fluid pressure.
• Try to avoid caffeine, smoking and alcohol.
• Get regular sleep and try to eat properly.
• Try to reduce your stress which can also cause the spinning sensation and ringing in your ears.

Non-surgical treatment:

Steroid Injection. The doctor applies some freezing to your ear drum while you lie on a bed. After some time, you will get a steroid injection into the middle ear and you will be asked to lie in the same position for 20 minutes.

You will return once or twice a week until your symptoms and attacks settle or the maximum number of injections have been done. Although there are very few risks to this procedure, it is important to know that it is still considered experimental.

Surgery

Surgery for Meniere’s disease is only recommended if you suffer from persistent vertigo that is affecting your quality of life.

There are 3 possible surgeries for Meniere’s disease. Your doctor will talk to you about which option may be right for you.

Labyrinthectomy
The surgeon removes a portion, or all of the inner ear, thereby removing both the balance and hearing function from the affected ear. This surgery will be done only if you already have near-total or total hearing loss in your affected ear.

Vestibular Neurectomy
The surgeon cuts the nerve that connects the balance and movement sensors in your inner ear to your brain. This usually corrects the problems you are having with vertigo, but still allows you to hear out of the affected ear.

Chemical Labyrinthectomy
This procedure destroys the vestibular tissue with controlled injections of an antibiotic, called Gentamicin, into your middle ear. The Gentamicin will be given a few times a day, for several days, through a tube inserted in the eardrum of your affected ear. At the start of this treatment, you may have a loss of balance, but if successful, the balance system in the treated ear will be destroyed, which will reduce or stop your attacks and you will still be able to hear out of this ear.